Health Care Complaints Commission v Rayamajhi

Health Care Complaints Commission v Karalasingham [2007] NSWCA 267

Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630

Health Care Complaints Commission v Philipiah [2013] NSWCA 342

Health Care Complaints Commission v Robinson [2022] NSWCA 164

Jung v R [2017] NSWCCA 24

Kavieris v Health Care Complaints Commission [2025] NSWSC 20

Prakash v Health Care Complaints Commission [2006] NSWCA 153

Windsor v Health Care Complaints Commission [2020] NSWCA 110

Nursing and Midwifery Board of Australia, Code of Conduct for Nurses, March 2018

Lyndal Ann Rayamajhi (also known as Lyndal Ann Cooper) (Respondent)

Pursuant to s 64(1)(c) of the Civil and Administrative Tribunal Act 2013 (NSW), publication of the residential address and email address of the Respondent is prohibited.

1. The Health Care Complaints Commission, (the Commission), brings proceedings for disciplinary findings and orders against Lyndal Ann Rayamajhi, (also known as Lyndal Ann Cooper), under the Health Practitioner Regulation National Law (NSW) (the National Law).
2. Ms Rayamajhi was first registered as a nurse in 2013. Ms Rayamajhi's registration lapsed in July 2024 after it was not renewed. She is currently unregistered. We note that in material before us, which we will detail later in this decision, Ms Rayamajhi has used the family name "Cooper" in her employment as a nurse.
3. The Commission filed an Amended Application on 27 September 2024 along with an Amended Complaint which sets out six separate complaints against Ms Rayamajhi together with particulars in support of those complaints.
4. The essence of the case which the Commission brings against Ms Rayamajhi is that she has a history of convictions for driving offences, has been disqualified from driving for those offences and has repeatedly failed to comply with driving disqualifications. Further and more significantly to these disciplinary proceedings, she has failed to notify the National Board of her criminal charges and convictions, has not complied with conditions placed on her registration by the Nursing and Midwifery Council (the Council) and has not complied with a notice issued by the Commission under the Health Care Complaints Act 1993 (the HCC Act) which required her to produce documents.

1. In its Amended Application the Commission seeks the following orders:

(1) An order under s 149C(4)(a) of the National Law that if Ms Rayamajhi were still registered the Tribunal would have cancelled her registration. There are three alternate grounds for seeking this order. Firstly, because Ms Rayamajhi is guilty of professional misconduct (s 149C(1)(b)); second, the circumstances of the offences render her unfit in the public interest to practise nursing (s 149C(1)(c)); and third, she is not a suitable person for registration in the profession (s 149C(1)(d)).

(2) An order under s 149C(4)(b) of the National Law that Ms Rayamajhi is disqualified from being registered for a period of 2 years.

(3) An order under s 149C(4)(c) of the National Law that the National Board is required to record the fact that if Ms Rayamajhi were still registered, the Tribunal would have cancelled her registration in the National Register kept by the Board.

(4) An order under ss 149C(5) and 149C(5A) of the National Law that Ms Rayamajhi is prohibited from providing a health service, as defined in s 4 of the HCC Act, permanently unless and until the Tribunal makes a reinstatement or other order under s 163B of the National Law.

(5) An order under s 149C(7) of the National Law that an application for review of the orders made about Ms Rayamajhi may not be made until 2 years from the date of the Tribunal's orders.

(6) An order under clause 13 of Schedule 5D of the National Law that Ms Rayamajhi pay the Commission's costs, as agreed or assessed.

1. At the hearing the Commission clarified that in seeking an order from the Tribunal under s 149C(4)(a) of the National Law, its primary focus was that Ms Rayamajhi is not a suitable person for registration in the profession: s 149C(1)(d) of the National Law. The Commission indicated that the orders it sought under s 149C(4)(a) of the National Law on the basis of professional misconduct and unfit in the public interest (s 149C(1)(b) and (c)) were alternate positions.

1. On 11 July 2024 substituted service orders were made by the Tribunal permitting the Commission to serve Ms Rayamajhi by providing documents to her residential and email address: Health Care Complaints Commission v Rayamajhi [2024] NSWCATOD 107. Orders were also made on the same date pursuant to s 64(1)(c) of the Civil and Administrative Tribunal Act 2013 (NSW), prohibiting the publication of Ms Rayamajhi's residential address and email address.
2. Material before us indicates that the Commission has complied with the Tribunal's orders for substituted service. The Commission's Application and Complaint were provided to Ms Rayamajhi by email on 16 July 2024 and sent to her residential address via pre-paid post on the same day. On 19 July 2024 the Tribunal made directions, including for Ms Rayamajhi to serve her Reply and material by 13 September 2024, and listed the matter for hearing. The Commission's documents in support of its case (including the Application and Complaint) were provided to Ms Rayamajhi by email on 16 August 2024 and sent on 16 August 2024 by overnight courier to her residential address.
3. Under cover of letter dated 1 October 2024 the Commission sent the Amended Application and Amended Complaint to Ms Rayamajhi by email on 1 October 2024 and to her residential address via pre-paid post on the same day. In addition the Commission also provided Ms Rayamajhi with the notice of listing for the hearing, the Tribunal's decision made on 11 July 2024, and Procedural Orders made by the Tribunal on 19 July 2024 and 27 September 2024. The Commission subsequently provided supplementary documents in support of its case to Ms Rayamajhi by email on 8 October 2024 and sent these to her residential address via pre-paid post on the same day.
4. Ms Rayamajhi has not attended any directions hearings or served any Reply or material in response to the Commission's case. In the Commission's letter dated 1 October 2024, provided to Ms Rayamajhi by email and sent to her residential address via pre-paid post on the same day, the Commission put Ms Rayamajhi on notice that the hearing could take place in her absence as a combined hearing comprising both Stages One and Two, being a consideration of whether the conduct alleged against her was proved (Stage One) and the protective orders the Commission would ask the Tribunal to make as set out in the Amended Application (Stage Two).

1. Ms Rayamajhi did not attend the hearing. The Tribunal has not received any contact from Ms Rayamajhi nor any material in reply to the Commission's case.
2. Section 165J(3) of the National Law allows the Tribunal to proceed with the hearing in the absence of a practitioner provided that notice of the hearing has been given. We were satisfied that Ms Rayamajhi had been given notice of the hearing.
3. The hearing proceeded to finality as a combined Stage One, that is; consideration of the evidence relevant to the Complaint, and; in the event of the Complaint being substantiated, Stage Two, being what disciplinary orders should be made.

