Health Care Complaints Commission v Narayan [2026] NSWCATOD 2;

1. Dr Narayan is 45 and was born in Fiji. He came to Australia in 2007 and qualified as a radiographer. He worked as a radiographer for some years.
2. Dr Narayan then undertook further studies in Australia and became registered as a medical practitioner on 4 January 2016. From February 2019 to September 2020, Dr Narayan was employed as a GP Registrar.
3. On 24 September 2020, Dr Narayan's registration was suspended by the Medical Council of NSW as a consequence of his conduct in relation to a patient and two colleagues in 2019 and 2020. On 16 June 2023, those complaints came before a differently constituted NSW Civil and Administrative Tribunal. Those complaints were finalised when that Tribunal suspended Dr Narayan's registration for a further three months ("the 2023 decision").
4. On 16 September 2023, the suspension was removed and conditions were imposed on Dr Narayan's registration. These included requirements to practise in a group practice, to consult no more than 25 patients a day and no more than 4 patients an hour, to practise no more than 40 hours a week and no more than 8 hours a day, to practise under category B supervision, to meet regularly with a mentor and to attend a psychologist for treatment. Those conditions remain on his registration.
5. While Dr Narayan's registration was suspended, Patient A, on 2 March 2023, made the complaint which is the subject of these proceedings. That complaint relates to Dr Narayan's conduct in 2020.
6. On 5 August 2024, Dr Narayan moved to Norfolk Island to work as a general practitioner.
7. On 25 June 2025, Dr Narayan had a heart attack and came to Sydney for treatment. His contract in Norfolk Island ended on 30 June 2025.
8. Since 28 August 2025, Dr Narayan has been working at the Campsie Healthcare Medical Centre at Campsie.
9. Dr Narayan could not sit for his final Fellowship examinations in October 2025 because of his heart attack. He expects to sit the examinations in mid 2026.

1. In the Stage 1 decision we determined complaints made arising out of Dr Narayan's conduct in 2020 in relation to Patient A. The Stage 1 findings which are relevant to our determination of Stage 2 are the following. This summary is only intended to enable an understanding of this Stage of the proceedings, is not in substitution for our previous detailed findings and omits some factual findings that we made.
2. Patient A consulted Dr Narayan after she injured her left knee on 30 January 2020. We found that:

(1) On 18 February 2020 Dr Narayan massaged Patient A's leg, pushed up her dress and almost touched her pubic area. He also conducted an examination of Patient A's breasts without offering a chaperone and without obtaining informed consent. He tweaked or otherwise touched her nipples which was not clinically indicated. Shortly after he had touched Patient A's breasts, he said 'oh they're not hard'. He asked Patient A for a hug and he hugged Patient A.

(2) On 13 March 2020 Dr Narayan inappropriately massaged Patient A's left leg above the knee and on the inner thigh which was not clinically indicated, asked Patient A questions about her sex life including whether her partner could give her orgasms, touched Patient A's genital region when it was not clinically indicated, told Patient A it was a shame her partner could not give her orgasms, told her he had taught a lesbian couple how to give each other the best orgasms, said to Patient A he could give her the best orgasm, asked Patient A for a hug and hugged her.

1. We found that this conduct was both unsatisfactory professional conduct and professional misconduct because the whole of the conduct amounted to conduct of a sufficiently serious nature to justify the suspension or cancellation of his registration.

1. In our Stage 1 decision we reviewed some inconsistencies in the evidence and found they impacted on the reliability of the whole of Dr Narayan's evidence: Stage 1 decision at [48]. Where there was a conflict between the evidence of Patient A and that of Dr Narayan we preferred the evidence of Patient A unless there was reliable contemporaneous evidence to the contrary: Stage 1 decision at [156].
2. We have further concerns about the reliability of Dr Narayan's evidence arising from the Stage 2 hearing.

1. We will discuss the expert evidence later in these Reasons. Relevantly for this issue, Dr Narayan saw Dr Samuels on 6 November 2025. In his report, in relation to the complainants in the 2023 decision, Dr Samuels said:

(Colleague 1)

149 I asked Dr Narayan to go through the issues involving (Colleague 1). He said she made a complaint that he had called from the hospital and said that he was masturbating about her in a cupboard. He continues to absolutely deny that.

