Health Care Complaints Commission v Hatoum [2025] NSWCATOD 166;

(3) Pursuant to clause 7 of Schedule 5D of the National Law, the disclosure of the name of any patient referred to within the evidence adduced in this proceeding (including exhibit A1) is prohibited.

1. This Judgment sets out the Tribunal's Stage 2 determination.
2. The HCCC identified the following documentation in support of its case in this Stage 2 hearing.

(a) The Stage 1 judgement.

(b) All of the evidence tendered in the Stage 1 hearing.

(c) A Stage 2 bundle of documents (370 pages) Exhibit A7.

(d) A copy of HotDoc website Exhibit A8.

(e) Two further written conditions to add if conditions are to be made. Exhibit A9.

(f) A written submission dated 31 October 2025, marked for identification MFI 5.

(g) A written chronology marked for identification MFI 6.

(h) A written submission in reply marked for identification MFI 7.

1. The Respondent identified the following documentation in support of his case.

(a) The Respondents Stage 2 bundle of documents Exhibit R3.

(b) An email chain re clinical communications Programme. Exhibit R4.

(c) The proposed list of Conditions. This supplied following the hearing at the request of the Tribunal. Marked as an exhibit R5

(d) Report of SWSPHN re workforce planning. Exhibit R6.

(e) A written submission marked for identification MFI 8.

1. In its submission the HCCC seeks the Tribunal make an order under section 149C(1)(b) of the National Law cancelling the practitioner's registration with a non-review period of 2 years.
2. In his submission the Respondent urged the Tribunal to impose a protective order which was a Reprimand and attach conditions to his registration.

The further evidence of the HCCC as contained in Exhibit A7, A8 and A9.

1. In Exhibit A7 the HCCC set out copies of documents provided by the Respondent as part of his case including copies of reports from Dr Anthony Pignataro a treating psychologist of the Respondent. Dr Pignataro was required for cross-examination by the HCCC. There were other documents which had been provided by the Respondent which were included for the assistance of the Tribunal as the HCCC intended to, and did, cross-examine the Respondent and Dr Pignataro on some of the information in those documents. Where necessary, we will identify the documents in exhibit A7 when we are addressing evidence which required reference to those documents.
2. Exhibit A7 also listed and contained documents generated by the Medical Council of NSW (the "Medical Council"). There were copies of supervisor reports between November 2022 and August 2025. We have had regard to all those reports. We have also had regard to numerous mentor reports provided between January 2023 and July 2025.
3. The Conditions attached to the Respondent's registration on 4 May 2023 are set out at page 206 of exhibit A7. The Conditions attached to the Respondent's registration at the date of the Stage 1 hearing (23 June 2025) are set out in exhibit A3 and referred to in the Stage 1 judgment. That exhibit sets out the conditions which were imposed on 16 August 2022 and still existing at the date of the hearing of the Stage 1 case. Additionally, the document discloses that on 25 July 2023 the Medical Council imposed 2 further conditions which prohibited the Respondent from consulting with female patients and further requiring he undertake a Clinical Communication Programme created by the Cognitive Institute. That course was to be undertaken prior to 25 July 2024. The Respondent was unable to complete the course by that date because of travel commitments and although he attempted to complete the course in another format, that proved not to be acceptable. Having heard the evidence of the Respondent about his attempts to undertake the course and his completion of the course prior to this hearing, we have accepted his evidence in relation to same.
4. Included in exhibit A7 is a copy of the Medical Council's section 150A decision dated 16 January 2024. This decision addresses an application by the Respondent seeking the conditions imposed under s.150 of the National Law, by the Medical Council, be reviewed. Upon hearing that application the delegates of the Medical Council declined to vary any of the conditions. The Medical Council Delegates made clear they were only empowered to consider the variation or discharge of conditions which were imposed by a s.150 determination. That then excluded conditions which were imposed by an earlier Tribunal.
5. The documents which were considered by the s150A Medical Council delegates are included in exhibit A7 as is the transcript from that hearing.
6. Documents from the Victoria Towers Medical Clinic being incident reports dated 2 November 2023 and 16 November 2023 are included in exhibit A7. These documents set out details of a complaint made by a patient to the assistant to the Practice Manager at Victoria Tower Medical. Although the complaint was made in November 2023, it is stated that the patient had last seen the Respondent in February 2023 and that is when she experienced the events she complained of at the hands of the Respondent. This was not a report by the patient referred to as Patient A in the Complaint filed by the HCCC in these proceedings. The report dated 16 November 2023 is that of the practice manager on the same subject matter. It sets out that a conversation had taken place between the practice manager and the Respondent about the report of the patient set out in the document "incident report" dated 2 December 2023. Following the conversation, in which the practice manager described the Respondent as "visibly upset about the claim of sexual misconduct", the Respondent resigned from the medical practice.
7. In relation to the reports dated 2 and 16 November 2023, the Respondent was cross-examined about the conduct described. He denied that any sexual activity or misconduct occurred. He has not been the subject of an action in this Tribunal about that alleged misconduct and we cannot give that complaint any weight in the determination we will make in this judgment.
8. Included in exhibit A7 is a copy of a transcript of the proceeding before the Medical Tribunal of NSW on 22 July 1999. The transcript sets out part of the evidence of the Respondent in that hearing. There are 42 pages of that transcript. It details the complaint of a female patient who the Respondent massaged during a consultation. The Respondent had denied there was any sexual activity between he and the patient or that he was engaging in the "treatment" by massaging the patient for his own personal sexual gratification or purpose. It is also noted by us that the transcript refers to evidence the Respondent had given in the "criminal trial".
9. The transcript of July 1999 addresses alleged misconduct by the Respondent with three female patients. The Medical Tribunal accepted the evidence of misconduct and ordered the Respondent's registration be cancelled and that he not be eligible to apply again for registration for three years. The Tribunal concluded that the misconduct of the Respondent with the three female patients was "presumably for some form of sexual gratification" on the Respondent's part.
10. We note at this point that the AHPRA Evidentiary Certificate which became exhibit A3 in the stage 1 proceeding attests that the Respondent was registered from 1 July 2010 to 31 July 2020. Thereafter he was suspended from 31 July 2020 to 16 August 2022. Between 16 August 2022 and 6 June 2025 (the date of the certificate) the Respondent was registered subject to conditions. During the period 31 July 2020 and 16 August 2022, the Tribunal had further heard a Complaint brought by the HCCC against the Respondent and ordered he undertake a further short period of suspension, having taken into account the lengthy period he had been suspended under the Medical Council orders. The National Register of Health Practitioners, from which the detail of registration was extracted was established on 1 July 2010. The record does not set out earlier registration details for the Respondent.
11. There appears no dispute that on 4 January 1994 the Respondent was first registered as a medical practitioner in Australia. That information is contained in a Sect 244A Evidentiary Certificate set out at page 205 of exhibit A1 (Stage 1 hearing). That document further shows that from 6 August 1999 to 27 May 2003 the Respondent's name was removed from the Register as set out in orders of the Medical Tribunal of NSW. The Respondent was again registered from 28 May 2003 until 20 June 2005 subject to conditions. Thereafter from 21 June 2005 until 30 June 2010 he had unconditional registration.
12. At page 365 of exhibit A7 the HCCC has included a response by the Respondent to a complaint made by a patient. The response is addressed to the HCCC. The patient complaint was dated 12 December 2012. The complaint addressed aspects of the care of the patient between December 2011 and November 2012. The Response made clear that the Respondent "unequivocally denied" all allegations made by the patient against the Respondent. The Respondent also referred to a complaint which had been made by another patient, apparently during the same time period. He stated that in relation to each patient he had received demands for payment of money. He advised the HCCC he had been so affected by the complaints that he had decided to leave general practice and seek employment within a hospital setting.
13. The document details the allegations made by the patients and the Respondent's responses. The allegations allege sexual conduct by the Respondent with the patient. The allegation is detailed and is wholly denied by the Respondent. There is no evidence of disciplinary proceedings being taken against the Respondent in relation to the detailed complaint.
14. Exhibit A8 is a print-out of a web site called HotDoc. This document was tendered to show the number of Arabic speaking general practitioners servicing the public at Bankstown NSW. The search does extend to other suburbs in the general geographic vicinity of Bankstown.
15. Exhibit A9 contains two further conditions which the HCCC submitted would be appropriate to include were the Tribunal, contrary to the case proffered by the HCCC, to order a suspension of the Respondent's registration followed by the imposition of conditions once the practitioner resumes practice.

1. The Respondent relied upon a bundle of documents tendered and marked as exhibit R3. In that exhibit we noted, in particular, the following documents.
2. The first document in the exhibit is a Statement dated 5 November 2025 and signed by the Respondent. In that "Statement" we noted the following:

(a) The Respondent referred to his statement dated 5 June 2025 which was tendered in the Stage 1 hearing. In particular he referred to the detail of the further education he had undertaken since the complaint of Patient A was raised with him.

(b) The Respondent listed the further education he engaged in during the period of suspension 31 July 2020 to 22 August 2022. We have had regard to that list.

(c) In relation to the Stage 1 decision, the Respondent states that although disappointed with the determination, he has accepted it completely.

(d) We note the Respondent stated: "I accept that I was ill equipped to manage the patient's presentation and I should have referred her to a female colleague." "I also offer my sincere apologies to the patient for the way I made her feel". In relation to the last of those statements, we note that when giving his oral evidence before us the Respondent was asked by a Tribunal member whether he had provided an apology to the patient at any time. The Respondent said he would have liked to do so however he was prevented from that course of action given a prohibition against contact with her.

(e) In his statement the Respondent informed us "I genuinely believe that I am practicing appropriately and that I have managed to achieve a sensible and sustainable work life balance." The Respondent is presently practicing at First Care Medical in Bankstown. There are 7 other practitioners who practice at that medical facility. The Respondent also stated: "I can assure the Tribunal that I understand the significance of my conduct. It was inappropriate and I am disappointed to think that I have damaged the reputation of the profession which I love."

