ORDERS

The Tribunal orders that:

1. Under section 196(2)(a) of the Health Practitioner Regulation National Law (Victoria) Act 2009 Dr Hanna is reprimanded.
2. Under section 196(2)(b) of the Health Practitioner Regulation National Law (Victoria) Act 2009 a condition be imposed on Dr Hanna's registration requiring that he undergo education in accordance with the specific requirements as listed in Annexure A.
3. Under section 196(2)(b) of the Health Practitioner Regulation National Law (Victoria) Act 2009 a condition be imposed on Dr Hanna's registration requiring that he submit to a one off audit of his practice in accordance with the specific audit of practice requirements as listed in Annexure A.
4. Under section 196(3) of the Health Practitioner Regulation National Law (Victoria) Act 2009 the review period for the conditions referred to in paragraphs 2 and 3 above is 9 months.

On 21 February 2019 the Tribunal made the following orders under s 17 of the

Open Courts Act 2013 (Vic);

1. The disclosure by publication or otherwise of any report of the whole or any part of this proceeding, or of any information derived from this proceeding, which identifies or has the effect of identifying the patient, witnesses or notifiers is prohibited.
2. This order applies throughout Australia on the basis that the Tribunal's reasons for decision for final orders are published on AustLII and that website may be accessed throughout Australia. The privacy of the people referred to in order 1 would be breached if persons living outside Victoria know or come to know their identity.
3. This order operates until the death of all of the patient, witnesses and notifiers.

1. Dr Onsy Hanna was, at all relevant times, a registered medical practitioner. These proceedings, brought under the Health Practitioner Regulation National Law (Victoria) Act 2009 (National Law), consider the professional consequences for Dr Hanna having prescribed clinically inappropriate and excessive amounts of testosterone to a patient between 13 January 2012 and on or about 12 November 2014 (the Relevant Period).
2. Dr Hanna's conduct came to light as a result of an investigation by the Drugs and Poisons Regulation (DPR), a branch of the Department of Health and Human Services (DHHS). DPR is responsible for investigating health practitioners who are alleged to have breached the Drugs Poisons and Controlled Substances Act 1981 (Vic) (Act) and the Drugs Poisons and Controlled Substances Regulations 2006 (Regulations).
3. On 13 October 2016, the Australian Health Practitioner Regulation Agency (AHPRA), on behalf of the Medical Board of Australia (Board), received notification from DHHS about the conduct of Dr Hanna and the alleged contraventions of the Act and the Regulations.
4. On 17 October 2016, AHPRA, on behalf of the Board, received notification from Dr Hanna that criminal charges had been laid against him.
5. On 6 December 2016, the criminal proceedings were heard in the Magistrates Court of Victoria. Dr Hanna pleaded to and was found guilty of three charges of breaches of the Regulations. The Court made an order that, without conviction, he be fined $6,000 and ordered to pay the prosecution costs.
6. On 8 November 2018, the Board referred one allegation relating to Dr Hanna's conduct to this Tribunal. It did so as it was required to do under s 193(1)(a)(i) of the National Law, once it reasonably believed Dr Hanna had engaged in conduct that constituted professional misconduct.
7. When the matter came before this Tribunal for hearing the parties had prepared an agreed statement of facts and had also agreed on proposed findings and determinations to be made under the National Law. Dr Hanna admitted the allegation made by the Board and agreed the conduct should be characterised as professional misconduct. We agree that the proposed findings are appropriate and have made findings set out in full below.
8. The parties jointly proposed the Tribunal determine that Dr Hanna should be reprimanded and that conditions should be imposed on his registration requiring that he undergo education and submit to a one-off audit of his practice, the terms of which are set out in Annexure A.
9. For the reasons discussed below we agree that it is appropriate that Dr Hanna be reprimanded for the conduct and that the proposed conditions be imposed on his registration.

1. The following is taken from the parties agreed statement of facts:

1.1 Dr Onsy Hanna (Dr Hanna) was first registered as a medical practitioner on 19 January 1998.

1.2 The [Board] was established and replaced the previous State and Territory boards (or participating jurisdictions and co-regulatory jurisdictions) on 1 July 2010. Accordingly, Dr Hanna has been subject to the [National Law] since that time, including over the period in which the conduct alleged in the Notice of Allegations occurred, being on dates occurring between 13 January 2012 and 12 November 2014.