150 He does remember a discussion about her bringing in some new chairs, and he said he did make some reference to the chairs, and he acknowledged that he used "the f word".

(Colleague 2)

151 Dr Narayan said there was another complaint ... who said he touched her shoulder, and he said he had done that to get her attention. She made a comment that he had said to her, they could go behind a screen and engage in sexual activity. Dr Narayan was adamant that he did not say that.

Discrepancies in the Complaints

152 I asked Dr Narayan about these discrepancies. He said that in the initial Section 150 Hearing there was an adjournment following these revelations and he said he had a discussion with his lawyers who told him that it would not be in his interests to admit to aspects of the complaint and deny other aspects of the complaint and that he would not be believed. He said that as a consequence of this, he just followed the legal advice and admitted to all complaints. Dr Narayan reiterated that the comment about giving a patient an orgasm was made to Patient A, not Patient B.

153 He denies making a comment about masturbation ... and he strongly denies making a comment ... about going behind a screen and having sexual intercourse.

154 Dr Narayan said it was because after the Hearing resumed and then admitting all of these allegations, that he was then accused of "misleading" the HCCC and his employer, but he said that was not the case.

155 Dr Narayan also told me that Patient B made an allegation that he had tried to hug her and he said again that that was not true.

1. In an affidavit prepared on 20 November 2025 Dr Narayan said he disagreed with paragraphs 149 to 155 of the report. He said:

I do not continue to deny what I did or say that I only changed my evidence based on legal advice at the time of the s 150 hearing.

1. Dr Narayan told us that he had been trying to explain to Dr Samuels that he had lacked insight and was experiencing significant personal difficulties, which contributed to his initial denial of the complaints but he later reflected on what had occurred and accepted what he had done. He admitted the complaints based on his reflections rather than any advice from his lawyers.
2. We do not accept the evidence of Dr Narayan for the following reasons:

(1) Dr Samuels was called to give evidence. He was not asked about these paragraphs of his report, in fact he was not cross examined at all. The rule in Browne v Dunn (1893) 6 R 67 ordinarily requires that, where the evidence of a witness is to be challenged on a basis that may be capable of being explained or addressed by the witness, such a challenge should be made clear. That is usually done by cross-examination. Otherwise there can be a denial of procedural fairness if the evidence is rejected on a ground which was not, but should have been, raised with the witness. This rule applies to this Tribunal: Qasim v Health Care Complaints Commission [2015] NSWCA 282 at [53].

(2) In cross examination Dr Narayan said that Dr Samuels had either misunderstood what he had said or he had misunderstood what question Dr Samuels had asked. We do not accept this explanation. Dr Narayan's explanation itself was very complicated and difficult to understand. Dr Narayan said Dr Samuels did ask that question, he had said that to Dr Samuels, but the issue is the context. His counsel suggested that the misunderstanding arose because of the ambiguity of the terms "Hearing" and "Tribunal" in paragraph 165 of the report. We do not understand how this is an explanation and Dr Narayan has not referred to that paragraph in his affidavit.

(3) The paragraphs of the report are clear. This is not a case where a doctor has made a single entry about a fact and could have made an error. Dr Samuels raised two factual matters which he explored in some depth with Dr Narayan whom, he recorded, was quite definite in his denial and volunteered the explanation about his relying on the legal advice.

1. We do not accept the evidence of Dr Narayan in his affidavit. We find that this impacts on the reliability of his evidence.

1. In our Stage 1 decision we found that Dr Narayan had engaged in some conduct which he had either not admitted or had denied.
2. When he gave evidence at the Stage 2 hearing he was asked whether, as a result of the Stage 1 decision, he now admitted those matters.
3. We are satisfied that Dr Narayan was evasive and uncooperative when answering these questions. In effect he said his position was unchanged, although he couldn't articulate what that position was and said he needed to see the documents from April this year to be able to answer the question.
4. We find that this impacts on the reliability of Dr Narayan's evidence.

1. Later in this decision we discuss Dr Narayan's failure to inform his supervisors about the Stage 1 hearing. In his oral evidence Dr Narayan agreed that he had not told them but said he had told his mentor and his psychologist. The mentor's notes are in evidence and there is no reference to such a disclosure. There is no updated report or document from his psychologist from which we could ascertain whether Dr Narayan had told his psychologist.
2. We do not accept Dr Narayan's evidence about disclosure to his mentor and we find that this impacts on the reliability of his evidence.