1. The Respondent then included 14 letters of reference and support for himself in circumstances where the authors of the letters were provided with and had read a copy of the Stage 1 decision. Many of the references come from persons of significant professional and community standing. Many have known the Respondent and his family for many years. The references attest to the Respondent's community and family activities. The references express in different ways confidence in the Respondent being able to practice appropriately and within acceptable guidelines. The Respondent is clearly respected and admired by the reference writers. Some of the writers of the references were required for cross-examination by the HCCC. We will refer to that evidence further in this judgment.
2. The Respondent included as the last document in exhibit R3 a Report from Dr Anthony Pignataro, consultant clinical psychologist. We will refer to that evidence hereafter. Dr Pignataro was required for cross-examination.
3. Exhibit R4 is an email chain between the Respondents solicitor Mr Andrew Davey and Ms Ratcliff at the Ministry of Health and a third party, an officer of the Cognitive Institute. This relates to the requirement imposed upon the Respondent to undertake and complete a course conducted by the Cognitive Institute. The course which the Respondent was required to undertake fell within a time when the Respondent was to be absent from Australia. The emails demonstrate all that was done by and on behalf of the Respondent to comply with the condition which had been placed on his registration.
4. Exhibit R5 is a draft of conditions which the Respondent would agree to if he is permitted to continue practicing. The Respondent did tell us directly and through his counsel, that he would abide by any condition which the Tribunal might require as a condition of his registration.
5. The final exhibit in the Respondent's case is exhibit R6. This document is a printout of a section of "PHN South Western Sydney". This is from the Primary Health Network for South Western Sydney. It addresses an issue which was raised in the hearing before us. That issue is concisely encapsulated in the following words: "If the Respondent has his registration cancelled or suspended by the Tribunal, what impact will that potentially have on the population in the subject defined district, seeking medical services from a GP?" It was tendered to address the evidence tendered by the HCCC in Exhibit A8 (the HotDoc website). The exhibit asserts a scarcity of GPs in various age and practice makeups in the district. It forecasts a growth in population of 32% by 2041. It laments the loss of bulk billing GP practices. It states that the district "ranks amongst the regions in Greater Sydney and NSW with the lowest GP density per capita. It names Bankstown amongst the top 5 priority catchments necessitating focused attention for registrar placements.

1. The Respondent gave evidence for a number of hours. We had the opportunity to hear his evidence and observe his demeanour as he gave his evidence. There was nothing about the way in which he gave his evidence or the content of same that led us to believe he was being dishonest or attempting to deceive or distract us.
2. We noted the following in particular from Respondents oral evidence.
3. The Respondent in evidence-in-chief was asked about the suggested "self-directed plan" referred to in paragraph 10 of Dr Pignataro's report dated 18 November 2025 (Tab 32 in exhibit R3). He said he had participated in that plan. That plan was designed to move the Respondent into more diverse activities which involved his experiencing normal day to day contact with females outside the confine of his immediate family. Dr Pignataro had directed he should join "blended gender social and recreational/social activities."
4. The Respondent was asked about the completion of the Cognitive Institutes Clinical Communication Program by 25 July 2024. He had completed it at a later date, namely 13 September 2024. He explained why that had happened and the steps he had taken to try and comply with the completion of the course by the specified date. The Respondent said he found the course helpful. He said it was the first time he had any training on interviewing patients. He said the course involved role playing.
5. In relation to his current cohort of patients at Bankstown, the Respondent said his patients' usual cohort is currently consisting of Palestinian and Gaza refugees. Otherwise, his patients are predominantly from middle eastern backgrounds. He works 4 days a week.
6. The Respondent was cross-examined by counsel for the HCCC. In that evidence we noted the following.
7. The Respondent was asked if he remembered a patient from his 1996 practice days who had alleged he had a conversation with her about masturbation. He did. He was taken to the transcript of the hearing before the Medical Tribunal in 1999 where at page 333 of Exhibit A7 there are questions about that allegation. He was asked in that 1999 proceeding if he had a qualification as a sex therapist. He said he did not.
8. In the cross-examination before us the HCCC asked the Respondent if that experience in the 1999 proceeding had put him on notice that he should not talk to patients about that their masturbation habits. He replied that it had.
9. The Respondent agreed that when in 2022 the Tribunal permitted his reinstatement, he appreciated he was being given another chance to practice.
10. The fact that the Respondent had changed his name (he had removed the hyphenated section of his name which had been Abou-Hatoum and thereafter used the name Hatoum). He gave an explanation for the change which was family related, and we accept that explanation.
11. The Respondent was taken to page 4 of exhibit A7 which is a copy letter authored by the Respondent, dated 16 November 2011. It was a response to a complaint by a patient relating to care by the Respondent between September 2007 and December 2009. He denied he had asked this female patient whether she "helped herself" which in the setting of the consultation was a reference to the patient masturbating. He denied that he had touched the patient inappropriately.
12. The Respondent was asked about a complaint made be a patient in 2013. He was taken to page 365 of exhibit A7 where a copy of a letter he had written, and dated 27 February 2013, was set out. The letter was addressed to the HCCC and answered a complaint made by a patient. The Respondent agreed the patient was female and that as a consequence of the complaint he had decided to leave the practice and seek work in a hospital. When asked why he had done that he said he had received threats which required him to pay money to a person and if not paid a complaint would be made.
13. The Respondent was then asked about an interview he had participated in with the Medical Council, which detailed complaints by 2 female patients about his conduct. He remembered the event. He agreed there was no further action taken against him.
14. In answer to a question the Respondent agreed he had blamed a "lapse in judgment" as being the preamble to the 2022 complaints made against him. He agreed that in 2022 he was permitted to return to practice by the Tribunal. That was in circumstances where the Medical Council had suspended the Respondents registration on 31 July 2020 and the Tribunal continued that suspension for another 6 weeks approximately.
15. It was put that the discussion which the Respondent had with Patient A regarding masturbation (as set out in the Stage 1 decision), demonstrated poor character on his part. He replied that the consultation did. He agreed the consultation had taken place only 59 days after his supervision condition had lapsed. He had also not seen his mentor since his supervision condition ceased.
16. In relation to the ratio of men as opposed to women who the Respondent saw as patients when he worked at VTM, the Respondent said he mainly saw male patients.
17. The Respondent was asked to look at a copy of a warning letter sent to him dated 10 May 2023 from the director of the Victoria Tower Medical practice. (A7 page 49). He said that he had been told a patient complained that he had "fat-shamed" her. There was nothing else asked in relation to that matter by the HCCC.
18. On page 48 of exhibit A7 there is page 12 of a Review Interview Report. The interview took place on 6 June 2023. The Respondent was asked about the portion of the report which stated: "The reviewers asked Dr Hatoum about a comment in his mentor's report in regard to communication issues. He said there had been an issue with a colleague in regard to discussing the best way to manage Care Plans, as there was no policy in the practice in regard to who could do those. Following the team discussion, he assisted the practice to devise a policy, which was then unanimously accepted by the other GPs. He denied that there had been any other communication issues at work, other than the one when he first joined, which has been outlined in earlier reports and satisfactorily addressed at the practice." The Respondent agreed he had told the reviewers that he had no other difficulties at work. He did not think he had told the reviewer about the "warning letter". He agreed he had said there were no further complaints and that his mentor was pleased with his progress. He also agreed he had said that he continued to see Dr Pignataro who had told him all was going well.
19. At page 88 of Exhibit A1 there is a copy of an email dated 26 June 2023. The email is from Dr Attia to an officer at the Ministry of Health. It was in answer to a request from the Ministry as to the three incidents of negative feedback on the performance of the Respondent. The three instances were reported as: 1. A female patient making an anonymous complaint to the practice. She had said she felt uncomfortable with the Respondent's line of questioning. She presented with symptoms of abdominal pain and as the Respondent was trying to find a cause for her symptom, he proceeded to ask her about her sexual health and sexual activity. The patient felt the questions were inappropriate. 2. The second incident involved and overweight patient who complained to the practice that she felt "fat shamed" by the Respondent. 3. The final incident was with a patient who mistakenly said she saw her psychologist twice a week when she meant to say twice a month. The Respondent made a comment in jest to the patient to the effect that she must enjoy seeing the psychologist. The patient did not appreciate that comment.
20. The Respondent was then asked about the Medical Council having imposed a further condition on the Respondent's registration in July 2023. Those conditions restricted his practice to seeing male patients only. The Respondent was asked whether he had experienced transitioning to seeing male patients only following the addition of the Condition in July 2023. It appears from his answer that the difficulty fell to the practice manager to ensure female patients did not book on-line to see the Respondent.
21. At page 320 and 321 of exhibit A7 a document titled Incident Report is set out. The document was completed at the Victoria Tower Medical practice and is dated 16 November 2023. It sets out a report to the practice manager from his personal assistant. It states a female patient attended the practice to complain about a consultation she had with the Respondent in February 2023. The reported complaint was: The patient did not wish to be identified to the Respondent. "The patient said that Dr Hatoum sat very close to her and rubbed her in her thigh and said, "don't worry. I'm going to help you.".... "whilst Dr Hatoum was rubbing her in her thigh he was going for her middle." "whilst making the complaint the patient was so scared that she was hiding behind the door so that nobody could see her."
22. The report set out that the practice manager had spoken to the Respondent about the complaint and that he was not able to respond to the complaint. He was visibly upset about the claim of sexual misconduct. The following day the practice manager received an email from the Respondent which stated his intention to resign from the practice.
23. The Respondent was asked if he was shocked by the reported complaint. He said he was disappointed. He did not know who the patient was. He decided at that time to explore the possibility of moving to hospital work only. He denied he had touched any such patient in a sexual way.
24. The Respondent was asked about a part of his evidence in a section 150A hearing conducted on 20 December 2023 by delegates of the Medical Council. The evidence was: "Every time I get into trouble it is essentially to do with communication, talking to female patient about sensitive issues or anxiety and depression." The Respondent was asked "does that mean you are aware you have a difficulty communicating with female patients and that is an ongoing issue?" The Respondent answered: "yes".
25. The Respondent commenced working at the practice in Bankstown, where he currently works, in March 2024. He is not an owner of the practice. The owner of the practice knows about this proceeding and the outcome of the Stage 1 determination. The owner is Dr Nguyen who gave evidence in this hearing.
26. In relation to the communication skills necessary to see female patients, the Respondent was asked what he was doing to address that. He said he is now receiving counselling with Dr Pignataro to address his communication issues, particularly with females.
27. In re-examination the Respondent was asked if he was receiving any benefit from the supervision sessions, he currently engages in. He said he felt there was benefit to him. The supervisor goes through a standard set of questions with him. She asks about whether he has any problems to raise with her. She askes about any interesting cases that he has encountered since the last meeting. She sometimes raises interesting cases which she has encountered since the last meeting.

