1. Pursuant to Section 45A(2)(h) of the Medical Practice Act and Section 77(4)(h) of the Health Professions Registration Act 2005, Dr Christian's registration as a medical practitioner is cancelled, effective from 31 October 2012.
2. Pursuant to Section 45A(2)(i) of the Medical Practice Act and Section 77(4)(o) of the Health Professions Registration Act, Dr Christian is disqualified from applying for registration as a medical practitioner under Section 77 of the Health Practitioner Regulation National Law (Victoria) Act 2009 for a period of two years.
3. Pursuant to Section 45A(2)(c) of the Medical Practice Act and Section 77(4)(c) of the Health Professions Registration Act, Dr Christian is reprimanded.
4. Pursuant to Section 45A(2)(d) of the Medical Practice Act and Section 77(4)(d) of the Health Professions Registration Act, a future grant of registration to Dr Christian will be subject to:
   • (a) Dr Christian undertaking, at his own expense, a further education course for general practitioners in the prescription of drugs and poisons approved by the applicant, the Medical Board of Australia (Board), in the six months before Dr Christian applies to the Board for registration; and
   • (b) Dr Christian providing to the Board evidence of his completion of the proposed education to the satisfaction of the Board.
5. Pursuant to Section 45A(2)(e) of the Medical Practice Act and Section 77(4)(e) of the Health Professions Registration Act, a future grant of registration to Dr Christian will be subject to the outcome of an assessment of Dr Christian's health, including memory and cognitive function, conducted at his own expense firstly by a neuro-psychologist and secondly by a medical practitioner being either a psychiatrist, neuro-psychiatrist or geriatrician nominated by the Board who is to be given a copy of the examining neuro-psychologist's report prior to assessing Dr Christian's memory and cognitive function at Dr Christian's expense.