1. We have significant concerns about the reliability of the evidence of Dr Narayan. While we decline to find that Dr Narayan will say whatever he thinks will benefit his case, as submitted by counsel for the HCCC, we do not consider that he was fully frank in relation to key issues.

1. The Health Practitioner Regulation National Law (NSW) (the "National Law") provides that we can:

(1) caution or reprimand Dr Narayan: s 149A(1)(a).

(2) place conditions on Dr Narayan's registration: s 149A(1)(b).

(3) order Dr Narayan to undergo medical or psychiatric treatment or counselling: s149A(1)(c).

(4) order Dr Narayan to complete a specified educational course: s149A(1)(d).

(5) impose a fine: s149B (1).

(6) suspend Dr Narayan's registration for a specified period or cancel his registration: s149C(1).

1. The fact that we have found that Dr Narayan's conduct was of a sufficiently serious nature to justify suspension or cancellation of his registration does not mean it must be suspended or cancelled.
2. The objectives of the national registration and accreditation scheme are to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered: National Law, s 3(2)(a). The main guiding principle is that the protection of the health and safety of the public must be the paramount consideration: National Law, s 3A(1).
3. In Health Care Complaints Commission v Do [2014] NSWCA 307 at [35] the Court explained that the protection of the health and safety of the public is not confined to protection from malpractice or incompetence but includes protecting the public from the similar misconduct or incompetence of other practitioners; upholding public confidence in the standards of the profession by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct is a deterrent to the practitioner and all other practitioners. Public confidence is maintained by signalling that those whose conduct does not meet the required standards will not be permitted to practise.
4. The purpose of disciplinary orders is protective rather than punitive: Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 at p 637. Nevertheless the orders may be punitive in effect and those punitive effects may be directly relevant to the need for protection: Director-General, Department of Ageing, Disability and Home Care v Lambert [2009] NSWCA 102 at [83].
5. However, any protective orders should not result in "more serious consequences for the practitioner than is reasonably necessary in execution of the protective purpose of the legislation": NSW Bar Association v Meakes [2006] NSWCA 340 at [114].

1. In determining the appropriate protective Orders we have taken the following matters into account:

1. In determining that Dr Narayan was guilty of professional misconduct in Stage 1 we took into account the following matters as indicators of the very serious nature of Dr Narayan's conduct. We again rely on these matters in determining the appropriate protective orders:

(1) Dr Narayan conducted physical examinations of Patient A which were not clinically indicated, he made sexual remarks, he touched Patient A in a sexual way and he used words and acted in a way that might reasonably be interpreted as being designed or intended to arouse or gratify sexual desire.

(2) The conduct was a serious abuse of the trust in the relationship between doctors and patients.

(3) The doctor-patient relationship is inherently unequal. Patient A was a vulnerable patient. She was a young woman. It is clear from his records that Dr Narayan knew that Patient A had suffered "multiple adverse events" including having "lost her home" in a bushfire. We have accepted that Patient A told Dr Narayan that she was a sexual assault survivor. To receive healthcare, Patient A had to allow Dr Narayan to conduct physical examinations. Dr Narayan's breach of sexual boundaries in the doctor-patient relationship exploited this power imbalance.

(4) Patient A had a right to expect that Dr Narayan's examinations and treatment would only be undertaken in her best interests.

(5) Patients subjected to sexual behaviour from their doctor may suffer emotional and physical harm.

(6) Members of the community should never be deterred from seeking medical care, permitting intimate examinations or sharing deeply personal information, because they fear potential abuse.