1. Dr Van Minh Nguyen provided a written reference for the Respondent which was part of Exhibit R3. He is the owner of the practice at which the Respondent currently practices. Dr Hatoum had joined the Bankstown practice in March 2024. He has seen a copy of the Stage 1 decision published by the Tribunal in 2025. Since March 2024 Dr Hatoum has been employed seeing only male patients. There has been no reported complaints about his work as a GP. Dr Nguyen has confidence in the future complying practice of the Respondent should he be permitted to continue his practice as a GP.
2. Dr Nguyen was required by the HCCC for cross-examination. We noted the following inn his oral evidence.
3. He was asked what he had been told by the Respondent as to why he required a supervisor to be able to work in the medical practice owned by Dr Nguyen. He said he had been told by the Respondent that a female patient had spoken to him by telehealth. She had then seen him in a face to face consultation. The Respondent had spoken to her about sexual health matters without her consent and she had registered a complaint against him. That led to the HCCC commencing this proceeding.
4. Dr Nguyen does not read the Respondents patient notes. He does not sit in on the Respondents consultations. The Respondent had not spoken to Dr Nguyen about a prior cancellation nor having a prior supervision before this proceeding in the Tribunal. Dr Nguyen does visit the practice at which the Respondent works and talks to him on those occasions. He discusses interesting medical cases with the Respondent.

1. Dr Ponse is the Respondent's current Medical Council approved supervisor. She provided a Supervisors Report in response to a request made by the Respondent's solicitor via a letter dated 6 November 2025. She set out that the Respondent had spoken to her about the conduct which led to the commencement of this proceeding. The report is very supportive of the Respondent in his medical practice. She supports his continuing to practice as a GP. She gave her opinion that the Respondent is not a risk to the community in terms of his competency and safety as a GP.
2. Dr Ponse was required by the HCCC to give oral evidence. We noted the following from that evidence.
3. Dr Ponse was asked what the Respondent had told her about the circumstances which required her to be a supervisor. She said he had told her he was de-registered in 1999 due to a complaint about his treatment of female patients. She had first met him in March 2024. The Medical Council had provided her with detail of the respondent's background as a medical practitioner.
4. Dr Ponse was asked what discussions she had undertaken with the Respondent about working with female patients. She said they had some discussions about his working with female patients, and he is studying female patient medicine. She does not observe him in consultation with patients. He does not observe her in consultation with patients. She is able to see patient records created by the Respondent only when she sees those patients herself. Patient confidentiality does not permit her to undertake a random audit of the Respondents medical records. She said she can see how he is caring for his patients in the Practice.
5. Dr Ponse said the Respondent had told her of a criminal conviction entered against him in 2022. She currently has approximately fortnightly sessions with the Respondent as his supervisor. She also enquires of the practice manager and practice nurse if there had been any complaints about the Respondent.
6. Dr Ponse is happy to continue to be the Respondent's supervisor.
7. Dr Ponse shares about 20 patients with the Respondent. She is paid to be the Respondent's supervisor and that payment comes from the practice not the Respondent directly.

1. Dr Pignataro has been the Respondent's consultant psychologist for a number of years now. He has provided a number of reports for the Respondent for the purpose of the Tribunal proceedings. In the hearing before the Tribunal in May 2022, Dr Pignataro provided reports and also gave oral evidence. In the hearing before us he was taken to some of that evidence. In this proceeding, a report from Dr Pignataro was provided to the Tribunal in this Stage 2 hearing. In the decision of the Tribunal published 6 July 2022 and reported as Health Care Complaints Commission v Hatoum [2022] NSWCATOD 72, the Respondent's evidence relating to his therapy work with Dr Pignataro is set out, in part, in paragraphs 98 and 99. The evidence of Dr Pignataro is referred to extensively in paragraphs 127 to 175. It is clear that the Tribunal in the 2022 decision relied heavily on the evidence of Dr Pignataro.
2. The report of Dr Pignataro in evidence before us is found in exhibit R3 at Tab 32. The report is reasonably concise and we have noted the following in particular from that evidence.
3. The Respondent has been a patient of Dr Pignataro since September 2020. In recent times Dr Pignataro reports he has seen the Respondent for therapy in 2024, monthly from 6 March to 4 December, except when he was on holidays. In 2025 he has seen him on six separate occasions from March 20 to 18 November 2025.
4. In relation to his opinion as to whether the Respondent has developed understanding and insight into the inappropriateness of his conduct with Patient A, (specified in the Stage 1 evidence), Dr Pignataro opined that the Respondent understands that his past style of interviewing had a detrimental effect on Patient A. He stated the Respondent has demonstrated remorse to him and accepts that his actions have resulted in the possibility of losing his right to practice again.
5. In relation to whether the Respondent is likely to engage in similar conduct to that found to be inappropriate in the Stage 1 decision, Dr Pignataro stated: "Dr Hatoum does not have concerns with erotic transference for female patients. That is, having feelings that are romantic, intimate or sexual for female patients. I do not have any evidence from my dealings with him that he has difficulty with having such feelings for female patients."
6. Dr Pignataro set out some of the actions/activities he has encouraged/recommended the Respondent to engage in. These include activities which broaden his outside contact with females by joining blended gender social and recreational groups. In response to that recommendation Dr Pignataro reports: "He has moved away from all male recreational or social activities and commenced attending social and recreational activities such as running, swimming, cycling and Bible study, involving both men and women in order to develop greater confidence in managing female social interactions.
7. At the conclusion of his report, Dr Pignataro stated: "I would also recommend that Dr Hatoum undertake a women's health course and work in a women's health service should such a recommendation be considered by the medical council. In addition, ongoing psychological intervention would also provide a guarantee to ensure that no further violations occur and to report to the Medical Council if such violations occurred."

1. Dr Pignataro was required for cross-examination and presented to the Tribunal to provide his oral evidence. In the cross-examination of Dr Pignataro by the HCCC we noted the following in particular.
2. Dr Pignataro was asked by the Respondent's senior counsel whether he thought it would be beneficial for the Respondent to continue to engage with Dr Pignataro in counselling/therapy. Dr Pignataro replied: "Yes, in hindsight, there were areas of psychology we did not address. Following the 2022 decision of the Tribunal, it became an issue."
3. Dr Pignataro was cross-examined by the HCCC.
4. In his report dated 23 October 2021 at paragraph 4 Dr Pignataro agreed he had stated the Respondent had developed insight into past conduct. At paragraph 5 of that report, he agreed he had opined that reoffending by the Respondent was unlikely in the context of his understanding his past work and the risks to Dr Hatoum of boundary violation.
5. At paragraph 9 of that October 21 report, Dr Pignataro agreed he had stated that ongoing psychological sessions would be useful however he could not guarantee no further offending. In his evidence before us Dr Pignataro said that was in relation to the prior 2022 offending.
6. Dr Pignataro was asked about some of his evidence given in the 2022 Tribunal hearing. At paragraph 138 of the decision the Tribunal recorded that Dr Pignataro had expressed his opinion that the Respondent would not present a risk as a medical practitioner. Dr Pignataro said that assessment related to the Respondent having falsified medical records.
7. Paragraph 151 of the 2022 Tribunal decision is as follows and was read to Dr Pignataro:

"Members of the Tribunal asked Dr Pignataro: "What tools have you given him which he can use in the future if he is faced with a similar situation and thereby put his filter at a higher presence in his mind than it did when he was offending?" Dr Pignataro said: "I have highlighted two regulatory mechanisms by which he operates. One he rationalises problems so as to suppress any concerns he has. I have indicated to him that he should be referring to colleagues where there are problems before making decisions which are detrimental to him. He does not have to rely on his own abilities to solve problems when he is feeling overwhelmed with a problem."

Dr Pignataro said in relation to that paragraph: "He has demonstrated that he is committed to change."

1. When asked if he thought the Respondent was ready to see female patients Dr Pignataro stated: "He does have standing to deal with male patients. I don't think he is seeking validation."
2. Paragraph 169 of the 2022 Tribunal decision was read to Dr Pignataro as follows:

"Dr Pignataro was asked why the offending in 1999 and subsequently had not been a learning experience for the Respondent. Dr Pignataro said that the offences were different in nature. They have not re-occurred so there has not been a reoffending of that conduct. We are now seeing him present in a way we have not seen before. This therapy has allowed him to look into his own intra-psychic functioning. By doing that it allows us to know that he is aware now of how he was and how he is. His new level of insight allows us comfort with the idea that he has the support of professionals around him, to allow him to practice in a way that will guarantee him the ability to serve others."