1. Allegation One: On or about 31 May 2005, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a) and (b) of the definition of 'unprofessional conduct' in section 3(1) of the Medical Practice Act ('the MP Act'), in treating his patient, Patient A, and that conduct was of a serious nature in that:
   • Dr Christian prescribed dexamphetamine for Patient A in circumstances where he did not have a permit for such prescription, and he knew or ought to have known that he was required to hold a permit;
   • Dr Christian failed to notify the Department of Human Services (the Department) that Patient A was a drug-dependent person, which Dr Christian had reason to believe or ought to have had reason to believe was the case; and
   • Dr Christian failed to maintain adequate medical records.
2. Allegation Two: In the period from on or about 21 June 2000 until on or about 19 March 2001, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a) and (b) of the definition of 'unprofessional conduct' in section 3(1) of the MP Act, in treating his patient, Patient B, and that conduct was of a serious nature in that:
   • Dr Christian prescribed codeine phosphate for Patient B in circumstances where Dr Christian did not have a permit for such prescription and where he knew or ought to have known that he was required to hold a permit.
3. Allegation Three: In the period from on or about 27 March 2001 until on or about 31 October 2005, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a) and (b) of the definition of 'unprofessional conduct' in section 3(1) of the MP Act, in treating Patient B, and that conduct was of a serious nature in that:
   • Dr Christian prescribed MS-Contin for Patient B in circumstances where Dr Christian did not have a permit for such prescription and where he knew or ought to have known that he was required to hold a permit.
4. Allegation Four: In the period from on or about 30 November 2007 until on or about 20 July 2009, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a) and (b) of the definition of 'unprofessional conduct' in section 3(1) of the Health Professions Registration Act ('the HPR Act'), in treating Patient B in that:
   • Dr Christian prescribed MS-Contin for Patient B without a permit in circumstances where he was required to hold a permit, the Department had previously advised him that he needed to apply for a permit to continue prescribing a Schedule 8 poison for Patient B and Dr Christian's permit for prescribing morphine for Patient B had expired; and
   • Dr Christian failed to implement a system to ensure he applied for permits to prescribe a Schedule 8 poison for Patient B.
5. Allegation Five: In or about December 2002 until on or about 6 April 2004 and, from on or about 4 January 2005 until on or about 23 May 2006, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a), (b), (c) and (e) of the definition of 'unprofessional conduct' in section 3(1) of the MP Act, in treating his patient, Patient C, and that conduct was of a serious nature in that:
   • Dr Christian prescribed Oxycontin for Patient C in circumstances where Dr Christian did not have a permit for such prescription and where he knew or ought to have known that he was required to hold a permit;
   • from on or about 28 October 2005 until on or about 23 May 2006, Dr Christian prescribed Oxycontin for Patient C without a permit although the Department had previously advised him that he appeared to have contravened the Drugs, Poisons and Controlled Substances Act 1981 (Victoria) ('the DPCS Act') and Drugs, Poisons and Controlled Substances Regulations 1995 (Victoria) in relation to his prescribing for Patients A and B and Dr Christian had signed an acknowledgement form confirming the Department had advised him of the permit requirements;
   • Dr Christian failed to notify the Department that Patient C was a drug-dependent person, which Dr Christian had reason to believe or ought to have had reason to believe was the case;
   • Dr Christian failed to initiate appropriate treatment for Patient C's drug dependence;
   • Dr Christian inappropriately relied on Patient C to reduce her use of Oxycontin; and
   • Dr Christian failed to implement a system to ensure he applied for permits to prescribe a Schedule 8 poison for Patient C.
6. Allegation Six: From on or about 20 March 2003 until on or about 19 June 2007, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a), (b), (c) and (e) of the definition of 'unprofessional conduct' in section 3(1) of the MP Act, in treating his patient, Patient D, and that conduct was of a serious nature in that:
   • Dr Christian prescribed Sustanon for Patient D without clinical indication and without taking all reasonable steps to ensure a therapeutic need existed for Patient D to take Sustanon;
   • Dr Christian inappropriately prescribed high dosages of Sustanon for Patient D in quantities exceeding his recommended dose and in circumstances where he knew Patient D was administering more Sustanon than his recommended dose;
   • Dr Christian failed to refer Patient D to specialist medical practitioners;
   • Dr Christian failed to have an appropriate management plan regarding Patient D's use of anabolic steroids; and
   • Dr Christian failed to maintain adequate medical records.
7. Allegation Seven: From in or about May 2007 until on or about 19 June 2007, Dr Christian engaged in unprofessional conduct, as defined in paragraphs (a), (b), (c) and (e) of the definition of 'unprofessional conduct' in section 3(1) of the MP Act, in treating Patient D and that conduct was of a serious nature in that:
   • Dr Christian continued to prescribe Sustanon for Patient D and in quantities that exceeded Dr Christian's recommended dose in circumstances where the Department had advised him that Patient D had sought prescriptions for anabolic steroids from multiple medical practitioners and another medical practitioner had informed Dr Christian that he had been prescribing testosterone for Patient D;
   • Dr Christian failed to notify the Department that Patient D was a drug-dependent person, which Dr Christian had reason to believe or ought to have had reason to believe was the case; and
   • Dr Christian inappropriately relied on Patient D to reduce his use of Sustanon.
8. Allegation Eight: The Tribunal makes no finding in relation to Allegation 8.
9. Allegation Nine: From on or about 5 September 2007 until on or about 14 October 2008, Dr Christian engaged in professional misconduct, as defined in paragraphs (a) and (b) of the definition of 'professional misconduct' in section 3(1) of the HPR Act, in treating Patient D in that:
   • Dr Christian continued to prescribe Sustanon for Patient D, and in quantities that exceeded his recommended dose, without clinical indication and without taking all reasonable steps to ensure a therapeutic need existed for Patient D to take Sustanon, and in circumstances where Dr Christian knew Patient D was administering Sustanon in quantities that exceeded his recommended dose, the Department had advised him that Patient D had sought prescriptions for anabolic steroids from multiple medical practitioners and another medical practitioner had informed him that he had been prescribing testosterone for Patient D;
   • Dr Christian failed to notify the Department that Patient D was a drug-dependent person, which Dr Christian had reason to believe or ought to have had reason to believe was the case;
   • Dr Christian inappropriately relied on Patient D to reduce his use of Sustanon;
   • Dr Christian failed to ascertain whether other medical practitioners were also prescribing anabolic steroids for Patient D;
   • Dr Christian failed to refer Patient D to specialist medical practitioners; Dr Christian failed to have an appropriate management plan regarding Patient D's use of anabolic steroids; and Dr Christian failed to maintain adequate medical records.

1. On 31 May 2005, Patient A consulted the Dr Christian, for the first time.
2. In an entry dated 31 May 2005 in his clinical records for Patient A, Dr Christian noted:

'Narcolepsy. On Dexamphetamine. Restless leg syndrome ... Has been attending Dr A. Sasse 9791 6555'