1. We have already mentioned (and considered in Stage 1) the other complaints which resulted in the suspension of Dr Narayan's registration for three years from 24 September 2020. The complaints were made by a patient and two colleagues. The complaints were considered by a Tribunal and we have already said that we will refer to this as the 2023 decision.
2. Dr Narayan's conduct considered in the 2023 decision occurred between March 2019 and August 2020 and thus overlaps chronologically with the complaints made by Patient A in these proceedings. However the timing of Patient A's complaint to the regulatory authorities means her complaint is now being considered separately.
3. In relation to the patient in the 2023 decision, who was then aged 31, Dr Narayan admitted that, on 8 August 2020, (shortly after he had treated Patient A) during a medical consultation he said to her "I had a dream about you last night ... and I had to have a cold shower", "What time will you be free tonight", "I can do massage", "You will have the experience of a lifetime. Gee I didn't even have to do anything and I had the best orgasm of my life". Dr Narayan asked whether she was up to date with her pap smears, made jokes about probing her while holding a long swab, dimmed the lights, pointed to the examination bed and said "Get ready for me", and, after the patient said to him "You've just had a baby, haven't you" answered "We can make new babies" and "Life's short". Dr Narayan tried to kiss the patient at the end of the consultation. Dr Narayan also admitted he contacted the patient twice by telephone without a genuine clinical basis.
4. In relation to the first colleague, Dr Narayan admitted that between around mid 2019 and August 2020 he told her that he liked her outfits, told her she was always on his mind, called her while she was at work and asked "What are you wearing", "What are you doing" and "When are we going on a date", called to tell her he was inside a cupboard masturbating, blocked her exit through a door and said a group of chairs was impractically arranged, especially if she wanted to sit on top of him and "fuck" him.
5. In relation to the second colleague Dr Narayan admitted that between 22 March and 10 July 2019 he asked her if she had received any sexual relief for her stress, offered to come to her house "For some midnight stress relief", entered the room in which she was working and said "You know if we just pull the curtains across no-one else will know we are even here", touched her on the shoulder and said "I can come over on Sunday and help you relieve the stress".
6. We accordingly bear in mind that Dr Narayan has been found to have acted in a similar way in relation to some of the complaints leading to the 2023 decision and some of the complaints in these proceedings, particularly in relation to the sexual nature of the language he used. Accordingly, at least some of our Stage 1 findings in relation to Patient A's complaint cannot be considered isolated incidents.

1. Professor Dianna Kenny, a psychologist, was retained by Dr Narayan's solicitor, to provide an opinion in relation to Dr Narayan's conduct. She had prepared earlier reports for the 2023 decision and the Stage 1 hearing. She gave evidence and was cross examined.
2. Professor Kenny diagnosed Dr Narayan as suffering from a post-traumatic stress disorder ("PTSD"), a major depressive disorder and a male hypoactive sexual desire disorder in 2020 arising from a history of severe childhood abuse and neglect, with scant opportunities for emotional development. Dr Narayan's unresolved childhood trauma had contributed to his maladaptive coping strategies, his difficulty with affect regulation, his low libido and his relational insecurity throughout adulthood so that he used patients to fill emotional voids, bolster self-esteem and regulate internal distress.
3. Professor Kenny was of the view that the conduct underlying the 2023 decision was a form of reaction formation, an unconscious psychological defence mechanism whereby a person expresses emotions, desires, or impulses opposite to their true, anxiety-provoking feelings, often to an exaggerated degree. In this case Dr Narayan engaged in the conduct to compensate for his true emotions, desires, or impulses - an attempt to demonstrate to himself and others that he is a normal, sexually functioning heterosexual adult male or at least to give that impression.
4. It was unclear to us what Professor Kenny's final position was in relation to Patient A's complaints. This is because she was very reluctant to accept that the more serious conduct (which was denied by Dr Narayan) occurred. She said that there were three types of truth - mine, yours and objective - and often the objective truth is not known. Professor Kenny found it very difficult to answer questions incorporating an assumption that the Stage 1 findings reflected what had happened. She said there had been conflicting evidence at the Stage 1 hearing in respect of which the Tribunal had privileged the statement from Patient A. Professor Kenny also accused counsel for the HCCC of being committed to making an assumption that the conduct did occur.
5. Professor Kenny said her opinion was valid whether or not the conduct had occurred because it was founded on Dr Narayan's childhood trauma and his depression, PTSD and his male hypoactive sexual desire disorder. Of course, if the conduct had not occurred, there would be no need for Professor Kenny to explain it.
6. We infer from the whole of her evidence that Professor Kenny would apply the reasoning she used in relation to the complaints considered in the 2023 decision to Patient A based on our Stage 1 findings.
7. The HCCC retained a psychiatrist, Dr Samuels. He agreed that Dr Narayan met the diagnostic criteria for complex trauma, there was evidence of a post-traumatic stress disorder stemming from an episode of sexual abuse as a child, and his recent heart attack and agreed with the diagnosis of a male hypoactive sexual desire disorder.
8. Dr Samuels described Dr Narayan as having personality vulnerabilities characterised by difficulty in interpersonal relationships (particularly with women), issues with his sexual identity and sense of self.
9. We accept these diagnoses and explanations for Dr Narayan's conduct.
10. However we do not consider this evidence to be of any great weight in our determination of the appropriate protective Orders.
11. We decline to accept the submission made by counsel for Dr Narayan that, if the expert evidence is accepted, there is a lack of moral turpitude on the part of Dr Narayan which means he bears a lower moral culpability. Our focus is on the safety of the public.
12. Dr Narayan's conduct was sexualised both in the language that he used and his touching of Patient A and it occurred, regardless of whether Dr Narayan did it because he gained some personal sexual gratification or whether he was reassuring himself and others about his sexual identity.