1. Dr Pignataro was reminded that the 1999 offending referred to in paragraph 169 of the judgment involved alleged inappropriate touching of three women.
2. Dr Pignataro was then asked about the content of paragraph 175 of the 2022 Tribunal judgment which noted Dr Pignataro's opinion that the Respondent was now able to respect appropriate boundaries. He added however that the current proceeding is about the Respondent not keeping boundaries. Dr Pignataro said: "He knew about boundaries but didn't have experience with dealing with female patients about sexual boundaries. It seemed to me to be too casual in his nature for the patients."
3. Dr Pignataro agreed that at the time the Respondent saw Patient A (as referred to in the Stage 1 proceeding) he had been attending upon Dr Pignataro for counselling for two years.
4. It was put to Dr Pignataro that therapy does not prevent the type of behaviour found by the Tribunal against the Respondent at Stage 1 of this proceeding. Dr Pignataro said that he disagreed. He said there is no complaint raised against the Respondent outside of his communication with female patients.
5. The Tribunal members asked Dr Pignataro why he considered the experience the Respondent had with disciplinary proceeding in 1996 and 1999 act as a deterrent for future contact with female patients and addressing sensitive (to the female) issues. Dr Pignataro said: "There was a lapse of judgment, expertise, in his inexperience with these types of patients and discussing sensitive and awkward matters. It was awkward for him."
6. In further questions from Tribunal members Dr Pignataro, when asked about the allegation that a female patient claimed he had "fat shamed" her, said he could not recall being told about that. In relation to the patient who mistakenly said she had been seeing a psychologist twice a week, Dr Pignataro opined that the Respondent may have trivialised that statement. He also had no recall of being told about an allegation made by a female patient that the Respondent had rubbed a female patient's thigh. This was a complaint made by a patient to a practice staff member and who refused to be named. No further action was taken in relation to that claim as the Respondent, when asked about the allegation by the practice manager, became very angry and resigned the next day.
7. Dr Pignataro was told that the Respondent, in his consultation with Patient A, had referred her to Dr Pignataro as the only bulk billing psychologist he knew practicing in the area. Dr Pignataro stated that he did not know Patient A. He said he is known to the medical centre where the Respondent was practising when the offending with Patient A occurred, and he is referred clients by that practice.
8. It was put by the HCCC to Dr Pignataro that it is difficult to predict how the Respondent might deal with female patients in the future if he is permitted to see them as a medical practitioner. Dr Pignataro answered: "It is not if he understands what is required of him. The issue which arose in 2022 and which had been addressed in counselling has been addressed."

1. The written submission provided by the HCCC was marked as MFI 5. In that document, which is lengthy and very detailed, we noted the following in particular.
2. We note the HCCC confirmed it seeks a cancellation order with a non-review period of 2 years. The HCCC also seeks a cost order.
3. The HCCC set out its submission on the principles applicable to the Tribunal considering the imposition of a protective order. We will address these matters of legal principle later in this judgment.
4. The HCCC commenced its submission with the following statement in support of a cancellation order being made in this case.

(1) Given the Tribunal has found the subject matter of the complaint proved,[1] the Tribunal may exercise its disciplinary powers.[2] The relevant principles include:

(a) the protection of public safety and health is paramount;[3]

(b) public protection is achieved by ensuring that only health practitioners who are suitably trained and qualified to practice in a competent and ethical manner are registered;[4]

(c) the objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining the 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 conduct 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 requisite standard will not be permitted to practice;[5]

(d) it is not necessary to make a finding that the practitioner is probably permanently unfit to practise before registration can be cancelled.[6]

1. The HCCC submits that the seriousness of the Respondent's established misconduct is at such a level that it requires an order cancelling his registration and a non-review period of significant time (it submits 2 years). The combination of the established failings on the part of the Respondent to adequately explain to Patient A, during a telehealth consultation, the report provided by the radiologist on the CT scan undertaken by Patient A, together with his misconduct in the consultation the following day, are added to by the inadequacy of the medical notes made by the Respondent for his consultations with Patient A. That combination of misconduct the HCCC submits, requires a strong denouncement which will register with both the Respondent and the profession (specific and general deterrence.)
2. The HCCC submits that in this case the Respondent was already on notice about the consequence of misconduct with female patients. The Codes of conduct applicable to medical practitioners are detailed and instructive in relation to the requirement to maintain sexual boundaries. Further the HCCC reminds the Tribunal that Patient A had not consented to any discussion taking place with the Respondent on matters of sexual health.
3. The HCCC highlighted the many courses the Respondent had undertaken prior to meeting with Patient A. The courses included ethical and legal considerations in General Practice; A Norwegian Medical Association course titled Fundamentals of Medical Ethics; Common Medico-Legal issues for general practitioners; Managing difficult patients; and, Ethics, obligations, knowledge and skills Professionalism in in medicine.
4. The HCCC then set out the following in relation to disciplinary proceedings the Respondent had already been a party to before he met Patient A. The HCCC stated:

(1) "Before the consultation with Patient A, the practitioner was already on notice about the importance of avoiding inappropriate comments:

(a) in 1999, he was deregistered based on inappropriate comments and touching of three female patients (which he denied, but was found proven) including asking a female patient in 1996[7] about masturbation;[8]

(b) having already been cross-examined[9] about talking to a female patient about masturbation, and having already been criticised by the former Tribunal because he thrice betrayed the trust placed in him by vulnerable women,[10] the practitioner was on notice to be careful about his conduct with female patients.

(2) In preparation for his reinstatement application, the practitioner offered assurances that he had made changes:

(a) in 2002, he told Dr McMurdo that he "admits that his behaviour is outgoing, flamboyant and exuberant compared with many medical practitioners, and says he has changed this very consciously";[11]

(b) he also attended counselling sessions with Dr Chung,[12] saying that he had engaged in introspection and "made changes in his practice ... re-arranging the seating arrangements in his office and his way of relating to his patients.... and instituted remedial behavioural change ... to prevent future repetition of such problems arising in his patient relationships";[13]

(c) the practitioner also assured the Tribunal that he "was guilty of inexperience and of poor communication skills" and had "I instituted many small but important changes to the way I practised medicine. I am very anxious to avoid these sorts of problems in the future".[14]

(3) In 2013, the practitioner gave evidence[15] at the section 150 hearing about the allegations by two other female patient complaints, which he denied.[16] He assured the delegates that after those allegations (including alleged inappropriate sexual questions and inappropriate touching[17]), he had decided to gradually withdraw from general practice in order to "protect himself",[18] he was no longer examining female patients unaccompanied,[19] he had removed the lock on his consultation room door and the curtain between the desk and the couch and he "intends never to conduct an intimate examination of a woman except in an emergency, or in the presence of a chaperone".[20]

(4) In 2014, the practitioner assured the Counselling Interviewers that his receptionist is trained to ensure that he is not put in the position of needing to see female patients, he had deliberately not had a curtain in his room or a lock on his door and he mentioned seeking advice from his indemnity provider on further measures to help protect him from complaints:[21]

(a) he also assured the Counselling Interviewers that he recognised that he needs to take further steps to safeguard himself from complaints, that he intends to see no female patients (apart from children and elderly solely Arabic speaking women), to not see female patients unless there is another female staff member present in the practice (and employ a practice nurse), to change his approach with patients such that he is less "friendly" and easy going (as was his previous approach) and be more reserved in his interactions, e.g. he will be less likely to enquire about their relationships or sensitive issues in their lives, to refer patients to psychologists (rather than offer support or counselling himself) and to be more aware that any physical contact can be misinterpreted;[22]

(b) the Counselling Interviewers reminded the practitioner "in the strongest of terms of the importance of strict boundaries, good communication and being aware of the needs of vulnerable patients";[23]

(c) the Counselling Interviewers also advised him not to consult females between 14 and 75 when his conditions fall away;[24]

(d) at that time, the Counselling Interviewers were satisfied that the practitioner was determined to make the changes in his practice and career direction required to remove as much as possible the risk that he will be the subject of future complaints so no further action was taken.[25]

(5) In 2020, the practitioner assured the Council[26] that he had been "very strict" about not seeing female patients since 2014 because of his past difficulties in relation to boundary issues to protect himself from further allegations (but sometimes might see a female patient if she comes in with her husband, is very elderly and only speaks Arabic, or if a mother attends with her children and there are no other GPs available to see her).[27] The practitioner considered himself a 'handsy' person (he talked with his hands, was likely to reach out to touch and comfort patients) but assured the Council that he ensures he keeps physically distanced by placing the female patient on one side of the desk and himself on the other.[28] The practitioner told the Council that he interpreted the Counselling Interviewers' advice (not to see female patients between the ages of 14 and 75) to mean he should not see unaccompanied female patients for his own protection, to guard against accusations, and stuck to the Counselling Interviewers' advice most of the time (unless the female patient was accompanied or a CTP matter).[29] Following his participation in a the section 150 hearing in July 2020, the practitioner moved the desk in his consultation room so that he could not physically touch patients while he was seated in consultation.[30]

(6) In July 2022, the practitioner was put on notice that the Tribunal was concerned about boundaries, noting that his past proven conduct "leaves us concerned about the practitioner's ability to be able to recognise what are proper boundaries for a doctor/patient relationship and for the practitioner to be able to abide by those boundaries."[31]"

1. The HCCC further addressing the issue of seriousness of the Respondent's conduct submitted:

"During the practitioner's conduct with Patient A in October 2022, he already knew that she was vulnerable:

(1) he knew she had anxiety and had recently suffered a miscarriage;[32]

(2) he thought the patient had an anxiety problem and needed a psychologist;[33]

(3) during the consultation, he apparently suspected underlying issues (serious concerns such as potential domestic violence or potential sexual abuse).[34]"

1. That knowledge of the Respondent set out above, the HCCC submits added to the risk that Patient A's health could be seriously damaged by the Respondent questioning her on matters related to sexual health during his consultation with her. The HCCC reminds the Tribunal that the Respondent had no special sexual health training or qualification to embark on the subject with Patient A as he did.
2. The impact upon Patient A is canvassed in the following submission of the HCCC.