2. Notification in respect of Dr Hanna's professional conduct

2.1 On 13 October 2016, the Australian Health Practitioner Regulation Agency received a notification from Mr Chris Falcke, Manager, Health Practitioner Compliance Monitoring, [DPR, DHHS**]**. The notification contained information about Dr Hanna's alleged contraventions of the [Regulations].

2.2 The notification followed an investigation carried out by DHHS, which concluded that Dr Hanna appeared to have:

(a) between 13 January 2012 and 12 November 2014, prescribed a total of 390 ampoules of testosterone to [the patient] equating to approximately 3 ampoules per week; and

(b) the recommended maximum testosterone dosage for androgen deficiency listed within the Australian Medicines Handbook Online was 1 testosterone 250 mg/mL ampoule every 2 to 3 weeks.

3.1 On 20 October 2016, the Board decided, pursuant to section 160 (1) (a) of the National Law, to commence an investigation into Dr Hanna's conduct.

(a) on 15 June 2015, Dr Hanna was visited at his medical clinic by a DHHS representative in order to provide detailed counselling to him on his legislative responsibilities under the Drugs, Poisons and Controlled Substances legislation, and to examine his health records in relation to [the patient]: and

(b) On 15 September 2015 Dr Hanna participated in a tape -recorded interview with DHHS where he, amongst other things, acknowledged that he did not prescribe in an appropriate manner for [the patient] and advised that he had learned from this experience and has now undertaken multiple steps to ensure he does not find himself in a similar situation in the future.

3.3 On 17 October 2016, AHPRA, on behalf of the Board, received notice from Dr Hanna of criminal charges having been laid against him.

3.4 On 6 December 2016, in the Melbourne Magistrates Court, Dr Hanna pleaded to, and was found guilty of, three charges under regulation 8(1)(c) of the [Regulations] namely:

(a) at Mount Waverly between 16 January 2012 and 1 May 2012, on four occasions, he prescribed testosterone, a drug of dependence, for one of his patients, in circumstances where he had not taken all reasonable steps to ensure that a therapeutic need existed for that drug;

(b) at Mount Waverly, between 17 May 2012 and 14 October 2013, on thirteen occasions, he prescribed testosterone, a drug of dependence, for one of his patients, in circumstances where he had not taken all reasonable steps to ensure a therapeutic need existed for that drug;

(c) at Mount Waverly between 21 November 2013 and 12 November 2014, on eight occasions, he prescribed testosterone, a drug of dependence, for one of his patients in circumstances where he had not taken all reasonable steps to ensure that a therapeutic need existed for that drug.

4.1 On 8 November 2018, the Board, having formed a reasonable belief that Dr Hanna had behaved in a way that constitutes professional misconduct, determined to refer the matter to the Tribunal pursuant to section 193 (1)(a)(i) of the National Law.

4.2 The allegation contained in the Notice of Allegations is as follows:

(a) professional misconduct within the meaning of paragraph (a) and/or (b) and/or (c) of the definition of professional misconduct in section 5 of the National Law;

(b) unprofessional conduct within the meaning of the definition of unprofessional conduct in section 5 of the National Law;

in that, between on or about 13 January 2012 and on or about 12 November 2014, his prescribing of testosterone (Primoteston[1]) to the patient was clinically inappropriate and/or excessive.

(i) at all relevant times, Dr Hanna was a medical practitioner registered by the Board and working as a general practitioner at Family Care Medical Centre, Mount Waverly;

(ii) at all relevant times the patient was a patient of Dr Hanna;

(iii) during the relevant time, Dr Hanna prescribed approximately 390 testosterone 250mg/ml ampoules to the patient (at an approximate rate of three 250mg ampoules per week) which was approximately nine times the normal therapeutic dose range for this medication;

(iv) on 6 December 2016, in the Melbourne Magistrates' Court, Dr Hanna pleaded to, and was found guilty of, three charges under regulation 8(1)(c) of the Drugs, Poisons and Controlled Substances Regulations 2006, namely;

• (A) at Mount Waverly between 16 January 2012 and 1 May 2012, on four occasions, he prescribed testosterone, a drug of dependence, for one of his patients, in circumstances where he had not taken all reasonable steps to ensure that a therapeutic need existed for that drug;

• (B) at Mount Waverly between 17 May 2012 and 14 October 2013, on thirteen occasions, he prescribed testosterone, a drug of dependence, for one of his patients, in circumstances where he had not taken all reasonable steps to ensure that a therapeutic need existed for that drug; and