1. Since 2020 Dr Narayan has been attending for counselling and guidance through various health professionals, which we will explain in more detail later.
2. In October 2025 Professor Kenny assessed Dr Narayan as fit to practice safely subject to conditions on his registration. She noted he had maintained active engagement in psychotherapeutic sessions, with attendances on mentors, supervisors and at tailored education programs. His emotional stability appeared to have improved, with increased self-regulation, reduced intrusive symptoms, and clinical recovery from acute depressive episodes and PTSD symptoms. She concluded Dr Narayan demonstrated insight into past errors, emotional vulnerabilities, and areas for personal improvement, expressing strong motivation to adhere to professional standards and recognizing the gravity of boundary violations.
3. Her concerns were that the depth and complexity of his past trauma may have enduring effects on interpersonal boundaries under severe stress or emotional destabilization, his heart attack and these proceedings were causing severe psychological strain and distress and there was some risk of self harm.
4. Similarly Dr Samuels considered that Dr Narayan had taken significant steps in terms of professional development to better understand professional responsibilities, boundaries and ethics, and in dealing with his childhood traumas. He felt that with the imposition of conditions, continuation in therapy, close monitoring and oversight, Dr Narayan would not pose a health and safety risk to the public.
5. However, we have serious concerns about Dr Narayan's level of insight, particularly in relation to the connection between stress and its effect on his performance at work.
6. In 2025 Dr Narayan was practising under the conditions which had been placed on his registration after the 2023 decision. The conditions were designed to protect Dr Narayan from repeating his conduct when stressed. The Tribunal held:

217 In this case, the Respondent whilst carrying a huge load of shame and confusion arising from his traumatic history, found himself in a situation where he was working far too many hours each week and being subjected to the events of natural disasters impacting upon the people living in the geographic area in which he worked, flooded him with work which could not be put aside. Those circumstances, coupled with his personal relationship dynamics, apparently exposed him to stresses he had never faced before and eroded the ability he had demonstrated until that time, to not let his (now diagnosed) PTSD and other mental health issues cause him to conduct himself in a manner towards the three complainants, which we have set out above... (Health Care Complaints Commission v Narayan [2023] NSWCATOD 90)

To practise under category B supervision in accordance with the Medical Council of NSW's Compliance Policy- Supervision (as varied from time to time) and as subsequently determined by the appropriate review body.

a. At each supervisor meeting, which is to be weekly for the first month of the Respondent's return to practice, then fortnightly for the next two months of his practice and thereafter monthly, the practitioner is to review and discuss his practice with his approved supervisor with particular focus on: ...

* The Respondent's wellbeing and compliance with these conditions.

1. Dr Narayan's evidence in his affidavit prepared on 27 October 2025 is that:

13 With the benefit of hindsight, I realise that in 2020 I was suffering from burnout and was not coping well with my extensive workload and study requirements...

27 Since starting work in broader multi-cultural locations in Sydney and Norfolk Island, my work environment has been very positive. I have had 6 supervisors, and all of them have been very polite, respectful, kind, accommodating and considerate. I have felt well supported and have not experienced any burn out since...

30 I also have regular debriefing sessions and reflections with my supervisors, mentors, therapists and employer. We review progress, challenges and any changes needed to ensure a supported and safe practice along with a good work/life balance...