(1) "After the practitioner's conduct, Patient A suffered emotional harm: have never walked out of a doctor's office feeling so violated and uncomfortable in my life."[35] Patient A sought psychological support[36] and was very reluctant to talk.[37] She felt vulnerable and uncomfortable when the practitioner commented on anatomical size and intimacy with her husband, she wanted to change medical centres because she was concerned that she would panic if she saw the practitioner again.[38] After multiple psychology sessions, Patient A's psychologist felt her anxiety was sufficiently under control and encouraged her to lodge her complaint.[39]"

1. In a number of detailed paragraphs in its submission the HCCC submitted cancellation is needed to denounce the practitioner's poor care for Patient A and his poor records made of his consultations with her.
2. The HCCC then addressed a submission that cancellation was necessary because the Tribunal cannot be satisfied that the practitioner's character is reformed. The HCCC highlighted areas of the evidence which it submitted showed that when the Respondent met with Patient A for a consultation, he demonstrated poor character. The HCCC pointed to the Respondents conduct in 1996 when he improperly touched three female patients. It submits that demonstrates poor character. Again, his falsifying records for two patients in 2019 demonstrated poor character. Both those examples were canvassed in proceedings before differently constituted Tribunals.
3. One of the indicators of reformed character is the demonstration by a practitioner that he/she has insight into past offending. Then, having accepted the error of that conduct and developed a strategy to ensure no further offending is likely to occur, it can be said that the practitioner has developed insight. In this case the HCCC submits the Tribunal could not be satisfied the Respondent does have insight into his offending conduct.
4. The HCCC then addressed the requirement for protective orders to act as a general deterrent to other practitioners. It submitted:

"The Commission submits that cancellation is needed to deter other practitioners from similar misconduct and to uphold high professional standards of the profession:

(1) the practitioner's proven conduct was a serious departure from the standards expected of a general practitioner;

(2) the practitioner's conduct has the potential to bring the profession into disrepute."

1. In relation to the non-review period of 2 years which the HCCC submitted was required, it submitted:

(1) The Commission seeks a 2 year non-review period. The relevant principles include:

(a) the Tribunal has the power to set a non-review period;[40]

(b) the Court of Appeal has cautioned against relying on the "range" of orders made in previous disciplinary proceedings and emphasised that the predominant consideration is the protection of the public;[41]

(c) the fixing of a non-review period protects the public by sending a clear message of denouncement of the practitioner's conduct to other professionals, by attempting to predict the time in which a practitioner may reasonably take steps to rehabilitate, by indicating the minimum period within which the Tribunal considers the person should not be able to practise their profession, by sending a message to the practitioner, the public and the profession about professional standards and the seriousness of the breach and by holding open to the practitioner the possibility of return to the profession at a later time.[42]

(d) a 2 year non-review period is needed to censure the practitioner's proven professional misconduct and send a strong message, to him and other health practitioners, that such conduct cannot be condoned;

(e) a 2 year non-review period is needed to allow the practitioner further time to reflect on his deficiencies, gain genuine insight, complete relevant therapy and demonstrate reformation of character so he can practise safely and ethically in future;

(f) a 2 year non-review period will act as a deterrent to other members of the profession and maintain public confidence and professional standards.

1. The HCCC submitted that a suspension for a period of time is an inadequate protective order in the circumstances of this Respondent. It set out detail for that submission and including the following:

"In 2022, the Tribunal suspended the practitioner's registration.[43] The Tribunal explained why a further suspension was required at that time, given that his conduct in 2019 was "contrary to the ethical and legal practice of medicine", even though he had already been suspended for almost two years..[44] At that time, the Tribunal was also "concerned about the practitioner's ability to be able to recognise what are proper boundaries for a doctor/patient relationship and for the practitioner to be able to abide by those boundaries."[45] In October 2022 (only 59 days after that suspension ended), the practitioner failed to maintain professional boundaries with Patient A. Given the practitioner's proven professional misconduct, the Tribunal cannot be confident that a further suspension would be effective so cancellation is appropriate to protect the public."

1. The HCCC addressed a condition which the Respondent was submitting the Tribunal could consider imposing. The HCCC submission is as follows:

A gender condition is inappropriate to protect the public

(1) A gender chaperone condition (not to treat any female patients without a chaperone) is not desirable. In August 2013, a chaperone condition was imposed on the practitioner's registration.[46] In August 2014, the practitioner told the Council interviewers that instead of using a chaperone, he had decided not to see any female patients at all.[47] The practitioner is no longer subject to a chaperone condition. Since 2017, it is recognised that chaperone conditions are ineffective to protect the public.[48]

(2) A gender restriction condition (not to treat any female patients) is inadequate to protect the public. From 25 July 2023, a gender restriction condition was imposed on the practitioner's registration.[49] The gender restriction condition continues, by operation of the National Law, until the complaint about the practitioner is disposed of by the Tribunal.[50] Now that the subject-matter of the complaint has been proven,[51] the Tribunal may consider all the evidence now available and cancel the practitioner's registration to protect the public. The fact that the Council delegates exercised their discretion to impose a gender restriction condition, as an interim measure, based on the limited material before the delegates at that stage,[52] does not constrain the Tribunal's own power to cancel the practitioner's registration after the Stage 2 hearing.

(3) Given the seriousness of the practitioner's proven conduct with Patient A, imposing a gender restriction condition now would inadequately signal to the profession the gravity of such conduct and would fail to maintain appropriate standards conducive of maintaining public confidence.

(4) A gender restriction condition is impractical in general practice. Although the practitioner claimed that he had "hardly ever seen female patients", avoided seeing female patients and tried to avoid women's health, he found it difficult to avoid female patients in general practice:

(a) after his conditions fell away (from around 2016), the practitioner saw about 20-30% female patients in his own general practice;[53]

(b) after he started working at a group general practice (in August 2022), he saw female patients;[54]

(c) by October 2022, about half the practitioner's patients were female;[55]

(d) the online booking system made it difficult to see no female patients;[56]

(e) the practitioner later told his supervisor that he had difficulty addressing the gender restriction condition as he had previously developed a mixed gender patient base;[57]

(f) the practitioner also told the Council that the gender restriction condition was difficult to manage in a large general practice; [58]

(g) the practitioner's mentor noted that the gender restriction condition was difficult for the practice to accommodate,[59] and the practitioner's supervisor noted that it had created a difficult working environment.[60]

(5) A gender restriction condition is inappropriate in principle. Implicit in a gender restriction condition is an acknowledgement that the practitioner represents an unacceptable risk to the health and safety of a very substantial proportion of the public - female patients. There would need to be compelling reasons for imposing a condition of that kind. Such a condition implies a greater measure of vigilance with respect to 50 per cent of the public than to the remaining half of the public. In the circumstances of this case, such a condition would send an undesirable message to medical practitioners and the public.[61]

(6) Imposing a gender restriction condition is inconsistent with the trust which has been bestowed on the practitioner:

(a) Being granted registration as a medical practitioner is a privilege. The practitioner was entrusted to practice safely when he was first registered in 1994[62] then started working full time in general practice in 1995.[63] He then breached the trust bestowed on him when he "got in trouble" in his first year in general practice.[64] In July 1996, during a consultation with a female patient [Patient A1, aged 21] the practitioner engaged in inappropriate touching and sexual comments.[65] Seventeen days later, during a consultation with another female patient [Patient B1, aged 31], the practitioner engaged in inappropriate touching and sexual comments.[66] Less than 2 months later, the practitioner had a consultation with another female patient [Patient C1, 29 years old][67] the practitioner asked Patient C1 whether she masturbated[68] and engaged in inappropriate touching and sexual comments.[69] As a result of his conduct towards three female patients, his registration was cancelled in 1999.[70]

(b) Being reinstated as a medical practitioner is a privilege. The practitioner was reinstated in 2003[71] and entrusted to safely return to practice, with conditions including that he initially practice as a supervised general hospital position.[72] The practitioner then attained Fellowship of the Royal Australian College of General Practitioners in 2005[73] then returned to general practice in 2007.[74] He then breached the trust bestowed on him when he, in 2019, added to the records for another "young lady"[75] [Patient A2], created a backdated prescription and fabricated her medical history, without her knowledge or consent, to attempt to defraud the insurance company,[76] to make her injuries appear worse than they actually were.[77] As a result of his conduct regarding this female patient (and similar conduct regarding a male patient), the Tribunal suspended his registration in July 2022 then entrusted him to return to practice under conditions.[78]

(7) Given the seriousness of the practitioner's lengthy disciplinary history, he cannot be trusted to practice safely and ethically as a general practitioner in future, so the only appropriate order is cancellation.

1. The HCCC also submitted the imposition of a condition which required the Respondent to continue counselling/therapy sessions with his psychologist does not protect the public.
2. The HCCC then addressed the costs order it seeks. It submitted:

"The Commission seeks an order that the practitioner pay the Commission's costs as agreed or assessed because:

(a) the Tribunal has the power to award costs;[79]

(b) the Court of Appeal has affirmed that costs are awarded to compensate the successful party and accepted that as a general rule, costs of proceedings before the Tribunal should follow the event;[80]

(c) the Commission is the successful party because the complaint was fully proven;

(d) the presumption that the successful party is entitled to receive costs is generally only displaced where there has been some disentitling conduct by the successful party;[81]

(e) there was no disentitling conduct by the Commission to warrant a departure from the general rule."

1. In the hearing the Respondent's senior counsel informed the Tribunal that the Respondent makes no submission opposing the cost order sought by the HCCC. Nonetheless the Tribunal needs to be satisfied that such an order should be made.
2. The HCCC also provided a written submission in reply to that of the Respondent. We have read that submission. We find no need to comment further on that particular short written submission.