1. At this consultation, Dr Christian prescribed dexamphetamine for Patient A
2. In September and October 2005, the Drugs and Poisons Regulation Group, Department of Human Services ('the Department'), discovered that Dr Christian had prescribed dexamphetamine without a permit for Patient A in circumstances where another medical practitioner held a permit to treat Patient A and had identified him as being a drug-dependent person.
3. In a letter to Dr Christian dated 21 September 2005, Mr Chris Falcke ('Mr Falcke'), Senior Drugs and Poisons Officer, the Department, noted that Dr Christian had prescribed dexamphetamine for Patient A, informed Dr Christian that the DPCS Act and the Drugs, Poisons and Controlled Substances Regulations 1995 (Victoria) ('the DPCS Regulations 1995') required a medical practitioner to hold a permit from the Department prior to prescribing the Schedule 8 drugs and dexamphetamine, advised Dr Christian to obtain a permit if he wished to continue prescribing dexamphetamine for Patient A, and requested Dr Christian to respond in writing indicating the circumstances of his prescribing for Patient A.
4. In a letter to the Department dated 12 October 2005, Dr Christian stated: on 31 May 2005, Patient A consulted him, reported that he was suffering from narcolepsy and restless leg syndrome, and had been investigated by Dr S, a specialist physician, and Dr H, a respiratory physician, and gave Dr Christian letters and reports relating to his medical condition; Patient A reported that his usual doctor was away and had not left him a prescription for dexamphetamine; Patient A was distressed, his speech was incessant, he was restless and he paced round the room; and Dr Christian rang the HIC to obtain an authority to prescribe dexamphetamine for Patient A.
5. In a letter to the Department dated 24 August 2009, Dr Christian stated that, on 31 May 2005, Patient A 'was extremely distressed and causing some disturbance in the waiting room', and Dr Christian 'rang the HIC in order to obtain an authority for Dexamphetamine', as 'this was the quickest way to diffuse a situation which appeared to be getting out of control'.
6. In a letter to the Medical Practitioners Board of Victoria (predecessor to the Board) ('the MPBV'), dated 26 April 2010, Dr Christian stated that, on 31 May 2005: Patient A consulted him and 'appeared restless, agitated & paced around the room'; Patient A reported that he suffered from narcolepsy and restless leg syndrome, he had seen Dr S and Dr H regarding his conditions, and had been commenced on dexamphetamine, and his doctor was away and had not left him a prescription; Dr Christian explained to Patient A that he could not prescribe dexamphetamine for him which made him 'more agitated and somewhat threatening'; Dr Christian 'thought the best thing to do to ease the situation was to ring the HIC an [sic] obtain an authority'; and 'I was of the opinion that I could ring the HIC to obtain permission for drugs of authority until Mr Falcke informed me I needed a special permit' in his letter to Dr Christian dated 21 September 2005.

1. From 21 June 2000 until 19 March 2001, Dr Christian prescribed codeine phosphate, a Schedule 8 poison, for Patient B for a continuous period greater than 8 weeks in circumstances where he did not have a permit for such prescription.
2. From 27 March 2001 until 31 October 2005, Dr Christian prescribed MS-Contin, a Schedule 8 poison, for Patient B for a continuous period greater than 8 weeks in circumstances where he did not have a permit for such prescription.
3. In September and October 2005, the Department discovered that Dr Christian had prescribed MS-Contin without a permit for Patient B.
4. By letter dated 28 October 2005, the Department informed Dr Christian that it appeared he had prescribed MS-Contin for Patient B without a permit in contravention of relevant legislation, explained that the purpose of the permit system was 'to enable treatment with Schedule 8 drugs to be co-ordinated and monitored to prevent concurrent prescribing by other practitioners' and 'to reduce the possibility of deliberate misuse or iatrogenic dependence', and advised Dr Christian that he needed to apply to the Department for a permit if he wished to continue prescribing Schedule 8 drugs for Patient B.
5. On 7 November 2005, the Department granted a permit to Dr Christian to prescribe morphine for Patient B for a period of 12 months.
6. By letter dated 11 November 2005, the Department advised Dr Christian to review his legislative responsibilities so that he did not inadvertently contravene the DPCS Act and/or the DPCS Regulations 1995 in the future, and enclosed copies of an Acknowledgement Form for Dr Christian to sign, confirming he had reviewed information regarding the legislative requirements, which was also enclosed in this letter.
7. By letter to Dr Christian dated 24 March 2006, the Department noted that it had not received a response from Dr Christian to its correspondence and enclosed further copies of the Acknowledgement Form.
8. On 28 March 2006, Dr Christian signed the Acknowledgement Form.
9. On 6 November 2006, Dr Christian's permit to prescribe morphine for Patient B expired.
10. On 27 November 2006, the Department granted a permit to Dr Christian to prescribe morphine for Patient B for a period of 12 months, and informed him that 'APPLICATION FORMS CAN NOW BE DOWNLOADED FROM [THE DEPARTMENT'S] WEBSITE'.
11. On 26 November 2007, Dr Christian's permit to prescribe morphine for Patient B expired.
12. From 30 November 2007 until 20 July 2009, Dr Christian prescribed MS-Contin for Patient B in circumstances where he did not have a permit for such prescription.
13. On 23 July 2009, a Drugs and Poisons Officer attended Dr Christian's clinic to examine his patient records and reported that the records were scant and Dr Christian did not appear to have an effective system to ensure permit requirements were met.
14. By letter dated 24 July 2009, the Department informed Dr Christian that his permit to prescribe MS-Contin for Patient B had expired in late 2007, and advised him to obtain a new permit if he wished to continue prescribing Schedule 8 poisons for Patient B and to record permit expiry dates in a prominent manner.
15. On 28 July 2009, the Department granted Dr Christian a permit to prescribe morphine for Patient B for a period of 12 months.
16. By letter dated 12 August 2009, the Department requested Dr Christian to provide details of his treatment of Patient B.
17. In a letter to the Department dated 24 August 2009, Dr Christian stated: he had continued to prescribe MS-Contin for Patient B after the expiry of the permit on 26 November 2007; his prescribing since that date represented continuous treatment of Patient B; he had prescribed MS-Contin to treat chronic severe neck pain sustained by Patient B in an assault; 'it was an inadvertent oversight on my part for which I must sincerely apologise'; Patient B was referred in 2000 to Dr G, a psychiatrist who treats patients with chronic pain, and, in 2001, to the Caulfield Hospital Pain Clinic; and Dr Christian had attached a sticker to the front and inside cover of Patient B's file with the date when the next permit was due and highlighted that date on the computer reminder system.
18. By letter dated 5 October 2009, the Department informed Dr Christian that it appeared clear that his prescribing of Schedule 8 poisons for Patient B had contravened the legislative requirements.
19. In a letter to the MPBV dated 26 April 2010, Dr Christian stated: when Patient B consulted him on 1 June 2000, Dr Christian gave him a referral to the Caulfield Hospital Pain Clinic and commenced him on codeine phosphate; 'as [Patient B] got no relief from the codeine I commenced him on MS Contin'; and 'it was after the conversation with Mr Falcke in Sept. 2005 I realised I needed a permit and requested my receptionist to obtain the permits from the Drugs & poison's [sic] Unit'.