• (C) at Mount Waverly between 21 November 2013 and 12 November 2014, on eight occasions, he prescribed testosterone, a drug of dependence, for one of his patients, in circumstances where he had not taken all reasonable steps to ensure that a therapeutic need existed for that drug;

(v) at all relevant times, the Board's Good Medical Practice: A Code of Conduct for Doctors in Australia, (versions effective 1 July 2010 to 16 March 2014 and from 17 March 2014) (Code of Conduct) provided, amongst other things, that good medical practice involves:

• (A) 2.1 .1: assessing the patient, taking into account the history, the patient's views, and an appropriate physical examination. The history includes relevant psychological, social and cultural aspect;
• (B) 2.1.2: formulating and implementing a suitable management plan

(including arranging investigations and providing treatment and advice);

(vi) 2.2.2: ensuring that you have adequate knowledge and skills to provide safe clinical care;

(vii) 2.2.6: providing treatment options based on the best available information;

(viii) 2.2.10: making responsible and effective use of the resources available to you (in particular, 5.2.1: ensuring that the services you provide are necessary and likely to benefit the patient); and

(vi) Dr Hanna's conduct was in breach of the Code of Conduct.

5.1 Dr Hanna admits that he engaged in the conduct particularised in the Notice of Allegations, set out in paragraph 4.2 above.

5.2 Dr Hanna admits that the conduct set out in Allegation 1 constitutes professional misconduct within the meaning of paragraph (a) of the definition of professional misconduct contained in section 5 of the National Law.

1. The National Law defines 'professional misconduct'[2] in the context of a registered health practitioner as follows:
   • (a) unprofessional conduct by the practitioner that amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; and
   • (b) more than one instance of unprofessional conduct that, when considered together, amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; and
   • (c) conduct of the practitioner, whether occurring in connection with the practice of the health practitioner's profession or not, that is inconsistent with the practitioner being a fit and proper person to hold registration in the profession.
2. The Tribunal has power to make findings about conduct under section 196(1)(b) of the National Law.
3. We have made findings on the balance of probabilities, comfortably satisfied they were open on the evidence taking into account the seriousness of the allegation and the consequences of findings such as these.[3]
4. As a question of fact, we were satisfied on the material before us and on the admissions made by Dr Hanna that he engaged in the conduct described in the allegation and during the times specified.
5. Dr Hanna also admitted that the conduct described in the allegation constituted professional misconduct within the meaning of that term in the National Law.
6. We are satisfied that the conduct that formed the basis for the allegation amounted to professional misconduct within paragraph (a) of the definition of that term because the conduct was substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience. In this regard we agree with the submissions made on behalf of the Board[4] this was so given:
   • (a) Dr Hanna admitted to prescribing testosterone 250mg/ml ampoules to the patient on 25 occasions during the relevant period. During each consultation Dr Hanna had the opportunity to consider the patient's prescribing history and/or whether the rate at which he prescribed to the patient was appropriate, however, in contravention of his professional responsibilities to appropriately assess the patient, he failed to do so;
   • (b) Dr Hanna's conduct was frequent, occurring on 25 instances during the Relevant Period, which demonstrates it was not isolated and he contravened his professional responsibility to, amongst other things, implement a suitable management plan for the patient;
   • (c) Dr Hanna failed to monitor the rate at which he was prescribing testosterone to the patient and therefore breached his professional obligations to, amongst other things, provide treatment options to the patient based on the best available information;
   • (d) Dr Hanna failed to identify and/or consider whether testosterone was an anabolic steroid/drug of dependence, in circumstances where it is, and he therefore breached his professional obligation to ensure he had adequate knowledge and skills to provide safe clinical care;
   • (e) Dr Hanna was aware, from on or about 23 October 2013, that the patient was a body builder, but continued to prescribe testosterone in an excessive frequency without relying on any specialist expertise or referring the patient to a relevant specialist;
   • (f) Dr Hanna failed to identify that most of his prescriptions for testosterone authorised multiple repeats;
   • (g) Dr Hanna's conduct illustrates a failure to recognise and/or understand his professional obligations as set out in the Code of Conduct; and
   • (h) Dr Hanna's conduct contravened the Drugs Poisons and Controlled Substances Regulations 2006 and was a criminal offence.