1. In addition to the written submission, the HCCC provided a chronology of the disciplinary action the Respondent has faced since he was first registered as a medical practitioner in Australia. In that Chronology we noted in particular the following, about which there was no contention.

(a) The Respondent was first registered as a practitioner in Australia on 4 January 1994.

(b) On 6 August 1999 the Medical Tribunal of NSW delivered a judgment which cancelled the Respondent's registration for three years. That decision involved the Tribunal considering three complaints of very serious misconduct by the Respondent with three female patients. All of the complaints were established. In the hearing the Respondent had denied the complaints.

(c) On 28 May 2003 the practitioner's registration was reinstated.

(d) In 2005 the Respondent obtained fellowship of the Royal Australian College of General Practitioners.

(e) In 2013 the Respondent appeared before the Medical Council of NSW for a section 150 hearing concerning two complaints from female patients of inappropriate conduct. The Respondent denied the complaints. The Medical Council imposed conditions on the Respondent's registration including that he does not treat any female patients without a chaperone being present.

(f) On 2 July 2020 the practitioner was arrested and on 9 December 2020 he was convicted of one offence of "dishonestly obtain financial advantage by deception" pursuant to section 192E(1)(b) of the Crimes Act 1900 (NSW) and one offence of "make false document to obtain financial advantage" pursuant to section 253(b)(ii) of the Crimes Act [the convictions about Patient A2 and Patient B2].[82]

(g) On 31 July 2020 the Respondent's registration was suspended.

(h) On 21 January 2022 the Medical Council of NSW declined to remove the Respondent's suspension in a section 150A hearing instigated by the Respondent.

(i) On 6 July 2022 the Tribunal suspended the Respondent's suspension until 16 August 2022 and imposed conditions to apply on his resumption of practice.

(j) On 13 October 2022 the Respondent participated in a telehealth consultation with Patient A. The Complaint established at Stage 1 of this hearing addressed that consultation. On 9 June 2023 Patient A lodged a complaint about the Respondent with Ahpra.

(k) On 25 July 2023 the Medical Council of NSW imposed additional conditions on the Respondent including that he does not consult with female patients.

(l) On 20 January 2025 (amended 23 June 2025) the HCCC filed its Application for Disciplinary Orders in the Tribunal.

1. The HCCC emphasised particular aspects of its written submission and addressed questions asked by the Tribunal members.
2. The HCCC submitted that a cancellation of the Respondent's registration is necessary to "denounce the practitioner's serious misconduct". It submitted that in the particular circumstances of this case, cancellation is necessary to denounce the practitioner's inappropriate comments and actions.

1. The Respondent provided a written submission which was marked as MFI 8. We noted the following in particular in this submission.

(a) "The Respondent submits that the order sought by the HCCC is not necessary for the protection of the public and is not appropriate. As noted at Stage One, as soon as the complaints were drawn to his attention, the Respondent reflected on the conduct asserted and took responsibility for the mistakes he made. He has given evidence about his conduct, and his reflections, in a number of forums. Most of the HCCC complaint was admitted. The Respondent has taken every opportunity to engage in related education and training. Over the three years since the complaint, he has been fully committed to in adhering to the conditions of his registration and has embraced the opportunity for further learning. He is practicing safely and without complaint. Indeed, he has earned the praise and respect of his colleagues, as demonstrated by the reports of his referees, supervisor and mentor.

1. The complaints arose while the Respondent was working at Victoria Tower Medical (VTM) practice. They concern Patient A, who was unknown to the Respondent until he had two consultations with her, one by telehealth on 13 October 2022 and the second one face to face, on 14 October 2022.
2. In March 2024, the Respondent commenced practice at First Care Medical Centre Bankstown ('FCMC'), which accommodates eight general practitioners, two female practice nurses, two psychologists, one podiatrist, a physiotherapist and an exercise physiologist.
3. The FCMC is smaller than the VTM and the Respondent is a valuable member of the practice, where he has developed a strong following of regular patients.[83]
4. In the circumstances of this case, and for reasons expanded on below, the Tribunal is invited to make Protective Orders in the form of a strongly worded reprimand and a further period of conditions. A draft of proposed conditions is attached to these submissions and marked Annexure A. If the Tribunal is against the Respondent on such a submission, then a period of suspension is more appropriate than cancellation."
5. The Respondent then addressed each of the Complaints which had been addressed at the Stage 1 hearing. The submission pointed out that the Respondent had admitted Complaint One and each of its Particulars. He submitted: "The Respondent has conceded that at the time of the consultations he did not know a great deal about intestinal malrotation. He agrees, with the benefit of hindsight that he could have, although unusual, updated the referral to the gastroenterologist. (Stage One decision at [78])."
6. In relation to Complaint Two the Respondent submitted: "While the Respondent could not recall the precise form of words he used, he admitted asking questions and making comments to the effect of those reproduced in Particulars 1. a. to i. The Respondent reflected on his comments and was self-critical in oral evidence before both the Medical Council and the Tribunal." The submission then set out extracts from the Stage 1 judgment.
7. By way of further explanation given in relation to Complaint Two the Respondent submitted:

"With respect to Complaint Two, particular 2 (a), the Respondent denied that he deliberately winked at Patient A. He accepted that it was possible that Patient A perceived him to have done so, but he did not consciously do that. He explained that he was born in the Middle East and said: "I am a touchy type of person" (Stage One decision at par [28]). As he explained in s150 proceedings: "I definitely do not wink, ever. But I do grimace ... when I'm uncomfortable.. she might have perceived that I'm, you know, winking at her, when I'm maybe a little bit uncomfortable." (p130.7-14).

With respect to Complaint Two, particular 2 (b) the Respondent does not recall patting Patient A on the knee. He accepts that it is possible this occurred but said that if it did, he would have intended it only as a gesture of comfort (Stage One decision at par [27] and [44]). He has patted patients on the knee or back as part of reassurance to them (at [27]). The Tribunal was satisfied that the conduct had occurred and was critical of any touching without consent, irrespective of whether it was intended as a gesture of comfort (noted in Stage One decision at par [27]-[28]).

The Respondent accepted that the conduct he had admitted, set out in Complaint 2, amounted to unsatisfactory professional conduct under section 139B(1)(a) of the National Law."

1. The Respondent submitted he had admitted Complaint Three.
2. In relation to Complaint Four (the complaint under s.139E professional misconduct) the Respondent had denied this Complaint.
3. The Respondent submitted: "The bulk of the complaint, and the most serious conduct alleged, was admitted by the Respondent, who expressed his genuine regret at the distress caused to Patient A. While there were aspects of the two consultations where the evidence of Patient A and the Respondent differed, there was minimal factual dispute concerning the complaint itself. That can be condensed as a) whether the Respondent touched Patient A's knee (although he accepted that while he had no memory of this, he might have done so intending a gesture of comfort), and b) whether he winked at the patient (although he accept that he is expressive and might have made a facial gesture that was perceived as a wink). In circumstances where so little of the complaint that was in dispute, Patient A was not required for cross examination."
4. The Respondent then addressed matters of Legal Principles. The Respondent helpfully submitted the following: "The legal principles guiding the Tribunal in determining the appropriate Protective Orders are well known. They were summarised, for example, in HCCC v Della Bruna [2014] NSWCATOD 31 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 Submission set out further matters relating to legal principles as follows: "A finding by the Tribunal that the practitioner's conduct was "of a sufficiently serious nature to justify suspension or cancellation of their registration, does not mean that suspension or cancellation is the appropriate protective order to make in the circumstances of the present case: Health Care Complaints Commission v Karalasingham [2007] NSWCA 267, cited in Della Bruna at [89].
2. The Respondent emphasised that the National Law requires the Tribunal to exercise constraint. Section 3A(c) states that "restrictions on the practice of a health profession are to be imposed under the scheme only if it is necessary to ensure health services are provided safely and are of an appropriate quality."
3. Further the Respondent submitted: "The reputation of the medical and nursing profession is robust. "Denunciation" should not outweigh other important considerations, or override the significance of the restraint built into s3A(2)(c) of the National Law."
4. The submission then stated: "Whether the Tribunal should exercise its discretion to cancel the Respondent's registration is a matter of degree and judgment: Sabag v Health Care Complaints Commission [2001] NSWCA 411 at [82]. This requires an assessment of the gravity of the professional misconduct found proved, and consideration of remorse and insight, if any, demonstrated by the practitioner: Health Care Complaints Commission v King [2013] NSWMT 9."
5. The Respondent drew our attention to the decision in HCCC v Aref, [2018] NSWCATOD 133 at [24], where the Tribunal noted that it exercises a "wide discretion" in relation to appropriate protective orders and the circumstances of the case will determine the appropriate disposition: citing HCCC v Karalasingham [2007] NSWCA 267 at [67] (per Basten JA).
6. We accept the submission of the Respondent in relation to applicable legal principles.
7. The Respondent then addressed matters arising from the principles of law, set out in the submission above quoted, as applicable to the facts and findings made in this matter. The Respondent submitted there is ample evidence of reflection and insight on the part of the Respondent. That included his own evidence given in this hearing, the evidence of the course work he has undertaken, reports from his supervisors and mentors, the evidence of his referees and his commitment to continuing to engage with his psychologist Dr Pignataro. Detail of those stated areas of reflection and insight are set out in the submission at length. In particular the evidence of Dr Pignataro is set out in the submission as follows:

"Report of Consultant Clinical psychologist Dr Anthony Pignatoro

(a) The Respondent has continued to see his psychologist and has discussed the most recent complaint with him. As he explained in evidence before the S150 hearing, they cover a lot of issues about communication, childhood trauma and how that impacts the Respondent and how he might react or perceive things (HCCC Stage One brief, pp110-111).