46 Since September 2020, I have met with my Council approved supervisors in accordance with the conditions on my registration, initially on a weekly to fortnightly basis and now monthly. These sessions usually include discussion of the importance of maintaining boundaries in the doctor/patient relationship, the role of the doctor/patient relationship, workload management and wellbeing, and ethics and code of conduct.

47 My monthly supervision meetings with each of my supervisors have provided me with a valuable opportunity to improve on my overall practice and management of external stressors (our emphasis).

1. We are satisfied that the purpose of the condition on Dr Narayan's registration relating to supervision was that it was part of a strategy to proactively identify any unexpected stressors on Dr Narayan both in and out of the workplace and then assist Dr Narayan to manage those stressors. We are further satisfied that Dr Narayan understood this and purported to assert that he was fully complying with the condition and that he found the process to be supportive and successful.
2. The Stage 1 hearing took place on 10, 11, 14 and 15 April 2025 and we delivered our decision on 22 May 2025.
3. The supervision and mentor reports are in evidence.
4. In a report dated 28 June 2025 a supervisor noted:

We were made aware of a second HCCC Tribunal sitting in June via media outlets - this sitting was in April. Discussions with Dr Narayan about transparency around this situation and a non-conformance with our code of conduct were had. I am aware this is not relevant to his current conditions, but it did create concern for potentially new practice situation....

While patient feedback has generally been positive, there have been instances of dissatisfaction from certain individuals, particularly issues during a period of heightened stress for Dr Narayan. Unfortunately, he did not bring these concerns to the attention of Dr Hopcroft or myself, which might have provided an opportunity for us to support him more effectively during this challenging time...

Dr Narayan's contract will be completed on the 30th June without extension. Our organisational decision was unable to accommodate the new HCCC investigation and the waiting time to any new conditions. We also felt being on such a small island with the confronting media reports may not be the best environment for Dr Narayan.

Dr Narayan has provided exemplary care to the people of Norfolk Island and for him to be a permanent member of our team we have encouraged him to consider applying when his level B supervision is lifted.

Key Points

1 Breach of the Code of Conduct

2 Difficult political/community perception with media situation

3 Dr Narayan's lack of clarity and openness about the Tribunal in April

4 Challenge in making a decision that meets the needs of the community but offers Dr Narayan fair process

5 Collaboration with HR advice from Metro North, the Department of Infrastructure and legal balanced with concerns for Dr Narayan's wellbeing and future in such a small community

6 Impact of a doctor with strict conditions on the other health care providers and the balance of workload/on call

1. One of the supervisors gave evidence. She confirmed that she was told about the Stage 1 hearing by a staff member who had read a media report.
2. When asked about this issue Dr Narayan said it was a pity he had not confided in his supervisors, he had been waiting for the right time but had been beaten by the media.
3. We do not accept that explanation. The hearing was in April 2025. The media report was in June 2025. There was sufficient time for Dr Narayan to tell his supervisors.
4. The first document not only shows that Dr Narayan did not tell his supervisors, it also speaks of the link between patients being dissatisfied at the time when Dr Narayan was under heightened stress.
5. We are satisfied that either Dr Narayan does not genuinely appreciate the danger of his continuing to work while stressed because he has not actually gained meaningful insight into his psychological issues or else he deliberately, knowing he should have told his supervisors, decided not to do so possibly because he felt ashamed. We do not consider it necessary to determine which of these alternatives is the case - the result of both of them is that Dr Narayan has not, earlier this year, used readily available resources to reduce the risk of harm to patients.

1. In relation to specific deterrence, counsel for the HCCC agreed with the submission made by counsel for Dr Narayan that because the conduct underlying the Stage 1 decision was wholly concurrent chronologically with the conduct which was the subject of the 2023 decision, deterrence has been effected because Dr Narayan has not been the subject of any complaints relating to his behaviour since August 2020. Accordingly less weight is to be placed on further deterrence in these proceedings. We accept this submission, although we bear in mind that, for three of the years between August 2020 to December 2025 Dr Narayan's registration to practise was suspended.
2. In relation to general deterrence, we find that our decision must send a very clear and firm message to the profession that conduct of the kind engaged in is regarded as very serious.
3. We also take into account that other practitioners are entitled to see the standards of their profession upheld.
4. There is also the issue of public confidence in the medical profession.
5. Counsel for Dr Narayan relied on the decision of the Victorian Court of Appeal in Medical Practitioners Board of Victoria v Lal [2009] VSCA 109 to submit that public confidence is unlikely to be affected by the decision in a single case so that the question of public confidence may not arise in every case. It held:

59 Like the goodwill which attaches to a business, however, public confidence in the medical profession is not turned on and off like a switch. Public confidence is won - or lost - gradually, as the cumulative effect of the experiences of thousands of individuals in their dealings with medical practitioners over many years. The decision to register a particular person to practise medicine is unlikely, in our view, to have any material or lasting effect on the established reputation of the medical profession as a whole. It is not irrelevant that the standing of the medical profession in this community is very high....

63 The maintenance of public confidence in the medical profession is a proper concern of the Board. But, for the reasons we have given, we reject the argument that the Board must, in every case, consider the likely effect on public confidence of the particular registration decision at hand. There is nothing in s 6(2), or in the Act as a whole, which suggests that the possible impact on public confidence was a matter which the decision-maker was bound to take into account in assessing the public interest under s 6(2)(d).[39]

1. We do not accept that this principle applies in these proceedings. The widely accepted authorities in NSW, to which we have already referred, clearly state it is a relevant matter. Our Stage 1 decision is an example of the effect of a single decision made by a Tribunal can have on the public - the supervisor's note refers to "Difficult political/community perception with media situation". There was no suggestion that there were errors or exaggeration in the media reports.
2. Given our findings as to the seriousness of Dr Narayan's conduct, we are satisfied that in making our decision, we must take into account that public confidence in the medical profession is maintained by signalling that those whose conduct does not meet the required standards will not be permitted to practise.

1. Dr Narayan also says that since 2023 he has made considerable changes to his working arrangements to enhance his work-life balance and minimise fatigue. He is now working a maximum of 37.5 to 40 hours per week, seeing a maximum of four patients an hour, with no more than 25 patients a day. This is consistent with the conditions on his registration.
2. He has also taken other steps including avoiding personal interaction with patients, ensures chaperones and support persons are available, ensures he obtains informed consent, he has adopted a patient centred approach to all communication with patients, obtains input from colleagues and peers and has implemented steps to achieve a work-life balance.
3. Dr Narayan has regularly consulted Dr Gemayel, a psychologist over the past three years and two other psychologists on a few occasions. Dr Narayan said this has assisted him to identify the factors leading to that conduct and provided him with the tools and adaptive measures for coping with stress and anxiety.
4. We accept that Dr Narayan has undertaken extensive study and training to address the issues identified in the 2023 decision. These include:

(1) Group therapy and courses entitled "Respectful Me" and 'Men and Relationship" with Relationships Australia.

(2) Reviewed the Medical Board of Australia's "Good Medical Practice: a Code of Conduct for Doctors in Australia'" and the RACS Code of Conduct.

(3) NSW Health courses entitled "Code of Conduct", "Professional Ethics", "Privacy Module 1 - Know Your Boundaries" and "Health Professional Councils Authority Orientation".

(4) A 13 week Sydney University "Clinical Ethics" course.

(5) A "Building Connections" program focused on respectful communication.

(6) Online learning courses being "Approach to Care - Professional Issues", "Effective Communication Skills", "Youth Friendly Consultation Skills", and "Approach to Care - Difficult Conversations".

(7) Courses on "Dealing with Difficult People in Life and Work", "Develop Your Emotional Intelligence", "Professional Boundaries", "Professional Boundaries in Therapeutic and Care Work" and "Professional Boundaries A Health Professional's Guide".

(8) Dr Narayan attended a tailored program between 2 October 2025 and 11 November 2025 which focused on professional practice, ethics, ethical decision making and professional boundaries (including sexual boundaries). Unfortunately it is unclear whether they had any information about or discussed these proceedings.

1. Dr Narayan says he now understands that as a doctor he is in a position of authority, the community trusts he will act in their best interest and not abuse that power imbalance and he has learnt that a lack of awareness and absence of professional boundaries puts patients and doctors at risk of transgression, boundary crossing and boundary violation.

1. In addition, Dr Narayan has provided reports or letters from:

(1) Dr Daisy Gemayel, his treating psychologist. She says Dr Narayan has shown meaningful improvement and with ongoing engagement and adherence to relapse-prevention strategies, Dr Narayan has a favourable outlook for maintaining functional stability and preventing symptomatic relapse.