1. It therefore remains for this Tribunal to determine an appropriate sanction for Dr Hanna in respect of the conduct.
2. Section 196 (2) of the National Law provides that we may decide to do one or more of the following:
   • (a) Caution or reprimand Dr Hanna;
   • (b) Impose conditions on his registration;
   • (c) Require him to pay a fine of not more than $3000;
   • (d) Suspend his registration; or
   • (e) Cancel his registration.
3. Under s 196(3), if we decide to impose a condition on the practitioner's registration, we must also decide a review period for the condition.
4. The parties jointly submitted that the appropriate determination in this matter is that Dr Hanna be reprimanded pursuant to section 196(2)(a) of the National Law and for conditions to be imposed on his registration under s 196(2)(b), requiring that he undergo education and submit to a one-off audit of his practice, the terms of which are set out in Annexure A.
5. We were referred by the Board to the decision of the High Court in Commonwealth v Director Fair Work Building Industry Inspectorate.[5] The Board submitted in that case the High Court confirmed that:
   • (a) There is an important public policy benefit in receiving, and, if appropriate, accepting agreed penalty submissions: and
   • (b) Upon persuasion of the accuracy of the parties' agreement as to facts and consequences, and that the penalty the parties propose is an appropriate one, it is a highly desirable practice for the Court to accept the parties' proposal.
6. The Board noted that this submission had previously been accepted by the Tribunal and submitted that 'the Tribunal has found that departure from an agreed position ought not take place without clear or exceptional reason.' In this regard the Board referred to the decision of the then President Ross where His Honour said that the Tribunal should not depart from an agreed sanction were a negotiated settlement and proposed penalty are broadly speaking within the permissible range, having regard to all the circumstances.[6]
7. Nevertheless, the Board's submissions also acknowledged that, 'It is the duty of the Tribunal to determine the facts and the level of conduct alleged and the appropriate sanctions to be imposed in respect of that conduct. No agreement between a regulator and the professional person under review can supplant that duty.[7]

1. The principles which guide in the making of determinations in disciplinary proceedings are well established. The Tribunal's primary role is to protect the public rather than to punish health practitioners who engage in professional misconduct or unprofessional conduct. Determinations also assist to maintain proper ethical and professional standards, and act as a deterrent to other practitioners, so as to protect the public and to protect the profession in the sense of maintaining stature and integrity in the eyes of the public and the profession. That said, determinations may involve a degree of punishment for the purpose of specific deterrence (to deter the individual from repeating the misconduct) or general deterrence (to warn others in the profession against such misconduct). In this regard, the Board recognised the various aspects involved when considering the protection of the public in its written submissions.[8]
2. The Board also set out in its submissions some of the principles relating to the making of determinations, referencing the Tribunal's decision in Medical Board of Australia v Jansz[9] and Medical Practitioners Board of Victoria v Naik.[10] We agree with and adopt what was said in those decisions.
3. Dr Hanna agreed with the guiding principles detailed in the written submissions filed by the Board and added, by reference to relevant caselaw and the objectives of the National Law, that the order which the Tribunal is called upon to make is 'that order which, in its opinion, is necessary, and no more than is necessary, to maintain professional discipline and high standards of conduct'.[11]
4. Dr Hanna's written submissions, by reference to the Court of Appeal in Stirling v Legal Services Commissioner[12] also noted that delay is a relevant matter for the Tribunal to take into account so far as the effect which the lapse of time has on the accused. 'In particular it focuses attention on issues of rehabilitation and fairness'. The submissions further referenced a decision of the Tribunal in which it also noted delay, in the context of disciplinary matters, is a matter relevant for the Tribunal to consider. 'Regard is to be had to the burden of the uncertainty and the fact that the stress and anxiety are themselves a punishment which emphasises the consequences of the offending conduct.'[13]
5. We note also determinations in other cases of similar and analogous conduct will provide useful guidance and that consistency and proportionality are important.[14] However, what is necessary in any particular case to meet the objectives of determinations will depend on all the facts and circumstances.[15]