(b) In a report of Dr Pignataro to the Medical Council dated 13 December 2023, he confirmed that he was addressing the relevant issues with the Respondent, who has responded appropriately and with insight. He writes (HCCC Stage Two Bundle, p 306:

'There has been discussion with George regarding his communication with female patients related to sensitive health topics and how best to manage such topics. This has been a primary therapeutic topic following a recent complaint. This did have a significant negative impact on his mood state, general functioning and self-perception as a medical practitioner. Over the course of our recent sessions, he has become more confident with insight into the transferential interactions that may arise with vulnerable patients. In summary, George is without concerns at this time and I would support a change in supervision requirement from a level B to C.'

1. The Respondent submitted this is not a matter which requires the imposition of specific deterrence against the Respondent. The Respondent submits that the consultations with Patient A occurred over three years ago and he has demonstrated that since that time he has practised appropriately.
2. The Respondent provided a list of suggested conditions which he submits would ensure the safety of the public. He further submitted the Tribunal could have confidence he would comply with any conditions it deemed appropriate to apply to his registration.

1. In his oral submission his senior counsel emphasised the steps which the Respondent has taken to demonstrate he can practice without further breaching guidelines for good practice as a GP.
2. The submission stated that the Tribunal could be adequately satisfied that the public would not be at risk should the Respondent be permitted to practise with the conditions he has submitted would give the Tribunal that assurance. That practice could be permitted immediately with the Tribunal imposing a Reprimand on the Respondent or at the conclusion of a period of suspension should the Tribunal consider that is necessary.

1. The HCCC set out principles which it submitted will apply when the Tribunal is considering the imposition of protective orders following a finding of unsatisfactory professional conduct and/or professional misconduct. We have read and accept those matters referred to and do not repeat them here. However, the HCCC made some specific submissions in Reply to the submission of the Respondent on matters of law and we set that portion of the Reply submission out here:

"In reply to paragraphs 31-32 of the practitioner's submissions (which suggest that the Tribunal should exercise constraint) the Commission submits that the Tribunal should protect the public:

(1) the protection of the health and safety of the public must be the paramount consideration;[84]

(a) while one of the "other guiding principles" of the national registration and accreditation scheme includes that restrictions on the practice of a health profession are to be imposed under the scheme only if it is necessary to ensure health services are provided safely and are of an appropriate quality,[85] that must not take precedence over the "main guiding principle" which is that the protection of the health and safety of the public must be the paramount consideration;[86]

(b) while the adverse consequences for a practitioner may require that no more restrictive an order should be made than is necessary for the proper protection of the community and the other proper purposes of such an order,[87] there is also 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;[88]

(c) while some of the practitioner's referees suggest that cancellation may have personal consequences for the practitioner (for example, "a big blow to his identity"[89] and a "heavy emotional and professional price for his mistakes"[90]), these personal consequences are necessarily secondary considerations outweighed by the fundamental need to protect the health and safety of the public (which is not confined to protecting the practitioner's patients but also includes protecting the public from similar misconduct of other practitioners, denouncing such conduct and upholding public confidence in the standards of the profession by signalling that those whose conduct does not meet the requisite standard will not be permitted to practice[91]);

(d) while a range of protective orders may be available, the Tribunal's discretion must be exercised in a way that achieves the protective purpose foremost because focussing on the potential impact on the practitioner may create an appearance that the disciplinary jurisdiction is protective of the professional rather than protective of the public;

(e) accordingly, the Commission maintains its submissions that cancellation is the appropriate protective order.

(16) This type of submission is sometimes made by reference to another Tribunal decision,[92] which refers to a decision about a barrister.[93] With the proviso that decisions about barristers will have limited utility because there are significant institutional and functional differences between the regulation of legal practitioners and health practitioners,[94] that decision states (emphasis added):

"113 The point sought to be made in the authorities is, no doubt, that the Court or Tribunal making an order in disciplinary proceedings must have squarely in mind the protective purpose of the order, in the public interest. That is not to say that the adverse (punitive) effect on the practitioner should be ignored; clearly no order should be made which has more serious consequences for the practitioner than is reasonably necessary in execution of the protective purpose.

114 That being said, it may also be noted that the protective purpose may operate in different ways. First, by its direct effect upon the practitioner, the order will either remove that practitioner from membership of the profession ... or will provide a deterrent against the repetition of such conduct ... There are also important but indirect effects to be considered. First, the order reminds other members of the profession of the public interest in the maintenance of high professional standards. Secondly and more specifically, it may give emphasis to the unacceptability of the kind of conduct involved in the disciplinary offence. Thirdly, by speaking to the public at large, it seeks to maintain confidence in the high standards of the profession. The underlying purpose is not self-aggrandisement on the part of the profession, but a recognition of the social value in the availability of the services provided to the public, combined with an understanding of the vulnerability of many who require such services....

117 .... A finding of more serious misconduct than that adopted by the Tribunal should be seen as the justification for the imposition of an appropriate deterrent order, and not as itself a sufficient deterrent. To treat it otherwise is to diminish the quality of the adverse finding and to create an appearance that the disciplinary jurisdiction is protective of the professional, and not the public."

1. We accept the principles as stated by the HCCC as set out here, as we have also accepted the submission of the Respondent, which we have set out earlier, in relation to applicable legal principles.

1. It is trite to say that this decision has been troubling for the members of this Tribunal. The principal matter which has troubled us is the question of why the Respondent has found himself excursing into highly inappropriate and professional misconduct with some of the female patients he has seen as a medical practitioner. The circumstances of the facts which the Tribunal found established at Stage 1 of this hearing, do not demonstrate an isolated incidence of misconduct by the Respondent when consulting with a female patient. We have set out detail of the Tribunal having moved to cancel the registration of the Respondent in 1999 because of the findings of professional misconduct against him arising from established highly inappropriate conduct of the Respondent with female patients. That conduct was sexual misconduct.
2. The Respondent also faced the Tribunal again in 2022. In that case his misconduct was of a different nature yet clearly serious enough to have the Tribunal impose a suspension of his registration. Details of that decision of the Tribunal are referred to in this judgment.
3. The significant regret which the facts of this case show is that the Respondent has a great deal to offer the community where he practises in the Sydney area. He speaks a number of languages, including languages still in daily use in the Bankstown area of Sydney. He apparently holds the respect of many in his community as the references he has provided show. There is also evidence, unspecific, that he may be a successful investor thus providing for himself and his family.
4. The Respondent is in many respects a remarkable role model for people coming to Australia to establish a life far removed from conflict and deprivation in the land where they were born. Yet, there are aspects of his personality which have let him down and conversely demonstrated the type of behaviour which no-one should model to any section of our Australian community.
5. As seen hereafter we will consider each of the aspects of the considerations the Tribunal needs to address when making a protective order, however, the question which has led us to the regrettable conclusion that the Respondent's registration needs to be cancelled, is the fact that we have not been convinced that the public safety will be appropriately protected should the Respondent continue to practice at this time, even with the imposition of strict conditions. We have not been satisfied that there is a sufficient explanation for why the Respondent has acted in the manner with female patients in which two Tribunals have been satisfied he did act. Further the evidence from Dr Pignataro, although given in a very supportive manner for the Respondent, has not convinced us that the counselling undertaken and actions proposed to address the Respondents inability to behave appropriately with some of his female patients, will mean they will be safe to consult with him.
6. We have also considered imposing a condition that he not be permitted to consult with female patients, which might be applied to the registration of the Respondent, thereby allowing for the Tribunal to impose a suspension order and thereafter allow him to continue practising in a manner which would ensure the safety of any possible female patients. In relation to that proposal, we consider that we could not impose such a condition unless we had confidence that it would only need to apply during a time when the Respondent was receiving therapy from his consultant psychologist and in circumstances where we are satisfied that at the conclusion of that therapy the public as a whole (male and female) would be safe to consult with him.
7. We now turn to consider the other matters which the legal principles referred to earlier in this judgment, addressed.
8. The requirements of s 3 of the National Law. (Section 3B National Law (formerly 3A).
9. In this case we are not satisfied that, at this time, the public will be safe if the Respondent continues to practise as he seeks. We are not satisfied that conditions can be imposed which would keep female patients safe should they consult with the Respondent. For the reasons set out above, we are not satisfied that there is a proposal to address whatever the cause of the Respondent's inappropriate actions with female patients is, thereby making, in our view, it inappropriate to impose conditions which would permit practice by the Respondent, even though he would be restricted from seeing female patients. Such a course of action would cast onto the Medical Council of NSW the responsibility for overseeing such conditions, including the ability to vary and discharge same, where there was no foreseeable action on the part of the Respondent that would allow him at any future time to be safe to see female patients.

The protection of the public's confidence in the medical profession.

1. Given the seriousness of the misconduct of the Respondent it is, in our view, important to set protective orders which both the public at large and the profession itself will see as appropriate in the circumstances of the offending. This then goes to the public and the profession being able to maintain confidence in the high standard of medical practice by the profession. The fact that the Respondent has had his registration cancelled in 1999 for a similar offence relating to female patients, calls for more stringent protective orders in terms of the impact upon the Respondent. That is supported further where there is no acceptable and visible pathway to a reforming of the Respondent in relation to being able to practise safely with female patients.

1. We have addressed this to an extent earlier however, we take the view that the Tribunal, in this case, has to frame a protective order which addresses both specific and general deterrents. It is clear from the repeating of the same type of misconduct, (professional misconduct with female patients which has seen both inappropriate sexual conduct and inappropriate discussion with a female patient about sexual matters) by the Respondent, demonstrates he has not learnt that his practice as a medical practitioner must not cross clear boundaries which are well known and addressed in relevant codes of conduct which the Respondent is obliged to comply with. A progression in a consultation into sensitive medical matters (sexual health including masturbation) without the consent and request of the patient, is most disturbing for patients and more so for vulnerable female patients.
2. In terms of general deterrents, we conclude that the vast majority of practising medical practitioners has a clear understanding of boundaries which need to be and are respected in every day of their work. Nonetheless, lest it be the case that there are practitioners who could benefit from a revision of codes of conduct addressing boundaries with patients, we see this case as appropriate to do that. A Protective order which visits this case with a cancellation of registration will, we consider, send a clear message.