1. Ms Rayamajhi graduated with a Bachelor of Nursing from Charles Sturt University in 2013 and was first registered as a nurse in Australia on 26 September 2013.
2. Evidence before us indicates that in seeking nursing positions Ms Rayamajhi has used the family name "Cooper." Other material before us indicates that Police checks conducted in January 2017 via the Records Management System (RMS) in relation to driving offences show that on the Police system Lyndal Rayamajhi is also known as Lyndal Cooper. Finally, and in the context of seeking registration as a Registered Nurse in 2013, Ms Rayamajhi wrote a letter dated 8 August 2013 to the Nurses and Midwifery Board Registration Team in which she informed them of her past criminal history. She signed this letter as "Lyndal Cooper - Rayamajhi."
3. On 12 September 2021, under the family name "Cooper", Ms Rayamajhi commenced employment as a triage nurse (telehealth) with Medibank. Ms Rayamajhi's last shift as a triage nurse at Medibank was on 17 July 2022; her employment with Medibank was terminated on 3 March 2023.
4. In 2022 Ms Rayamajhi, under the family name Cooper, was employed by the Tasmanian Health Service (THS) as a Registered Nurse on the Medical Ward at the Mersey Community Hospital in Tasmania.
5. On 10 October 2022 Ms Rayamajhi, under the family name Cooper, commenced employment as a registered nurse with United Protestant Association (UPA). Her employment with UPA was terminated on 9 December 2022.
6. On 11 November 2022, the Council made an order pursuant to s 150(1)(b) of the National Law, that Ms Rayamajhi's registration as a nurse be subject to conditions with effect from 11 November 2022. These conditions are outlined later in this decision when we deal with this aspect of the Complaint.
7. On 19 December 2022, the Council varied the conditions on Ms Rayamajhi's registration by imposing a condition that she does not work as a registered nurse until reviewed by the Council.

1. There are six grounds for Complaint against Ms Rayamajhi. They are that Ms Rayamajhi:

(1) has been convicted of a criminal offence: s 144(a) of the National Law.

(2) is guilty of unsatisfactory professional conduct under s 139B(1)(b) of the National Law by contravening a provision of the National Law.

(3) is guilty of unsatisfactory professional conduct under s 139B(1)(c) of the National Law by contravening conditions of registration.

(4) is guilty of unsatisfactory professional conduct under s 139B(1)(e) of the National Law by contravening a provision of the HCC Act.

(5) is guilty of professional misconduct under s 139E of the National Law.

(6) is otherwise not a suitable person to hold registration in the nursing profession under s 144(e) of the National Law.

1. In the next section we will deal with the particulars which the Commission relies upon to support the individual complaints. However, we note that the particulars for Complaint Two erroneously refer to the Crimes Act 1900 (NSW) instead of the Road Transport Act 2013 (NSW). In context this is clearly a typographical error which was most likely not picked up when the Complaint was amended. We have not repeated the error.

Complaint One: Convicted of a criminal offence in NSW

1. The particulars for Complaint One are that Ms Rayamajhi has been convicted of the following offences:

(1) On 7 April 2017, in the Local Court of New South Wales at Dunedoo of Drive of motor vehicle during disqualification period, contrary to s 54(1)(a) of the Road Transport Act 2013 (NSW) (Road Transport Act);

(2) On 6 August 2018, in the Local Court of New South Wales at Dubbo of Drive motor vehicle during disqualification period (2nd+ offence), contrary to s 54(1)(a) of the Road Transport Act;

(3) On 9 June 2021, in the Local Court of New South Wales at Dubbo of Drive motor vehicle during disqualification period (2nd+ offence), contrary to s 54(1)(a) of the Road Transport Act.

Complaint Two: Contravention of a Provision of the National Law - Unsatisfactory Professional Conduct under s 139B(1)(b)

1. Complaint Two is that Ms Rayamajhi contravened s 130(1) of the National Law, by failing to notify the National Board of the following relevant events within 7 days of the event:

(1) When she was charged on 1 June 2018 with one count of drive motor vehicle during disqualification period (2nd+ offence), contrary to s 54(1)(a) of the Road Transport Act;

(2) When she was charged on 9 February 2021, with one count of drive motor vehicle during disqualification period (2nd+ offence), contrary to s 54(1)(a) of the Road Transport Act;

(3) The criminal convictions detailed in Complaint One particulars 1 - 3.

1. Further, Ms Rayamajhi contravened s 109(1)(b) of the National Law by failing to include in her application for renewal of registration a statement including details of any change in her criminal history that occurred in the preceding period of registration, in the renewal applications for the years 2017, 2018 and 2019.

Complaint Three: Contravene conditions on registration - Unsatisfactory Professional Conduct under s 139B(1)(c)

1. On 11 November 2022, and with effect from that date, the Council made an order under s 150(1)(b) of the National Law, that Ms Rayamajhi's registration as a nurse be subject to the following conditions (the conditions):

"1. To practice under direct supervision in accordance with the Nursing and Midwifery Council of New South Wales regulatory supervision policy (as varied from time to time) and as subsequently determined by the appropriate review body.

(a) to nominate a supervisor for approval by the Council, within 14 days of commencing work or as specified by the Council.

(b) to authorise the approved supervisor to provide written reports to the Council at monthly intervals, or as specified by the Council.

2. Not to practise until a supervisor has been approved by the Nursing and Midwifery Council of NSW.

3. To forward evidence to the Nursing and Midwifery Council of NSW within seven (7) days of 14 November 2022, that the practitioner has provided a copy of full conditions to her nursing employer/s.

4. Not to work night duty (between 10.00 pm and 6.00 am).

5. Within seven (7) days of a change in the nature or place of practice, the practitioner is to forward evidence to the Nursing and Midwifery Council of NSW that she has provided a copy of full conditions to the nursing employer/s.

6. To authorise the Nursing and Midwifery Council of NSW to exchange information with current and future persons or organisations at places where the practitioner works as a nurse in Australia, regarding any issues arising in relation to compliance with these conditions. She must only be employed as a nurse in circumstances where the employer has agreed to notify the Council of any breach of the conditions or unsafe practice; and exchange information with the Council related to compliance with the conditions.