1. In its written submissions,[16] which were adopted by Dr Hanna, the Board submitted the agreed determination which, as stated earlier, included a reprimand with conditions placed on Dr Hanna's registration, was appropriate because:
   • (a) Dr Hanna's conduct involved multiple contraventions of the Code of Conduct, which is an important means by which medical practitioners' behaviour is assessed;
   • (b) Dr Hanna failed to monitor the rate at which he was prescribing testosterone and failed to realise that most of his prescriptions authorised multiple repeats;
   • (c) Dr Hanna's conduct had the potential to have an adverse impact on patient GB's health, noting that adverse effects have been reported in the context of testosterone and/or anabolic androgenic steroid abuse; and
   • (d) Dr Hanna's conduct has the capacity to undermine the regard in which the profession is held by members of the public and is conduct that cannot be engaged in by members of the profession, such that there is a need for general deterrence.
2. The Board, submitted, however, that:
   • (a) Dr Hanna's conduct was isolated towards one patient; and
   • (b) Dr Hanna has since
     • (i) Completed an education plan with Avant, his insurer;
     • (ii) engaged in education with respect to high risk medicines and Drugs of Dependence; and

made changes to his practice so as to avoid engaging in similar conduct in the future.

1. Although we did not hear directly from Dr Hanna, the following was submitted on his behalf.
2. By way of background, Dr Hanna is 65 years old. He has been married for 37 years and has two adult children and two grandchildren. Dr Hanna initially obtained his medical qualification in and a Master's degree in general surgery in Egypt in 1986. He practised as a general surgeon until he fled Egypt for Australia for fear of religious persecution. Dr Hanna remains heavily involved with his church here in Australia.
3. On arrival in Australia he originally planned to continue to practice as a surgeon. Subsequently he decided to become a general practitioner. He joined a medical practice in Healesville as a general practitioner. He undertook further general practice training and became a fellow of the Royal Australian College of General Practitioners in 2007.
4. Dr Hanna practised in Healesville until the 2010 Black Saturday fires in which he lost many friends. He had significant involvement with the local community in the aftermath of the fires. Dr Hanna decided to move to Melbourne where commenced at his current practices. He works 5 days a week and alternate Saturdays across three clinics.
5. In relation to the allegations, it was submitted, not as an excuse but by way of explanation, that:
   • (a) Dr Hanna's responses given during the record of interview conducted demonstrated his remorse and that a conflation of errors and oversights and misunderstandings had led to the offending;
   • (b) The patient had been attending Dr Hanna well before the prescribing - since 2010 - and throughout the period of prescribing, had consulted Dr Hanna for a whole range of issues unrelated to prescribing of testosterone;
   • (c) Dr Hanna's notes of the first consultation when he prescribed testosterone record that the patient GB had produced a pathology report relating to androgen deficiency;
   • (d) At the time of his prescribing for the patient, Dr Hanna believed the treatment was therapeutically appropriate;
   • (e) Despite recording an instruction at the first consultation that the patient undergo relevant blood tests on a 6-monthly basis, he had, on only one occasion, requested such a test. It showed, however, the testosterone level to be within the normal range and Dr Hanna therefore assumed his prescribing was appropriate;
   • (f) Dr Hanna ceased prescribing testosterone in November 2014 as he had become uneasy about the frequency of the requests and the fact the patient was not presenting regularly for testing;
   • (g) The patient GB continued to see Dr Hanna after Dr Hanna told him he would no longer prescribe him the substances;
   • (h) Dr Hanna failed to understand there was no material difference in the regulations relating to private scripts as opposed to a PBS script; and
   • (i) At the time of prescribing Dr Hanna was unaware that the default setting on the computer software then being used allowed for five repeats.
6. Since the offending, Dr Hanna has taken positive steps to educate himself and make changes to his practice to ensure that such prescribing does not occur again. In particular, the Safescript System has been implemented at the medical practices which is a real time prescription monitoring system which, amongst other things, informs clinical decision making and improves patient safety so that the conduct the subject of this proceeding is precluded.
7. We were referred to a number of character references, each attesting to a kind and caring doctor who is well respected within the profession and noting the prescribing that occurred in this instance was out of character and has caused Dr Hanna genuine remorse and regret.
8. In terms of comparable cases, we were referred to Medical Board of Australia v Saykao[17] (Saykao). In that matter the practitioner had on 10 separate occasions during a period from 23 July 2007 to 7 September 2007 provided prescriptions for a patient to obtain 48 Sustanon[18] 250mg/ml 1 ml injections, as well as other steroids. At no time had the doctor conducted any tests to ascertain the patient's testosterone levels or kept any appropriate clinical notes, nor had he taken any or sufficient steps to ascertain that the patient had a therapeutic need for the medications being prescribed. The prescribed dosage in that case was also excessive and well outside the clinical guidelines. In that case the practitioner had been contacted by two pharmacists, each expressing concern regarding the filling of all the prescriptions so quickly and each time the practitioner had told them to fill the scripts. Subsequently each of the pharmacists contacted DHHS about their concerns regarding the doctors prescribing to the patient.
9. In Saykao, the practitioner was cautioned and reprimanded by the Tribunal, with conditions placed on his registration requiring him to undertake and complete, at his own expense, further education in relation to dealing with difficult patients and in prescribing practices.