1. In an entry dated 28 March 1992 in his clinical records for Patient C, Dr Christian noted, 'advised ... Pethidine addiction'.
2. In an entry dated 11 August 1992 in his clinical records for Patient C, Dr Christian noted, 'have advised her that I will not give her any more Pethidine'.
3. From December 2002 to 6 April 2004, and, from 4 January 2005 until 16 May 2006, Dr Christian prescribed a Schedule 8 poison, Oxycontin, for Patient C in circumstances where he did not have a permit for such prescription.
4. By letter dated 28 October 2005, the Department informed Dr Christian that it appeared he had prescribed MS-Contin for Patient B without a permit in contravention of relevant legislation, explained the purpose of the permit system, and advised Dr Christian that he needed to apply to the Department for a permit if he wished to continue prescribing Schedule 8 drugs for Patient B.
5. By letter dated 11 November 2005, the Department advised Dr Christian to review his legislative responsibilities so that he did not inadvertently contravene the DPCS Act and/or the DPCS Regulations 1995 in the future, and enclosed copies of an Acknowledgement Form for Dr Christian to sign, confirming he had reviewed information regarding the legislative requirements, which was also enclosed in the letter.
6. By letter to Dr Christian dated 24 March 2006, the Department noted that it had not received a response from Dr Christian to its correspondence and enclosed further copies of the Acknowledgement Form.
7. On 28 March 2006, Dr Christian signed the Acknowledgement Form.
8. In May 2006, the Department discovered that Dr Christian had prescribed Oxycodone without a permit for Patient C, a patient for whom another medical practitioner held a permit and had been concurrently prescribing Oxycodone for her.
9. By letter dated 18 May 2006, the Department informed Dr Christian that it had come to its attention that he had prescribed Oxycontin for Patient C without a permit and another medical practitioner held a permit to treat Patient C, and advised Dr Christian not to prescribe Schedule 8 poisons for Patient C without first obtaining a permit to do so.
10. In a letter to the Department dated 6 June 2006, Dr Christian stated: Patient C had a 'tendency to overuse medication'; Patient C attended another doctor for 6 months who prescribed Oxycontin for her and then returned to Dr Christian; 'I made a verbal contract with [Patient C] that I will continue to see her providing she weaned off her Oxycontin'; Patient C agreed to do so and Patient C was advised to attend the Alfred Hospital in the hope she would be weaned off Oxycontin; and Patient C was admitted to the Alfred Hospital in November 2005, but discharged with an increased dose of Oxycontin.
11. By letter dated 3 October 2006, the Department informed Dr Christian that, two months after he signed the Acknowledgement Form, he was found to have been prescribing Oxycontin without a permit on a regular basis for Patient C, who had been obtaining the same medication from another prescriber who held a permit to treat Patient C. The Department stated that, 'contravening the legislation, including permit requirements, renders a medical practitioner liable to prosecution', and requested Dr Christian to confirm in writing his receipt of the letter.
12. In a letter to the Department dated 19 October 2006, Dr Christian stated: in April 2006, Patient C consulted him and was distressed and had suicidal ideation, but no intent, and Dr Christian 'made a contract with [Patient C] that I would provide her with the Oxycontin as duty of care to my patient on the understanding she will ring the South Eastern Alcohol & Drug Service to undertake a detox program'; Patient C was admitted to the program on 11 July 2006 and informed Dr Christian she was off Oxycontin; and 'although I signed the acknowledgement form on 28th March 06, I, as a General Practitioner had duty of care to my patient and could not take the risk in a depressed patient'.
13. By letter dated 2 November 2006, the Department informed Dr Christian that, given that Patient C was obtaining prescriptions for drugs of dependence from another medical practitioner who held a permit to prescribe those drugs, and Dr Christian was concurrently prescribing similar drugs, Dr Christian's duty of care to his patient might have been better served if he had complied with his legislative responsibilities and applied for a permit to prescribe Schedule 8 poisons for Patient C.
14. In a letter to the Department dated 24 August 2009, Dr Christian stated, 'on 11th July 2006, [Patient C] was admitted to the Dandenong A & D unit and was detoxed' and 'I have not seen [Patient C] since mid October 2006'.
15. In a letter to the MPBV dated 26 April 2010, Dr Christian stated: when Patient C first consulted him in 1990, she was 'addicted to pethidine given for her chronic migraine', which he weaned her off in 1999; Patient C attended another doctor and obtained Oxycontin and, when she returned to consult Dr Christian a few months later, 'I expressed my displeasure and advised her that, if I were to continue to treat her, she would need to make a contract to wean her off her oxycontin prior to her going into the Alfred Hospital'; on her discharge from the Alfred Hospital, Patient C 'came out with more medication than she went in with'; Dr Christian advised Patient C 'to begin weaning off her oxycontin and book herself into the South Eastern Drug & Alcohol unit for a seven day detox program', which she completed on 11 July 2006; 'I have no excuse for not applying for a permit but can only say it was an aberration on my part as I was quite displeased with [Patient C] for obtaining the oxycontin knowing fully well her propensity to become addicted to medication'.