7. To complete a performance assessment by performance assessor/s approved by the Nursing and Midwifery Council of New South Wales and:

(a) comply with any instructions provided by the Council in relation to performance assessment.

(b) the costs of this assessment will be met by the Council.

8. The practitioner is responsible for the costs associated with complying with the conditions unless otherwise specified."

1. The particulars of Complaint Three set out how the Council-imposed conditions were contravened by Ms Rayamajhi. They are as follows:

(1) Condition 1 and 2: From 14 November 2022 until termination on 9 December 2022, Ms Rayamajhi worked as a nurse at UPA without an approved supervisor.

(2) Condition 3: Ms Rayamajhi failed to provide the Nursing and Midwifery Council within 7 days of 14 November 2022 with evidence that she provided a copy of the full conditions to her employer, UPA.

(3) Condition 3: Ms Rayamajhi failed to provide the Nursing and Midwifery Council within 7 days of 14 November 2022 with evidence that she provided a copy of the full conditions to her nursing employer, Medibank.

(4) Condition 6: Ms Rayamajhi failed to authorise the Nursing and Midwifery Council to exchange information with her employer UPA and Medibank regarding issues arising in relation to compliance with the conditions and engaged in employment as a nurse in circumstances where her employers were not aware of the conditions on her registration.

Complaint Four: Contravention of a provision of HCC Act - Unsatisfactory Professional Conduct under s 139B(1)(e)

1. Complaint Four comprises a singular particular. It is that Ms Rayamajhi contravened s 34A(4) of the HCC Act by failing, without reasonable excuse, to comply with a notice to give evidence/produce documents under s 34A of the HCC Act, issued by the Commission on 20 February 2023.

Complaint Five: Professional Misconduct under 139E

1. Complaint Five is that Ms Rayamajhi is guilty of professional misconduct under section 139E of the National Law in that she has:

(1) engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of Ms Rayamajhi's registration, and/or

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

1. For this Complaint, the particulars of Complaints Two, Three and Four are repeated and relied upon individually and cumulatively.

Complaint Six: Not a suitable person to hold registration under s 144(e)

1. Complaint Six is that under s 144(e) of the National Law, Ms Rayamajhi is otherwise not a suitable person to hold registration in her profession. The particulars are:

(1) Ms Rayamajhi's lengthy criminal history involving repeated instances of driving during a disqualification period.

(2) The conduct underlying the particulars in Complaints One, Two, Three and Four is a pattern of conduct exhibiting a disregard by Ms Rayamajhi's for her duty as a nurse to comply with all applicable legal and professional obligations.

1. To establish the convictions which form the particulars of Complaint One, the Commission relies on the following evidence:

(1) Certificate of Conviction dated 13 March 2023 showing that on 7 April 2017, Ms Rayamajhi was convicted in the Local Court of New South Wales at Dunedoo of Drive motor vehicle during disqualification period [on 15 January 2017 at Dunedoo], contrary to s 54(1)(a) of the Road Transport Act.

(2) Certificate of Conviction dated 10 March 2023 showing that on 6 August 2018, Ms Rayamajhi under the name "Cooper" was convicted in the Local Court of New South Wales at Dubbo of Drive motor vehicle during disqualification period (2nd+ offence) [at Dubbo on 1 June 2018], contrary to s 54(1)(a) of the Road Transport Act.

(3) Certificate of Conviction dated 10 March 2023 showing that on 9 June 2021, Ms Rayamajhi under the name "Cooper" was convicted in the Local Court of New South Wales at Dubbo of Drive motor vehicle during disqualification period (2nd+ offence) [at Dubbo on 9 February 2021], contrary to s 54(1)(a) of the Road Transport Act.

(4) New South Wales Police Facts Sheet in respect of each charge. These documents showed that charges were laid on 1 June 2018 and 9 February 2021. These documents also showed that checks conducted via the RMS and Police system revealed that Lyndal Rayamajhi was also known as Lyndal Cooper.

1. We are satisfied from the evidence that the convictions as particularised in Complaint One are established.

Complaint Two: Failure to notify National Board of a "relevant event"

1. Complaint Two is that Ms Rayamajhi is guilty of unsatisfactory professional conduct in that she failed to notify the National Board within 7 days of her charges and convictions (as required by s 130 of the National Law) and failed to disclose any change in her criminal history (as required by s 109 of the National Law).
2. Section 139B(1)(b) of the National Law relevantly provides that unsatisfactory professional conduct of a registered health practitioner includes a contravention by the practitioner (whether by act or omission) of a provision of the National Law.
3. All registered nurses are required to notify the National Board of certain charges and notify the National Board of all convictions within a tight timeframe. Section 130 of the National Law relevantly provides that registered health practitioners must give the National Board written notice within 7 days of being aware of being charged with an offence punishable by 12 months imprisonment or more. Section 130 of the National Law also relevantly provides that registered health practitioners must give the National Board written notice within 7 days of being aware of being convicted of any offence punishable by imprisonment.
4. All registered nurses are required to apply to renew their registration every year. Section 109(1) of the National Law relevantly provides that an application for renewal of registration must include or be accompanied by a statement that includes details of any change in the applicant's criminal history that occurred during the applicant's preceding period of registration. Criminal history is defined to include every charge for an offence and every conviction: s 5 of the National Law.
5. To establish the particulars of Complaint Two the Commission relies on the following evidence:

(1) New South Wales Police Facts Sheet in respect of the charges and Certificates of Conviction.

(2) An email from a senior regulatory officer at AHPRA dated 9 August 2023 indicating that AHPRA held no records that Ms Rayamajhi had ever lodged any "notice of event" under s 130 of the National Law.

(3) Renewal of registration lodged by Ms Rayamajhi in the form of screenshots for the years 2017, 2018 and 2019 indicating that in response to a question on each of her renewal forms, "Since your last declaration to AHPRA has there been a change to your criminal history that you have not declared to AHPRA", Ms Rayamajhi answered; "No."

(4) Renewal of registration lodged by Ms Rayamajhi in the form of screenshots for the year 2021 in which Ms Rayamajhi disclosed for the first time a change in criminal history being a charge of Drive whilst disqualified. This related to the charge of Drive motor vehicle during disqualification period (2nd+ offence) [at Dubbo on 9 February 2021].