1. It is well understood that a reprimand is not a trivial determination. A sanction of this form does not trivialise a lapse in professional standards.[19] For a professional person it has the potential for serious adverse implications.[20] It tells the public, patients and other practitioners that the standards expected of a practitioner have not been met and that the practitioner has been censured.
2. We accept specific deterrence is not a significant factor in determining the appropriate determination in this matter. We are satisfied that the proposed conditions which ensure further education and auditing will minimise any risk of the impugned conduct being repeated. We consider that a reprimand and the conditions proposed sufficiently address the need for general deterrence and meet the requirements of an appropriate determination in that they protect the community and the integrity of the profession. In our view the order to reprimand will flag to others that the behaviour is to be condemned.
3. In forming this view:
   • (a) We have given weight to the fact that Dr Hanna pleaded guilty and accept that he has properly admitted his misconduct and fully cooperated with the Board throughout the investigation;
   • (b) We give weight to the fact Dr Hanna agreed to the findings set out above and the proposed determinations;
   • (c) We accept Dr Hanna has shown remorse and has felt much shame that he has been used to further another's fraud. We accept he has demonstrated insight into his conduct and recognises that he made mistakes;
   • (d) We accept Dr Hanna's explanation of surrounding factors which led to the prescribing, including the fact the patient had been consulting Dr Hanna some years prior to the prescribing and Dr Hanna had believed he was his usual general practitioner. We note also that Dr Hanna ceased prescribing testosterone before the investigation by DHHS was undertaken;
   • (e) We have taken into account the delay in having this matter resolved. We accept Dr Hanna has, during this time, taken positive steps to educate himself, including undertaking modules relating to 'Safescript', 'High Risk medicine and clinical practice' and 'Prescribing Perils associated with Drugs of Dependence';
   • (f) We note there have been no previous transgressions and no further transgressions of his professional obligations;
   • (g) We had regard to the character references from people who know Dr Hanna both professionally and personally;
   • (h) We were mindful of consistency between the Tribunal's decisions and noted the determination imposed by the Tribunal in Saykao was also a reprimand and conditions imposed on the practitioner's registration. In this regard, we noted that whilst the prescribing in that case was over a shorter period of time, it continued notwithstanding the practitioner had been contacted by two pharmacists who raised concerns with the level of prescribing. This is to be contrasted with the present conduct where Dr Hanna ceased prescribing as a result of his own concerns and suspicions; and
   • (i) We were satisfied that the proposed conditions regarding further education and auditing will assist Dr Hanna to consolidate his learnings to date so as to minimise any risk of the conduct being repeated.

1. The Practitioner must undertake and successfully complete a program of education, approved by the Medical Board of Australia (the Board) / AHPRA and including a reflective practice report, in relation to topics including drug seeking and demanding patients, doctor shopping, and drug misuse.
2. Within 28 days of the notice of the imposition of these conditions, the Practitioner must make a nomination to undertake either one on one education or a formal education course (the education) as follows:

On the approved form (HPN24), nominate for approval by the Board/AHPRA an education course, assessment or program (the education) addressing the topics required. The Practitioner must ensure:

1. The nomination includes a copy of the curriculum of the education.
2. The education contains a formal assessment component.

1. nominate a person(s) to be approved by the Board/AHPRA to act as educator, and

1. provide acknowledgement that AHPRA will obtain a report from the approved educator at the conclusion of the education.

The Practitioner must ensure that the nomination of an educator is accompanied by acknowledgement, on the approved form (HPNA11), from the nominated educator and by an education plan outlining the form the education will take and how the topics of the education will be addressed

1. The education should consist of a minimum number of three (3) hours.
2. The Practitioner must complete the education within three (3) months of the notice of the Board's/AHPRA's approval of the education.
3. Within 14 days of the completion of the education, the Practitioner must provide to the Board / AHPRA:

1. Evidence of successful completion of the education. 2. A reflective practice report demonstrating, to the satisfaction of the Board, that the Practitioner has reflected on the issues that gave rise to this condition and how the Practitioner has incorporated the lessons learnt in the education into the Practitioner's practice.