1. From 20 March 2003, when Patient D first consulted Dr Christian, until 19 June 2007, and, from 5 September 2007 until 14 October 2008, Dr Christian prescribed Sustanon for Patient D.
2. By letter dated 11 November 2005, the Department advised Dr Christian to review his legislative responsibilities so that he did not inadvertently contravene the DPCS Act and/or the DPCS Regulations 1995 in the future, and enclosed copies of an Acknowledgement Form for Dr Christian to sign, confirming he had reviewed information regarding the legislative requirements, which was also enclosed in the letter.
3. By letter to Dr Christian dated 24 March 2006, the Department noted that it had not received a response from Dr Christian to its correspondence and enclosed further copies of the Acknowledgement Form.
4. On 28 March 2006, Dr Christian signed the Acknowledgement Form.
5. In May 2007, Mr Falcke spoke with Dr Christian and told him that Patient D had obtained prescriptions for anabolic steroids from other medical practitioners.
6. By letter dated 21 May 2007, the Department advised Dr Christian that it had come to its attention that he was one of a number of medical practitioners who appeared to have prescribed drugs of dependence for Patient D.
7. In an entry dated 19 June 2007 in his clinical records for Patient D, Dr Christian noted, 'discussed [with] Dr [J] today - last saw [Patient D] in April '07. Does need ... Sustanon ... for his impotence - ED'.
8. In January 2009, the Department discovered that Dr Christian had again prescribed testosterone for Patient D.
9. By letter dated 6 January 2009, the Department requested Dr Christian to provide details of the nature of his treatment of Patient D, informed Dr Christian of relevant legislative requirements under the DPCS Regulations 2006, and reminded Dr Christian that he was required under the DPCS Act to notify the Department if he had reason to believe that Patient D was a drug-dependent person.
10. In a letter to the Department dated 12 January 2009, Dr Christian stated: when Patient D commenced consulting him in March 2003, he told him he had been on Sustanon for erectile dysfunction and had previously consulted Dr J; Dr Christian discussed with Patient D the long-term effects of Sustanon; Dr Christian rang Dr J in relation to Patient D and he stated that Patient D had been on Sustanon for erectile dysfunction; Patient D had also attended Mr W, a urologist, and 'a couple of other Urologists for his condition'; 'when I confronted [Patient D] regarding Doctor Shopping [Patient D] denied the allegations'; 'I do not have reason to believe that [Patient D] is drug dependant [sic]'; and Patient D had Bilateral Testicular Atrophy.
11. By letter dated 12 August 2009, the Department requested Dr Christian to respond to questions regarding his treatment of Patient D and informed him of relevant provisions of the DPCS Regulations 2006.
12. In a letter to the Department dated 24 August 2009, Dr Christian stated that:

(a) he prescribed twelve Sustanon injections (three plus three repeats) for Patient D on 22 January 2007, 5 April 2007, 19 June 2007, 5 September 2007, 20 November 2007, 10 January 2008, 17 March 2008, 12 June 2008 and 14 October 2008;

(b) he prescribed Sustanon for Patient D to treat impotence;

(c) Patient D told Dr Christian he had been investigated by urologists and his previous general practitioner and commenced on testosterone, and informed him of the dose he was on;