1. We are not satisfied that the Commission has proved that in the renewal applications for the year 2018 Ms Rayamajhi contravened s 109(1)(b) of the National Law by failing to include in her application for renewal of registration a statement including details of any change in her criminal history that occurred in the preceding period of registration. We note that the declaration period for disclosures in the 2018 renewal of registration covers the period 1/6/2017 - 31/5/18. No charges or convictions were recorded against Ms Rayamajhi during this period. Accordingly, she had no change in criminal history to disclose.
2. However we find that the balance of the particulars in Complaint Two are proved in that Ms Rayamajhi failed to disclose a relevant event within 7 days, being the charges of 1 June 2018 and 9 February 2021 and the convictions of 7 April 2017, 6 August 2018 and 9 June 2021. We also find that Ms Rayamajhi failed to include in her application for renewal of registration a statement including details of any change in her criminal history that occurred in the preceding period of registration, in the renewal applications for the years 2017 and 2019.
3. In view of these findings we are satisfied that Complaint Two of unsatisfactory professional conduct against Ms Rayamajhi is established.

Complaint Three: Breach of Council-imposed Conditions

1. On 11 November 2022, the Council made an order under s 150(1)(b) of the National Law that Ms Rayamajhi's registration as a nurse be subject to conditions. Complaint Three is that Ms Rayamajhi is guilty of unsatisfactory professional conduct because she contravened these conditions.
2. Section 139B(1)(c) of the National Law provides that unsatisfactory professional conduct of a registered health practitioner includes a contravention by the practitioner, whether by act or omission, of a condition to which the practitioner's registration is subject.
3. The conditions which are relevant are that Ms Rayamajhi worked as a nurse at UPA without an approved supervisor (conditions 1 and 2), failed to provide evidence to the Council within 7 days, that she had provided a copy of the full conditions to her employers UPA and Medibank (condition 3); and failed to authorise the Council to exchange information with her employer UPA and Medibank regarding issues arising in relation to compliance with the conditions and engaged in employment as a nurse in circumstances where her employers were not aware of the conditions on her registration (condition 6).
4. We note that under the Code of Conduct for Nurses, Nursing and Midwifery Board of Australia, March 2018 Ms Rayamajhi was obliged to inform her employer of any restrictions imposed on her practice, including conditions: 1.1(b).
5. The evidence to support these particulars is contained in documentation and records provided by Medibank and UPA about Ms Rayamajhi's employment with them. It is also contained in communication Ms Rayamajhi had with the Council, about a complaint that they had received from Ms Rayamajhi's previous employer, the Tasmanian Health Service (THS).
6. Sometime before 12 September 2021 Ms Rayamajhi received an offer (addressed to Lyndal Rayamajhi) offering her paid employment as a triage nurse (telehealth) with Medibank. The offer letter does not have a date written on it. The offer letter indicated that the fixed term offer and continued employment during the fixed term period was subject to Ms Rayamajhi holding a relevant registration enrolment or authority to practice in order to fulfill the requirements of the role. The letter continued that " ... If at any time, as a result of any failure by you, your registration... to practice lapses, or conditions ... are placed upon it**,** ...you agree that is reasonable for Medibank to preclude you from performing some or all of your duties, and/or for you to cease being engaged by Medibank".
7. On 12 September 2021, Ms Rayamajhi commenced employment as a triage nurse with Medibank. This was before the Council imposed conditions on her registration. The Position Requirements included "Registered Nurse with current registration in good standing without sanctions or restrictions with AHPRA": Offer letter and Medibank Health Solutions letter to the Commission dated 16 March 2023. It can be inferred that Ms Rayamajhi must have known since 12 September 2021 that the imposition of any conditions on her registration in future would jeopardise her employment at Medibank.
8. In 2022, Ms Rayamajhi (using the name Lyndal Cooper) was also employed as a Registered Nurse on the Medical Ward at Mersey Community Hospital employed by THS. On 24 August 2022, THS wrote to Ms Rayamajhi by email (in the name of Cooper) regarding concerns about her performance and clinical safety while performing the duties of a Registered Nurse. This included failing to administer medication to patients including elderly patients, failing to look after patients and sleeping whilst on duty on the dates of 8-9 August, 17 August and 22-24 August 2022. Ms Rayamajhi's night shifts were cancelled and she was required to present for duty on 29 August 2022. Ms Rayamajhi failed to present for duty and vacated her accommodation: Letters by email to Ms Rayamajhi (Cooper) from Nursing and Operations Director, Department of Health Tasmania dated 24 August 2022 and 2 September 2022. We infer that Ms Rayamajhi knew from 24 August 2022 that THS had concerns about her clinical practice.
9. The letter dated 2 September 2022 from THS detailing the concerns about Ms Rayamajhi's conduct also requested her written response. Ms Rayamajhi did not respond: THS Complaint to AHPRA dated 20 October 2022.
10. By letter dated 27 September 2022, and in the name of Lyndal Cooper, Ms Rayamajhi received an offer of paid employment as a registered nurse on a permanent part-time basis (76 hours per fortnight) at United Protestant Association, Prunus Lodge, an aged care facility in Molong, NSW (UPA). The offer letter included these terms: "You acknowledge and agree that... there are no limitations on your ability to fully perform all your duties and responsibilities for UPA...You have an obligation to disclose certain matters during the course of your employment, including... any changed conditions to AHPRA registration."
11. Ms Rayamajhi signed the offer letter (in the family name Cooper) below the acknowledgement of these terms on 27 September 2022. We infer from this that Ms Rayamajhi knew that the imposition of any conditions on her registration would jeopardise her employment at UPA.
12. On 10 October 2022, Ms Rayamajhi started working as a registered nurse at UPA. Ms Rayamajhi practised at UPA under the name of Lyndal Cooper. Ms Rayamajhi worked day shifts and started working at UPA before the Council imposed conditions on her registration: UPA offer letter dated 27 September 2022, UPA file note 18 October 2022, UPA Complaint to the Commission received 7 December 2022, Statement to the Commission from the Regional Manager of UPA with annexed roster spreadsheet, dated 15 January 2024.