The requirement for the Protective orders to be no more punitive in nature upon a health practitioner than is absolutely necessary to protect the safety of the public.

1. We have considered in detail the possibility of different Protective orders which would achieve the requirements of Protective orders, as outlined earlier in these reasons, and at the same time permit the continued practice by the Respondent as a GP either immediately (with a Reprimand) or at the conclusion of a period of suspension, and we have regrettably reached the conclusion that only an order for cancellation will suffice. We have considered the possibility of imposing a reprimand, imposing a fine and/or ordering a suspension of the Respondent's registration for a defined time. We have concluded that none of the alternates to a cancellation will meet the requirements that Protective orders are required to perform.
2. In the case of the imposition of a suspension of the Respondents registration, as we have already canvassed, we could have no confidence that the Respondent would be fit to work with all patients who might seek his services, at the conclusion of any period which it might be appropriate to set as a period of suspension.
3. We are also troubled by the proposal that the Respondent be permitted to practise into the future with a condition that restricts that practice to male patients only as female patients may not be safe to consultation with him. We are of the view that a practitioner who cannot be trusted to practise safely with half of the population that may need medical services, then such a practitioner is probably not a fit person to practise as a medical practitioner at all.

The requirement that restrictions on the practice of a health profession member only be as restrictive as is necessary to ensure that health services are provided safely and of an appropriate quality.

1. Section 3A(2)(c) of the Health Practitioner Regulation National Law (NSW) (NSW) provides that: "restrictions on the practice of a health profession are to be imposed under the scheme only if it is necessary to ensure health services are provided safely and are of an appropriate quality."
2. The restriction we consider is necessary to impose in this case on this Respondent is to cancel his registration. In so doing we accept that the cancellation of the Respondents registration is the most restrictive action we can take against him in terms of interfering with his right otherwise to practise his profession. We also conclude that a cancellation is necessary, notwithstanding our acceptance that the population in the area where the Respondent has been practising in Sydney suffers now and will suffer in the foreseeable future, from a short supply of GP's. The fact that the Respondent will not be available to practise for some time is a very regrettable outcome from this determination.
3. It is clear from that already set out above, that we have considered alternate protective orders to that of cancellation of registration and have concluded that such a Protective order although the most restrictive available to us, is the only appropriate order in this case.

The period of time in which the Respondent is to be prevented from making application to the Tribunal to obtain further registration

1. As can be seen from the HCCC case, it seeks a period of 2 years from the date of the cancellation of the Respondents registration, before which he is to be prevented from making a further application for registration. We have considered that application of the HCCC and the stated reasons, however, we consider a period of 12 months is what is required. We have chosen that period conscious of the current delays which are experienced by applicants to the Tribunal seeking reinstatement orders. We consider that based on current experience, a non-review period of 12 months would most likely mean the Respondent having a wait of about 18 months before he could again make an application to the Tribunal to be eligible for registration.
2. We have also had regard to the requirement which the Respondent will need to fulfil to make a further application to the Tribunal. Without seeking to pre-empt or intrude in any way upon the decision of any future Tribunal which may be required to consider an application by the Respondent, we consider it likely the Respondent will need to have evidence to satisfy that Tribunal that the action which he has taken since the making of the Protective orders by this Tribunal, will satisfy the Tribunal that the Respondent will be able to practise in a manner which does not raise any concerns about safety for his patients of either sex.

1. The HCCC seeks an order that its costs be paid by the Respondent. The Respondent has not made any submission opposing such an order.
2. In this jurisdiction it is the case that costs follow the cause. The HCCC has been substantially successful in the action both at Stage 1 and Stage 2. Although the Respondent conceded many of the claims brought against him, it remained necessary for the HCCC to establish its case. The Respondent did not concede he was guilty of Professional Misconduct. The Tribunal found that he was guilty of Professional Misconduct.
3. There is nothing which has been brought to our attention which would warrant the Tribunal making a reduction in the costs order which the HCCC seeks and accordingly a costs order will be made.

1. We propose to make the following Protective Orders for the reasons set out above.

(1) The registration of the Respondent as a medical practitioner is cancelled pursuant to s 149C(1)(b) of the Health Practitioner Regulation National Law 2009 (NSW).

(2) Any application for review of order (1) may not be made until one year after the date of these orders.

(3) The Respondent is to pay the costs of the Health Care Complaints Commission of this proceeding as agreed or as assessed.

(4) Pursuant to clause 7 of Schedule 5D of the Health Practitioner Regulation National Law (NSW), the disclosure of the name, or the initials, of any patient referred to within the evidence adduced in this proceeding is prohibited.

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

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.

[3] Section 3B National Law (formerly 3A)

[5] HCCC v Do [2014] NSWCA 307 at [35]

[6] Chen v HCCC [2017] NSWCA per Basten JA at [14] and [20] and per Payne JA at [67]-[69]

[8] Exhibit A1: 1999 decision p 751 and 761

[9] HCCC Stage 2 material: Transcript p 333-334

[11] Exhibit A1: 2003 decision p 773-774

[16] HCCC Stage 2 material: Response p 4 and p 365

[17] Exhibit A1: 2013 decision p 781, 794

[21] Exhibit A1: Counselling Interview p 62

[22] Exhibit A1: Counselling Interview p 63

[23] Exhibit A1: Counselling Interview p 64

[24] Exhibit A1: Counselling Interview p 64

[25] Exhibit A1: Counselling Interview p 64

[31] Exhibit A1: 2022 NCAT decision paragraph 298-300

[32] Exhibit A1: S150 transcript p 117 line 36-46 and p 119 line 4-16 and 24-45; Practitioner's Stage 1 oral evidence; Stage 1 decision para 38

[33] Exhibit A1: S150 transcript p 117 line 30-35

[34] Exhibit A1: S150 transcript p 118 line 1-20

[35] Exhibit A1: Patient A email p 23-24

[36] Exhibit A1: Patient A statement p 20; Exhibit A1: Records p 425

[39] Exhibit A1: Patient A statement para 30 p 21

[41] Lee v HCCC [2012] NSWCA 80 [23]- [34]

[42] See generally: Chen v HCCC [2017] NSWCA 186 at [88]

[43] Exhibit A1: 2022 NCAT decision p 829

[44] Exhibit A1: 2022 NCAT decision p 829

[45] Exhibit A1: 2022 NCAT decision paragraph 298-300

[46] Exhibit A1: 2013 decision p 789-790; Exhibit A1: 2022 NCAT decision paragraph 60

[47] Exhibit A1: Counselling Interview p 62

[48] See 2017 Independent review of the use of chaperones to protect patients in Australia: https://www.nhpo.gov.au/sites/default/files/2020-08/Chaperone-review-report-WEB.pdf

[49] Exhibit A1: S150 transcript p 153; Exhibit A1: S150 decision p 179; Exhibit A3: AHPRA evidence certificate p 5

[51] Section 149 and 149C National Law.

[52] Exhibit A1: S150 material index p 181-182

[54] Exhibit A1: S150 transcript p 100; Exhibit A1: Review interview p 83

[55] Stage 1 decision para 37; Exhibit A1: Medicare p 615-616

[57] HCCC Stage 2 material: Supervision p 69

[58] HCCC Stage 2 material: S150A transcript p 253

[59] HCCC Stage 2 material: Mentoring p 193

[60] HCCC Stage 2 material: Supervision p 72

[61] See generally, HCCC v Gao (No 2) [2023] NSWCATOD 19 [114]

[62] Exhibit A1: Council evidentiary certificate p 205

[64] HCCC Stage 2 material: S150A transcript p 262

[71] Exhibit A1: Council evidentiary certificate p 206; Exhibit A1: 2003 decision p 775-776

[72] Exhibit A1: Council evidentiary certificate p 206; Exhibit A1: 2003 decision p 775-776

[73] Exhibit A1: Council evidentiary certificate p 205

[74] Exhibit A1: CV p 49; Exhibit A1: 2022 NCAT decision paragraph 86b

[75] Exhibit A1: 2022 NCAT decision paragraph 77

[76] Exhibit A1: 2022 NCAT decision paragraph 25 p 837

[77] Exhibit A1: 2022 NCAT decision paragraph 24 p 836

[78] Exhibit A1: 2022 NCAT decision p 829

[79] Clause 13(1) of Schedule 5D of the National Law

[80] HCCC v Philipiah [2013] NSWCA 342 at [42]- [46]

[81] Oshlack v Richmond River Council [1998] HCA 11; 193 CLR 72 at [40]; applied by the Tribunal in several decisions including HCCC v CSM [2016] NSWCATOD 125 at [98] and HCCC v Brush (No. 2) [2015] NSWCATOD 154 at [9]

[82] Exhibit A1: 2022 S150A decision p 816; Exhibit A1: 2022 NCAT decision paragraph 14

[83] Respondent Bundle, statement, par [15].

[87] Prakash v HCCC [2006] NSWCA 153 at [101] per Basten JA

[88] Prakash v HCCC [2006] NSWCA 153 at [91] per Santow JA

[89] Practitioner's Stage 2 Material: Antoun reference p 28

[90] Practitioner's Stage 2 Material: Moureed-Nan reference p 41

[91] See generally HCCC v Do [2014] NSWCA 307 at [35]

[92] HCCC v Schmaman [2019] NSWCATOD 82 at [88]

[93] NSW Bar Association v Meakes [2006] NSWCA 340

[94] See generally Chen v HCCC [2017] NSWCA 186 at [4] per Basten JA and at [59] per Payne JA (Leeming JA agreeing)