(d) 'I did not perform any initial tests as [Patient D] had already been investigated and was on testosterone';

(e) 'I did perform routine blood tests to determine whether or not the continued use of testosterone was having an adverse effect on other organs (liver, thyroid, kidney and testes)' and 'all these returned normal results';

(f) at his first consultation, Patient D informed him that he was not seeing Dr J;

(g) Dr Christian rang Dr J after the Department informed him that Dr J continued to see Patient D;

(h) in June 2007, Dr Christian communicated with Dr J 'regarding [Patient D's] treatment', Dr J informed him that Patient D 'was on Reandron for Erectile Dysfunction', and Dr J 'did not comment to me any reason not to continue treatment';

(i) as Patient D told him he had already seen three urologists, Dr Christian did not think it necessary to obtain further advice;

(j) Dr Christian determined the effective therapeutic dose from the history that Patient D gave him;

(k) Dr Christian did not believe that his prescribing, which represented a rate of administration that exceeded one injection per week, was consistent with an acceptable therapeutic dose, as he considered that it should be injected every two to three weeks;

(l) Dr Christian informed Patient D that his usage exceeded the usual therapeutic dose and he needed to use one injection every two to three weeks, and discussed the adverse effect of testosterone on his organ system;

(m) after Mr Falcke spoke with Dr Christian in 2007 and told him that Patient D had obtained the same or similar drugs from other medical practitioners, Dr Christian 'advised [Patient D] to reduce usage and reiterated the adverse effect of Testosterone';

(n) when Mr Falcke informed Dr Christian that Patient D was also seeing Dr J, 'I did confront [Patient D] with Dr shopping. He categorically denied this'; and

(o) Dr Christian continued to prescribe testosterone for Patient D until 14 October 2008, when he gave him his final prescription for testosterone.

1. By letter dated 5 October 2009, Mr Falcke asked Dr Christian to clarify his responses to the Department's questions in its letter dated 12 August 2009, because, on the information Dr Christian had provided, Mr Falcke was not satisfied that Dr Christian had taken all reasonable steps to comply with the DPCS Regulations 2006.
2. In a letter to the Department dated 20 November 2009, Dr Christian stated:

(p) at Patient D's first consultation with Dr Christian on 20 March 2003, Patient D told Dr Christian that he had been on testosterone for impotence since 1996, he had small testicles, he had seen three urologists, the last of whom was Mr W. Patient D 'was embarrassed when I asked if I could examine his testicles, so I did not force the issue', and, in his report, Mr W mentioned that Patient D had small testicles;

(q) 'I did not deem it necessary to perform any investigations for the following reasons

(i) [Patient D] had seen other general practitioners and Urologists, all of whom would have investigated him if they had found any cause to do so.

(ii) Besides his testicular atrophy and systolic murmur there were no other symptoms or signs that warranted investigation.

(iii) I did not consider it necessary to perform testosterone levels as [Patient D] had been on testosterone for a very long time and with all probability his levels would have been raised';

(r) 'When [Patient D] began to use his testosterone more frequently I advised him that, what he was doing was inappropriate and that he was to use his sustanon every two to three weeks';

(s) Dr Christian performed 'routine tests to determine whether or not [Patient D's] usage was affecting his organs' and 'besides a small ejaculatory volume all other tests returned normal results';

(t) Patient D told Dr Christian that he had seen Dr J, but could not remember the name of the other doctor he had attended, and 'to confirm [Patient D's] story I rang Dr J who did confirm that [Patient D] was on testosterone'; and

(u) 'Although [Patient D] was using more than the required amount of sustanon, I believe he used it according to the response he got and the demands of his partner'.

1. By letter dated 7 January 2010, the Department provided to Dr Christian a summary of permit requirements for prescribing Schedule 8 poisons from 1 March 2009.
2. In a letter to the MPBV dated 26 April 2010, Dr Christian stated: when Patient D first consulted Dr Christian, Patient D stated that he had suffered erectile dysfunction since 1996 and had been on testosterone, had been investigated by his previous general practitioner and three urologists, and had small testicles; Patient D began using testosterone more frequently in 2007 and Dr Christian 'advised Patient D to increase the interval between injections to prevent long term effect and performed routine blood tests & semen analysis'; 'besides a reduced volume of ejaculate all other tests were normal'; Patient D complied with Dr Christian's advice regarding the quantity of testosterone he should use for a few months, but returned to his normal usage; Dr Christian ceased prescribing testosterone for Patient D in October 2008 as Patient D did not comply with Dr Christian's advice; the only other medical practitioner whom Dr Christian spoke to regarding Patient D was Dr J, who informed him that he had prescribed testosterone for Patient D, but had not given him any since April 2007; Dr Christian had not been given the names of any other medical practitioners to contact; and 'if I had been given other names I would have contacted each & everyone of them as I did in the case of Dr [J].
3. In a letter received by the Applicant, the Medical Board of Australia (Board), on 13 July 2010, Patient D stated, 'I was, at one stage, also seeing Dr [J], without disclosing this to Dr. Christian'