13. On 3 November 2022, an officer of the Council spoke to Ms Rayamajhi by telephone. A file note dated 3 November 2022 was made by the Council officer which set out a record of this conversation.
14. The file note records that Ms Rayamajhi confirmed she also went by the name "Cooper." Ms Rayamajhi was advised that the Council had received a notification from THS reporting concerns about her clinical performance and conduct. Ms Rayamajhi stated that she was employed as a full-time registered nurse in the aged care context in Molong and was not aware of any concerns about her practice in Tasmania. The Council officer outlined the s 150 processes including risk assessment and urgent interim action, and that Ms Rayamajhi would be requested in writing to provide information.
15. By letter dated 4 November 2022 (and sent by both email and to Ms Rayamajhi's residential address) the Council advised Ms Rayamajhi that the Council intended to hold s 150 proceedings on 11 November 2022. This letter also served as a notice to Ms Rayamajhi to provide information to the Council by 11 November 2022.
16. This letter also attached the notice about the s 150 hearing on 11 November 2022. It stated: "The Council will now consider whether it is appropriate to suspend or place conditions on your registration while this notification is assessed... If you do not attend, the meeting will go ahead in your absence." The letter requested confirmation of receipt of the notice. The letter also attached the material the Council would consider at the s 150 hearing and a Fact Sheet about s 150 proceedings. A fact sheet informed Ms Rayamajhi that the Council could suspend her registration, impose conditions on her registration, and that she must comply immediately with any suspension or conditions imposed.
17. A Council File Note and email dated 9 November 2022 indicates that on 9 November 2022 an officer of the Council left a voicemail and an SMS for Ms Rayamajhi requesting that she confirm receipt of the emails sent to her in relation to the s 150 hearing to be held on 11 November and to confirm her attendance. On 9 November 2022 Ms Rayamajhi sent an SMS reply to the Council stating, "Sorry can we please postpone this."
18. On 10 November 2022, an officer of the Council left a voice message and sent an email to Ms Rayamajhi. The Council also sent an SMS to Ms Rayamajhi stating "Please check your email for important correspondence from the Nursing and Midwifery Council": Council File Note dated 10 November 2022 and Delivery receipt of SMS 10 November 2022.
19. The Council's email dated 10 November 2022 acknowledged receipt of the SMS request from Ms Rayamajhi that the s 150 meeting be postponed. The email continued, "The Council is unable to reschedule the meeting," and that the s 150 meeting is "to consider if there is a risk to public health and safety and determine whether conditions or a suspension is required as an interim measure. The Council will proceed with the section 150 meeting tomorrow via video conference ... Should you choose to not attend, the Council will proceed in your absence and you will be provided with the outcome in writing."
20. We infer from the totality of the Council's communication with Ms Rayamajhi that from 3 November 2022 she knew that the Council intended to hold s 150 proceedings which may affect her registration, that the s 150 hearing would go ahead without her if she did not attend on 11 November 2022 and that the Council may impose conditions on her registration.
21. On 11 November 2022, the Council held s 150 proceedings and imposed conditions on Ms Rayamajhi's registration. In deciding to impose conditions, the Council considered the concerns raised by THS and restricted Ms Rayamajhi's practice to protect the public.
22. By letter dated 14 November 2022 and sent by email the Council informed Ms Rayamajhi of the outcome of the s 150 proceedings and conditions it had imposed on her registration. The email was sent to Ms Rayamajhi at the same email address she had used with THS, UPA, Medibank, AHPRA, and later the Commission.
23. We also note that at any time after 11 November 2022 it was open to Ms Rayamajhi to contact the Council or AHPRA to find out about the outcome of the s 150 proceedings against her and the conditions imposed on her registration. It was also open to her to seek a review of the conditions.
24. Evidence provided by the Commission indicates that Ms Rayamajhi worked day shifts as an RN at UPA on 14-17, 19-24, 26-30 November 2022, and 1-2 December 2022. Evidence also indicates that Ms Rayamajhi did not advise UPA of the conditions which the Council had placed on her registration on 11 November 2022, undertook shifts where she was not practicing under direct supervision and worked for UPA without a Council approved supervisor.
25. On 5 December 2022, and as part of an unrelated routine check, the Regional Manager of UPA conducted a review of the status of all RN registrations employed by UPA. As part of this process the conditions which had been imposed by the Council on Ms Rayamajhi's registration were detected. Up to this point in time UPA had been unaware of the Council-imposed conditions on Ms Rayamajhi's registration.
26. On the same date Ms Rayamajhi was stood down by UPA pending investigation. She was terminated from her employment with UPA on 9 December 2022: statement of P McKenna, Regional Manager UPA, dated 15 January 2024 and annexed work roster and spread sheet.
27. We find on the evidence before us that whilst working for UPA Ms Rayamajhi contravened conditions 1 and 2 imposed on her registration which related to her obligation to practice under direct supervision and not to practise until the Council had approved a supervisor.
28. The evidence before us does not indicate nor does it suggest that Ms Rayamajhi provided the Council with evidence that she had provided a copy of the conditions to her employers UPA and Medibank. Nor does the evidence suggest that Ms Rayamajhi authorised the Council to exchange information with her employer UPA and Medibank regarding issues arising in relation to compliance with the conditions.
29. On the material before us we find that Ms Rayamajhi contravened conditions attached to her registration and which are particularised in Complaint Three as follows:

(1) Conditions 1 and 2, until her termination on 9 December 2022 she worked as a nurse at UPA without an approved supervisor.

(2) Condition 3, she failed to provide the Council within 7 days of 14 November 2022, evidence that she had provided a copy of the full conditions to her employer, UPA.

(3) Condition 3, she failed to provide the Council within 7 days of 14 November 2022, evidence that she had provided a copy of the full conditions to her nursing employer, Medibank.

(4) Condition 6, she failed to authorise the Council to exchange information with her employers UPA and Medibank regarding issues arising in relation to compliance with the conditions and engaged in employment as a nurse in circumstances where her employers were not aware of the conditions on her registration.

1. In view of these findings we are satisfied that Complaint Three of unsatisfactory professional conduct against Ms Rayamajhi is established.