1. Evidence of having undertaken and successfully completed the formal assessment component of the education (if applicable).

1. The Practitioner must submit to an audit of their practice (the audit), including any supporting records, within three months of successful completion of the education conditions, by permitting an auditor (the auditor) approved by the Medical Board of Australia (the Board)/AHPRA to attend any and all places of practice (public and private) for the purpose of the audit and by permitting the auditor to provide a report in relation to the findings of the audit. The audit and the audit report are to focus on the Practitioner's management of patients for whom he has prescribed a drug of dependence for, over the previous four months and must include, at a minimum, a review of the Practitioner's clinical records to determine that the Practitioner:

1. performs appropriate clinical assessments; 2. appropriately assesses the risk of prescribing;

1. appropriately identifies clinical indications for prescribing;

1. formulates appropriate treatment and management plans; 2. identifies the need to refer patients to specialists and provides appropriate referrals to specialists, where required; and 3. appropriately identifies and manages drug dependent patients.
2. Within 21 days of the notice of the imposition of these conditions, the Practitioner must provide to AHPRA:

1. nomination, on the approved form (HPN12), of an auditor(s) to be approved by the Board/AHPRA; 2. acknowledgement, on the approved form (HPN12), that AHPRA will seek a report from the approved auditor at the conclusion of the audit, and

1. acknowledgement, on the approved form (HPNA12), from the nominated auditor.
2. Within 28 days of the notice of the approval of the nominated auditor, the Practitioner must provide to the Board/AHPRA a written audit plan, that has been established with the approved auditor, outlining the form the audit will take and how the area of concerns for the Board will be addressed. The audit will take the form determined by the auditor.
3. In the event an approved auditor is no longer willing or able to provide the audit required, the Practitioner must notify the Board/AHPRA within 14 days of becoming aware of this and provide a new nomination of a proposed auditor(s) to the Board/AHPRA in the same terms as the previous nomination of auditor(s).
4. Within 21days notice of the imposition of these conditions the Practitioner must provide to AHPRA, on the approved form (HPC), the contact details of a senior person, such as the Director of Medical Services, Director of Nursing, Senior Practice Manager, Senior Manager, Senior Partner, Proprietor, Owner, or equivalent (the senior person) at each current place of practice. In providing this form, the Practitioner acknowledges that:
   1. AHPRA will contact the senior person and provide them with a copy of the conditions on the Practitioner's registration or confirm that the senior person has received a copy of the conditions from the Practitioner, and
   2. The Practitioner will be required to provide the same form:
      1. within seven days of the commencement of practice at each and every subsequent place of practice; and
      2. within seven days of each and every notice of any subsequent alteration of these conditions.
5. All costs associated with compliance with the conditions on their registration are at the Practitioner's own expense.

[1] Primoteston is a brand name of the drug testosterone

[3] In accordance with the principles in Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336.

[4] Applicant's written submissions dated 18 September 2019, para 30.

[5] [2015] HCA 46; (2015) 326 ALR 476.

[6] Secretary to the Department of Planning and Community Development v Muto [2011] VCAT 328 at [16].

[7] Medical Board v McGrath [2014] VCAT 641.

[8] Applicant's submissions, para [38] and [39].

[9] [2011] VCAT 1026 at [358] - [373].

[10] [2009] VCAT 755 at [60] - [61].

[11] Dr Hanna's written submissions dated 18 September 2019, para [3] & [4].

[12] [2013] VSCA 374 at para [121].

[13] Dr Hanna's written submissions at para [17] referencing Medical Board of Australia v Proctor (Review and Regulation) [2018] VCAT 576.

[14] Medical Board of Australia v Topchian (Occupational and Business Regulation) [2013] VCAT 86.

[15] Medical Board of Australia v Proctor (Review and Regulation) [2018] VCAT 576.

[16] Applicant's submissions, para [40].

[17] Medical Board of Australia v Saykao (Occupational and Business Regulation) [2011] VCAT 1338.

[18] Sustanon is a brand name of the drug testosterone.

[19] Peeke v Medical Board of Victoria, 19 January 1993 at page 6.

[20] Medical Practitioners Board of Victoria v Swieca (Occupational and Business Regulation List) [2009] VCAT 419.