NOTIFICATION TO THE MPBV REGARDING DR CHRISTIAN AND REFERRAL TO THE VICTORIAN CIVIL AND ADMINISTRATIVE TRIBUNAL

1. On 17 February 2010, the MPBV received a notification dated 15 February 2010 from Mr Falcke in relation to the professional conduct of Dr Christian.
2. On 25 November 2010, the Board determined, pursuant to section 59(2)(g) of the HPR Act, to refer the matter that was the subject of the notification from Mr Falcke to the Victorian Civil and Administrative Tribunal ('VCAT') for a Tribunal hearing.

1. During examination of Dr Christian by his Counsel at the hearing of this proceeding on 7 June 2012, Dr Christian stated that:

(v) when Dr Christian prescribed dexamphetamine for Patient A on 31 May 2005, he did not know about the permit system or that, if he was to prescribe dexamphetamine, he needed to obtain a permit to do so;

(w) Dr Christian should have found out from his colleagues or people in the profession about the permit system, but he did not do so;

(x) Dr Christian did not know about the permit system in 2001, 2002 and 2003;

(y) Dr Christian first knew about the permit system for anything 'only when [he] got the letter from Mr Moyle (Mr K L Moyle, Manager, Drugs and Poisons, the Department [Mr Moyle]), on ... 28 October 2005';

(z) after Dr Christian received a letter from the Department dated 21 September 2005 informing him that he needed a permit to prescribe dexamphetamine, Dr Christian did not believe he needed a permit to prescribe MS-Contin, though he should have known this;

(aa) Dr Christian realised he needed a permit to prescribe MS-Contin only when he received Mr Moyle's letter dated 28 October 2005

(bb) after Dr Christian received Mr Moyle's letter dated 28 October 2005, he asked his receptionist to ring the Department 'and get some permits, because I'd never seen a permit before'.

1. On 8 June 2012, the Tribunal adjourned the hearing in order for the Board to obtain further evidence.

1. Following the hearing, the Department provided evidence that Dr Christian had applied for and obtained permits to prescribe Oxycodone (as a Proladone suppository) for:

(cc) Patient C on 17 July 1990 (for a 3 month period) and on 22 November 1990 (for a 6 month period); and

(dd) Patient E (a patient of Dr Christian who was not previously mentioned in this proceeding), on 21 May 1998, 4 September 1998, 9 December 1998, 23 February 1999, 22 May 1999, 22 August 1999, 22 February 2000, 21 February 2001 and 20 February 2002 (the duration of those permits varied between 3 and 12 months).

EVIDENCE REGARDING THE STANDARD OF PROFESSIONAL CONDUCT EXPECTED OF MEDICAL PRACTITIONERS

1. On 20 December 2011, at the request of the Board, Dr Benny Monheit (Dr Monheit) prepared a report regarding Dr Christian's professional conduct.
2. The opinions expressed by Dr Monheit are accepted by the parties.

1. The Australian Medical Association's 'Code of Ethics', published in 2004 and editorially revised in 2006, includes guidelines on providing patient care and safeguarding clinical independence.
2. In Autumn 2000, the MPBV published a Bulletin, which included an article on pages 4 and 5 titled, 'Drugs of Dependence: Inappropriate Prescribing'.
3. In Spring 2000, the MPBV published a Bulletin, which included an article on page 8 titled, 'Forged Prescriptions'.
4. In the MPBV's Bulletin, Volume 2, June 2004, the MPBV published, on pages 13 and 14, summaries of informal hearings that involved findings of, respectively, inappropriate prescribing, and prescribing of anabolic steroids, specifically, Sustanon, by two medical practitioners to the same patient.
5. In the MPBV's Bulletin, Volume 3, September 2004, the MPBV published an article on page 18 titled, 'Managing Patients with Substance Use Problems', an article on pages 20 and 21 titled, 'Issues from the Drugs and Poisons Unit', prepared by the Department and detailing the permit system and legislative requirements for prescribing drugs of dependence, including dexamphetamine, and an article at pages 21 and 22 titled, 'Use of Drugs of Dependency in the Treatment of Chronic Pain'.
6. In December 2006, the MPBV published a Bulletin including a warning about diversion and trafficking of OxyContin, MS-Contin and Kapanol.
7. In December 2006, the MPBV published, 'Good Medical Practice: Guidelines on Professional Conduct', which provides guidance to medical practitioners on providing clinical care to patients, and maintaining their competence and performance, and states:

• conducting an adequate assessment of the patient's condition, based on an appropriate history and examination
• providing or arranging investigations or treatment, as appropriate'; and

• prescribe only the treatment, drugs, or appliances that serve the needs of patients'.