Complaint Four: Contravene a Provision of the HCC Act

1. Complaint Four is that Ms Rayamajhi is guilty of unsatisfactory professional conduct in that she contravened the HCC Act by failing to comply with a notice issued by the Commission.
2. Section 139B(1)(e) of the National Law provides that unsatisfactory professional conduct of a registered health practitioner includes a contravention by the practitioner of s 34A(4) of the HCC Act.
3. Section 34A(1) of the HCC Act provides that if the Commission is investigating a complaint and is of the opinion that a person is capable of giving information or producing documents that would assist in the investigation, the Commission may, by notice in writing given to the person, require the person to give the Commission, by writing signed by the person and within such time as is reasonable, and in the manner, specified in the notice, any such information of which the person has knowledge, or to produce to the Commission, in accordance with the notice, any such documents.
4. Section 34A(4) of the HCC Act relevantly provides that a person who is subject to a requirement under subs 34A(1) must not, without reasonable excuse, fail to comply with the requirement. We note that the legislation signals the importance of compliance with s 34A notices by providing that non-compliance is both unsatisfactory professional conduct and a criminal offence.
5. Acting on a complaint received from the Council, on 21 February 2023 the Commission sent Ms Rayamajhi an email attaching a letter and a notice issued by it on 20 February 2023 requiring her to give evidence/produce documents under s 34A of the HCC Act by 6 March 2023. The documents requested included her CV, contact details and any submissions. The notice was sent to the same email address which Ms Rayamajhi had used herself 12 days previously in which she had emailed the Commission asking what the Investigation of Complaint was about.
6. The notice included a clear warning: "Section 34A(4) of the Act creates an offence if you fail to comply with this notice without reasonable excuse and may constitute unsatisfactory professional conduct under the Health Practitioner Regulation National Law (NSW)." The notice included the text of s 34A of the HCC Act.
7. On 10 March 2023, the Commission sent Ms Rayamajhi a further email. This email again attached the notice dated 20 February 2023 and the letter dated 21 February 2023. It noted that the information requested had not been received by the due date. The email included: "We note that s34A(4) of the Health Care Complaints Act 1993 creates an offence if you fail to comply with this notice without a reasonable excuse and may constitute unsatisfactory professional conduct under the Health Practitioner Regulations National Law (NSW)." Ms Rayamajhi did not respond.
8. A file note made on 10 March 2023 records that an officer of the Commission telephoned Ms Rayamajhi. Ms Rayamajhi hung up. The officer attempted to call Ms Rayamajhi back but the call went to voicemail. The officer left a voicemail requesting a call back. Ms Rayamajhi did not respond.
9. There is no evidence available to us of Ms Rayamajhi providing a reasonable excuse (or any excuse) for the failure to comply with the requirements set out in the s 34A Notice. By failing to comply with the s 34A Notice and failing to provide a reasonable excuse for not complying, Ms Rayamajhi has contravened s 34A(4) of the HCC Act, and consequently such conduct constitutes unsatisfactory professional conduct as defined by s 139B(1)(e) of the National Law.
10. We are satisfied that Complaint Four of unsatisfactory professional conduct against Ms Rayamajhi is established.

1. Complaint Five is that Ms Rayamajhi is guilty of professional misconduct under s 139E of the National Law. In support of this Complaint the particulars of Complaints Two, Three and Four are repeated and relied upon individually and cumulatively.
2. Section 139E of the National Law provides as follows:

139E Meaning of "professional misconduct" [NSW]

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

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

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

1. The term "professional misconduct" does not have a specific meaning, and it is merely a category of "unsatisfactory professional conduct" which is sufficiently serious to justify suspension or cancellation_: Chen v Health Care Complaints Commission_ (2017) 95 NSWLR 334; [2017] NSWCA 186 at [19] (Basten JA) (Chen).
2. Professional misconduct requires an evaluative judgment to be made by the decision-maker as to the nature and seriousness of the conduct. Characterising the nature of the conduct with a view to determining its seriousness may involve consideration of a wide range of matters: Chen at [20] and Kavieris v Health Care Complaints Commission [2025] NSWSC 20 at [144].
3. In Health Care Complaints Commission v Robinson [2022] NSWCA 164 at [35], the Court noted that the "seriousness of the conduct" concerns not just acts or omissions but also the circumstances of their occurring. Justice Kirk at [36]-[37] remarked that the sorts of issues arising in characterising the nature of the conduct include:

"(1) the practitioner's state of mind at the time of the impugned conduct (eg whether conduct was deliberate or inadvertent);

(2) any knowledge the practitioner had of particular vulnerabilities in a patient;

(3) the risks of harm that the conduct was apt to create;

(4) the practitioner's knowledge, skill and training;

(5) the disciplinary history of the practitioner, as repeated inappropriate conduct may be treated as being of a more serious nature than isolated inappropriate conduct..."

1. The question is whether the conduct is of a sufficiently serious nature to justify suspension or cancellation. The conduct "must have the capacity to justify such an order, whether or not such an order should be made in particular circumstances": Health Care Complaints Commission v Karalasingham [2007] NSWCA 267 at [67].
2. In our view Ms Rayamajhi's conduct amounts to professional misconduct. The conduct underlying the particulars in Complaint Two (contravention of a provision of the National Law by failing to notify the National Board of criminal charges and convictions), Complaint Three (contravening conditions attached to her nursing registration) and Complaint Four (failing without reasonable excuse to comply with a notice issued by the Commission) is a pattern of repeated conduct demonstrating a disregard for her duty as a nurse to comply with legal and professional obligations.
3. We are satisfied that Complaint Five of professional misconduct against Ms Rayamajhi is established.

Complaint Six: Not a suitable person to hold registration

1. Complaint Six is that under s 144(e) of the National Law Ms Rayamajhi is otherwise not a suitable person to hold registration in her profession of nursing.
2. In support of this Complaint the Commission relies on Ms Rayamajhi's criminal history of repeated instances of driving whilst disqualified, and the conduct underlying the particulars in Complaints One, Two, Three and Four as indicating a pattern of conduct exhibiting a disregard for her duty as a nurse to comply with all applicable legal and professional obligations.
3. The phrase "suitable person" is not defined in the National Law.
4. Section 55 of the National Law deals with unsuitability to hold general registration and sets out the circumstances or criteria used to assess whether a person is unsuitable for registration. Accordingly, it offers guidance as to the meaning of suitable person.
5. Relevantly ss 55(b) and (h) of the National Law state that a National Board may decide that an individual is not a suitable person to hold general registration, if:

55 Unsuitability to hold general registration

(1) ...