(2) Dr Aung Khin, who has supervised Dr Narayan and Mr Uday Gore, who has mentored Dr Narayan pursuant to his conditions of practice. Their reports are very positive, but neither of them mention being aware of these proceedings.

(3) Mr Denis Christian, a member of the Norfolk Island community. He has experienced Dr Narayan to be a caring and committed doctor.

1. Professor Kenny and Dr Samuels considered that Dr Narayan is likely safe to continue to engage in medical practice with conditions on his registration.
2. We have been provided with a set of proposed conditions by counsel for Dr Narayan. They are essentially the same as his current conditions except:

(1) the requirement to discuss his "wellbeing" with his supervisor and mentor has been amended to "wellbeing personally and professionally".

(2) a requirement to attend for psychodynamic/interpersonal/emotionally focused psychotherapy as recommended by Dr Kenny;

(3) a requirement to attend for review by a psychiatrist.

1. We have decided that the only protective Order which would protect the health and safety of the public is cancellation of Dr Narayan's registration bearing in mind the seriousness of the conduct, the need for general deterrence and the maintenance of confidence in the medical profession.
2. We do not accept that the imposition of the proposed conditions on Dr Narayan's registration would be sufficient to protect the public from an unacceptable risk of harm as evidenced by Dr Narayan's failure to tell his supervisor about these proceedings.
3. In addition, in view of our findings as to the reliability of the evidence of Dr Narayan, we also place little weight on his assurances as to compliance with any conditions on his registration in the future.

1. Cancellation of Dr Narayan's registration means that, at the expiration of the period of cancellation, he must re-apply for registration and, inter alia, show that he has addressed the issues giving rise to the cancellation and should be permitted to resume practice. The period of cancellation also must be an appropriate consequence for his behaviour.
2. When giving evidence before us Professor Kenny said she believes he has come a long way and still has a long way to go. Two years of psychotherapy has not been enough. Professor Kenny said Dr Narayan is going to need considerable time to deal with his intense emotions as it is a work in progress.
3. Basten JA in Chen v Health Care Complaints Commission [2017] NSWCA 186 held at [22]:

The fixing of a period within which re-registration may not be sought may be seen to have a twofold operation. On the one hand, it indicates the minimum period within which the Tribunal considers the person should not be able to practise his or her profession; on the other hand, it holds open the possibility that an application for re-registration thereafter will at least be considered. It is entirely proper for the Tribunal to consider all aspects of the possible orders available to it in determining what order to make.

The Tribunal was permitted by s 149C(7) to identify a period of a time during which a re-registration application could not be made. Doing so indicated the seriousness, from the Tribunal's perspective, of the conduct. A practitioner wishing to challenge that period may do so by way of appeal. Contrary to the appellant's submission, a time fixed under s 149C(7) does not necessarily mean that the Tribunal has formed a view that things will have changed by the end of the period which has been fixed. The Tribunal is permitted by s 149C(7) to make clear in its orders the seriousness with which it views the conduct of the practitioner reflected in the complaints which have been proven. Such an order plays a part in the general deterrence reflected by the order.

1. Taking this evidence into account and the need for the period of cancellation to be an appropriate consequence for his behaviour, we will impose a one year period during which Dr Narayan cannot apply to be re-registered.

1. Counsel for the HCCC submitted that the appropriate costs order was for Dr Narayan to pay 90% of the HCCC's costs of the proceedings, as agreed or assessed, as the HCCC had not been successful in respect of all of the particulars of the Complaints.
2. This was not opposed by counsel for Dr Narayan.
3. An award of costs normally follows the event. Qasim (supra) at [85].
4. We will make the Order sought.

(1) Pursuant to s 149C(1)(b) of the Health Practitioner Regulation National Law (NSW) the registration of Dr Sharwan Narayan as a medical practitioner is cancelled.

(2) Pursuant to s 149C(7) of the Health Practitioner Regulation National Law (NSW) Dr Sharwan Narayan may not apply for a review of Order 1 for a period of one year from the date of this decision.

(3) Dr Narayan to pay 90% of the Health Care Complaints Commission's costs of the proceedings, as agreed or assessed.

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.