1. Pursuant to Section 45A(2)(h) of the MP Act and Section 77(4)(h) of the HPR Act, Dr Christian's registration as a medical practitioner is cancelled effective from five weeks after the Tribunal makes its order as to determinations in this matter.
2. Pursuant to Section 45A(2)(i) of the MP Act and Section 77(4)(o) of the HPR Act, Dr Christian is disqualified from applying for registration as a medical practitioner under Section 77 of the Health Practitioner Regulation National Law (Victoria) Act 2009 (Vic) for a period to be determined by the Tribunal.
3. Pursuant to Section 45A(2)(c) of the MP Act and Section 77(4)(c) of the HPR Act, Dr Christian is reprimanded.
4. Pursuant to Section 45A(2)(d) of the MP Act and Section 77(4)(d) of the HPR Act, a future grant of registration to Dr Christian will be subject to:

(a) Dr Christian undertaking, at his own expense, a further education course for general practitioners in the prescription of drugs and poisons approved by the Applicant, the Medical Board of Australia ('the Board'), in the six months before Dr Christian applies to the Board for registration; and

(b) Dr Christian providing to the Board evidence of his completion of the proposed education to the satisfaction of the Board.

1. Pursuant to Section 45A(2)(e) of the MP Act and Section 77(4)(e) of the HPR Act, a future grant of registration to Dr Christian will be subject to the outcome of an assessment of Dr Christian's health, including memory and cognitive function conducted at his own expense, firstly by a neuro-psychologist nominated by the Board and secondly by a medical practitioner being either a psychiatrist, neuro-psychiatrist or geriatrician nominated by the Board who is to be given a copy of the examining neuro-psychologist's report prior to assessing Dr Christian's memory and cognitive function at Dr Christian's expense.

1. The proposed determinations are uncontroversial with the exception of Determination No. 2 which reads:

Pursuant to Section 45A(2)(i) of the Medical Practice Act and Section 77(4)(o) of the Health Professions Registration Act, Dr Christian is disqualified from applying for registration as a medical practitioner under Section 77 of the Health Practitioner Regulation National Law (Victoria) Act 2009 for a period to be determined by the Tribunal.

Submissions have been received from both counsel on behalf of the Board and counsel on behalf of Dr Christian in relation to the appropriate period of disqualification. The Board request that the Tribunal disqualify Dr Christian from applying for registration as a medical practitioner for a period of three years and Dr Christian's counsel requests that this be a period of two years.

1. In determining the appropriate disposition, it is necessary for the Tribunal to have regard to various considerations. Principal among those is the requirement of protection of the public. Other considerations include the nature and gravity of the conduct, the requirement for general and specific deterrence and the maintenance of professional standards within the medical profession. At all times it must be borne in mind that the determination is not a punitive one.
2. Dr Christian is aged 64 years and has practiced medicine for 36 years. Prior to the matters giving rise to these proceedings there have been no matters in which Dr Christian has been the subject of any disciplinary proceedings. This is in Dr Christian's favour. It is also necessary to look at the nature of the actions of Dr Christian. The drugs involved are of a dangerous nature and that makes his actions serious. Also, regard must be had to the fact that his actions took place on a number of occasions over a significant period of time, some nine years. No evidence of any mental illness being suffered by Dr Christian was provided to the Tribunal. However, the Tribunal notes that it will be a requirement that Dr Christian be assessed as being psychologically suitable for re-registration.
3. The specific deterrence requirement is met by the determinations as proposed and in the view of the Tribunal the period of disqualification which will be imposed. This is not an insignificant determination. This also is sufficiently serious to provide a powerful message to the profession generally and thereby satisfies the requirement of general deterrence. Again, it is a determination which indicates that there is a requirement that professional standards within the medical profession must be high and must not be violated. The aspect of this which gave the Tribunal cause for concern is that there has been no suggestion that in the course of his actions that Dr Christian at any stage showed any concern for the consequences to his patients. He has displayed poor insight into the consequences of his actions. The requirement that the public be protected is manifestly met by the cancellation of Dr Christian's registration as opposed to suspension. Cancellation is a far more serious consequence. It means that there will be no automatic right to practice once the period of disqualification expires. The matter remains and will remain in the hands of the Board to assess whether Dr Christian is suitable to resume practice. The fact that there has been an agreement to cancellation of Dr Christian's registration satisfies the public protection criterion in itself and puts into a lesser context the period of the disqualification. Had the proposed disposition been suspension, the Tribunal may have taken a different view, however given that the proposed disposition is cancellation, it is the view of the Tribunal that a period of disqualification of two years is appropriate.
4. Accordingly, the orders of the Tribunal will be as proposed with the following amendments. The commencement of the cancellation which was proposed to be five weeks after the Tribunal makes its order will be effective from 31 October 2012 and in Order 2 the period of disqualification is for a period of two years.