(b) having regard to the individual's criminal history to the extent that is relevant to the individual's practice of the profession, the individual is not, in the Board's opinion, an appropriate person to practise the profession or it is not in the public interest for the individual to practise the profession; or

...

(h) in the Board's opinion, the individual is for any other reason -

(i) not a fit and proper person for general registration in the profession; or

(ii) unable to practise the profession competently and safely.

1. The meaning of the expression "not a suitable person to hold registration" was considered by the Tribunal in Health Care Complaints Commission v Brush [2015] NSWCATOD 120 at [72]- [73]:

"72. ... [I]n considering whether [the practitioner] "is a suitable person to hold registration," it is useful to have regard to the expression "fit and proper person." The latter has been the subject of detailed consideration by the authorities in various regulatory environments. Neither expression carry any precise meaning and take their meaning from their context, from the activities in which the person is or will be engaged and the ends to be served by those activities (see, for example, Australian Broadcasting Tribunal v Bond [1990] HCA 33; (1990) 170 CLR 321 at 380 per Toohey and Gaudron JJ.) In this case the context is the statutory scheme established for the registration and accreditation of health practitioners, a scheme designed to protect members 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 (ss 3(1) and 3(2)(a) of the National Law).

73. While some overlap between the concepts of "good character" and "being a suitable person to hold registration" / "fit and proper person" they are not identical. The former encompasses matters such as integrity, probity and scrupulosity; the latter embraces those concepts but also includes matters such as competence and technical skills."

1. That interpretation was cited with approval by the Tribunal in Health Care Complaints Commission v Istephan (No 2) [2017] NSWCATOD 116 at [116]- [118] and by the Court of Criminal Appeal in Jung v R [2017] NSWCCA 24 at [56] (Johnson J; Hoeben CJ at CL and Latham J agreeing).
2. Added to the cases set out above the term "not a suitable person to hold registration" takes its meaning from the statutory context in which it appears.
3. Here, the context is the registration and accreditation of health practitioners, designed to protect members 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: ss 3 and 3A of the National Law.
4. Ms Rayamajhi's criminal history of driving whilst disqualified and the conduct underlying Complaints Two, Three and Four establishes a pattern of conduct exhibiting a complete disregard for her duty as a nurse to comply with legal and professional obligations.
5. Ms Rayamajhi's failure to notify AHPRA of her criminal charges and convictions, notwithstanding that she had previously been counselled by the Council about her criminal history, showed disrespect for the role of AHPRA as a professional regulator.
6. After concerns were initially raised by Ms Rayamajhi's former employer THS, she failed to present for duty and respond to the concerns about her clinical practice and conduct which had been raised. Attempts by THS staff to contact her via phone and email were unsuccessful. Ms Rayamajhi then failed to respond to the Council, failed to attend the s 150 hearing, breached conditions imposed by the Council and failed to inform her two employers, UPA and Medibank, about her conditions.
7. Then by failing to respond to the Commission and comply with the notice issued by it, notwithstanding a clear warning about non-compliance, Ms Rayamajhi continued to show disregard for her professional obligations in the context of the Commission's investigation into the complaint made by the Council that she had breached the conditions imposed by it on her registration.
8. We have no confidence that Ms Rayamajhi would practise in a competent and ethical manner. For all these reasons we conclude that Ms Rayamajhi is not a suitable person to hold registration as a nurse.
9. We are satisfied that Complaint Six that Ms Rayamajhi is otherwise not a suitable person to hold registration as a nurse is established.

1. Having determined that Ms Rayamajhi is not a suitable person to practise nursing, and given that she is no longer registered, the Tribunal's discretionary powers that if she were still registered the Tribunal would have suspended or cancelled her registration are enlivened: s 149C(4)(a) of the National Law. We interpolate to observe that even if we had not found that Ms Rayamajhi is not a suitable person to practise nursing, our finding about her professional misconduct would have independently enlivened our powers under s 149C(4)(a) of the National Law.
2. In the exercise of functions under a NSW provision, the protection of the health and safety of the public must be the paramount consideration: s 3B of the National Law. In exercising our functions to determine the appropriate orders, we are required to have regard to the objectives and guiding principles of the national registration and accreditation scheme set out in ss 3 and 3A: s 4 of the National Law.
3. Section 3(2)(a) of the National Law makes it clear that 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.
4. This involves a consideration of the maintenance of standards of the profession, preservation of public confidence in the profession and, more broadly, the protection of the community: Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [91].
5. 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) 41 NSWLR 630 at 637.
6. Protecting the health and safety of the public is not confined to protecting current or potential patients but includes protecting the public from similar misconduct of others and upholding public confidence in the standards of the profession: Health Care Complaints Commission v Do [2014] NSWCA 307 (Do) at [35].
7. In Do, Meagher J (with whom Basten and Emmett JJ agreed) [at 35] referred to the importance of denunciation of misconduct as follows:

"The objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct operates both as a deterrent to the individual concerned, as well as to the general body of practitioners. It also maintains public confidence by signalling that those whose conduct does not meet the required standards will not be permitted to practise."

1. When exercising powers under s 149C(1) and by extension 149C(4) when a practitioner is no longer registered, guidance from the construction given to a complaint made under s 144(e) of the National Law that a practitioner is not a suitable person to hold registration, is contained in the decision of Gleeson JA in Windsor v Health Care Complaints Commission [2020] NSWCA 110 at [112] and [114]:

"112. The starting point is to recognise that the same particulars of underlying conduct can be characterised in more than one way for the purpose of s 144 of the National Law, when the Tribunal is exercising its powers under s 149C(1). That is, the underlying conduct relied upon for a complaint is not mutually exclusive to one of the complaints that can be made under s 144(a) to (e). ...

114. Similarly, underlying conduct with respect to the circumstances of a criminal offence which is of a sufficiently serious nature to render a practitioner unfit to practise (s 149C(1)(c)), may also be characterised as rendering the practitioner unsuitable for registration (s 149C(1)(d)). Importantly, the meaning of 'suitability' is not fixed or comprehensively defined in the National Law and includes aspects of competence (s 55(1)(d) and 55(h)(ii), as does s 139(b)), impairment (s 55(1)(a)) and criminal conduct (s 55(1)(b))."

1. Ms Rayamajhi did not attend the hearing and has not participated in the disciplinary process. We have no evidence as to her attitude to, or an explanation from her about, the totality of her conduct which is the subject of the Complaint. Nor do we have any material as to the degree to which Ms Rayamajhi accepts responsibility and accountability for her actions. There is no evidence as to her insight, remorse or any effort she has made to address the issues raised by her conduct.
2. Ms Rayamajhi has demonstrated an inclination to disregard her professional obligations when dealing with regulatory authorities in order to pursue her own interests. Given the nature and extent of Ms Rayamajhi's conduct, we cannot be satisfied that there is no risk that she would not behave in a similar fashion again. The paramount consideration is the protection of the health and safety of the public. We are satisfied that it is appropriate and necessary that if Ms Rayamajhi had been registered we would have cancelled her registration.
3. In our view, the public's ability to entrust their care to the nursing profession is undermined if an order is not made that if Ms Rayamajhi were still registered, we would have cancelled her registration. Such an order would publicly condemn her conduct and serves to act as a specific and general deterrent, to uphold the standards of the nursing profession and to preserve public confidence in the profession.
4. Such an order will also assist in upholding the integrity of the profession in the eyes of the public. In our view the public's confidence in the nursing profession to protect their safety would be seriously undermined if a practitioner who on multiple occasions did not adhere to duties of disclosure under the National Law and who failed to comply with conditions imposed on their registration was permitted to continue to practise.

1. We have found that Ms Rayamajhi is not a suitable person to hold nursing registration, and if she were still registered we would have cancelled her registration under s 149C(1)(d) of the National Law.
2. We also consider that the disqualification and non-review period of 2 years as sought by the Commission under 149C(4)(b) and 149C(7) is appropriate. This will enable Ms Rayamajhi time to reflect on her conduct and potentially give her the opportunity to take steps to demonstrate that she can be trusted to act honestly in her dealings with regulators; and has otherwise addressed her wrongdoings.

1. The Commission seeks a prohibition order against Ms Rayamajhi on the basis that she poses a substantial risk to the health of members of the public. It seeks that she be prohibited from providing any health services, as defined by s 4 of the HCC Act, permanently unless and until the Tribunal makes a reinstatement or other order under s 163B of the National Law.
2. The Tribunal can make a prohibition order if it is satisfied that the practitioner poses a substantial risk to the health of members of the public: National Law, s 149C(5). An order of this kind is aligned with the protective purpose of the legislation.
3. Section 4 of the HCC Act defines "health service". It includes the following services, whether provided as public or private services, as follows--

(a) medical, hospital, nursing, and midwifery services,

(b) dental services,

(c) mental health services,

(d) pharmaceutical services,

(e) ambulance services,

(f) community health services,

(g) health education services,

(h) welfare services necessary to implement any services referred to in paragraphs (a)-(g),

(i) services provided in connection with Aboriginal and Torres Strait Islander health practices and medical radiation practices,

(j) Chinese medicine, chiropractic, occupational therapy, optometry, osteopathy, physiotherapy, podiatry, and psychology services,

(j1) optical dispensing, dietitian, massage therapy, naturopathy, acupuncture, speech therapy, audiology, and audiometry services,

(k) services provided in other alternative health care fields,

(k1) forensic pathology services,

(l) a service prescribed by the regulations as a health service for the purposes of this Act.

1. The question of whether a person poses a substantial risk to the health of the public must be assessed by evaluating the risk posed to the public if the person were to be involved in the provision of health services.
2. In this case Ms Rayamajhi failed to comply with driving disqualification criminal laws, repeatedly failed to comply with professional obligations to declare charges and convictions, repeatedly failed to comply with conditions imposed on her registration and failed to engage with the Council, the Commission and disciplinary proceedings. Practice conditions were imposed on Ms Rayamajhi's registration due to concerns about her clinical practice, including allegations that she placed vulnerable elderly patients at risk.
3. Ms Rayamajhi could use her nursing training to seek work as an unregistered health practitioner working with vulnerable patients with limited oversight, such as aged carer, assistant in nursing or disability worker. We are satisfied that in the future Ms Rayamajhi may place patients at risk as an unregistered practitioner.
4. On the evidence before us, we find that Ms Rayamajhi poses a substantial risk to the health of members of the public if she were to be involved in the provision of any health services. A prohibition order ensures that the protective purpose of the orders that we have made is not significantly undermined. This is because if Ms Rayamajhi were permitted to provide health services during the period when her registration would have otherwise been cancelled, it would diminish the protective purpose and undermine confidence held in the profession.

1. The Commission seeks an order that Ms Rayamajhi pay its costs as agreed or assessed.
2. The case law is well settled in support of the general proposition that costs follow the event: Health Care Complaints Commission v Philipiah [2013] NSWCA 342 at [42]. The Commission has been successful in establishing the Complaint in its entirety. It has been successful in obtaining the findings it sought and an order for cancellation. There has been no disentitling conduct on its part and we can see no reason to depart from the general rule as to costs. An order for costs will be made.

(1) Under s 149C(4)(a) of the Health Practitioner Regulation National Law (NSW) if Ms Rayamajhi were still registered the Tribunal would have cancelled her registration.

(2) Under s 149C(4)(b) of the Health Practitioner Regulation National Law (NSW) Ms Rayamajhi is disqualified from being registered for 2 years from the date of this decision.

(3) Under s 149C(4)(c) of the Health Practitioner Regulation National Law (NSW) the National Board is required to record the fact that if Ms Rayamajhi were still registered, the Tribunal would have cancelled her registration in the National Register kept by the Board.

(4) Under ss 149C(5) and 149C(5A) of the Health Practitioner Regulation National Law (NSW) Ms Rayamajhi is prohibited from providing a health service, as defined in s 4 of the Health Care Complaints Act 1993 (NSW), permanently unless and until the Tribunal makes a reinstatement or other order under s 163B of the Health Practitioner Regulation National Law (NSW).

(5) Under s 149C(7) of the Health Practitioner Regulation National Law (NSW), an application for a review of the orders made about Ms Rayamajhi may not be made until 2 years from the date of the Tribunal's orders.

(6) Under clause 13 of Schedule 5D of the Health Practitioner Regulation National Law (NSW) Ms Rayamajhi is to pay the costs of the Health Care Complaints Commission 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.