(b) Guidelines: Sexual boundaries in the doctor-patient relationship.[4]

We observe that these documents provide extremely clear guidance to medical practitioners concerning their responsibilities. We refer to the extracts set out in the Board's Outline of Submissions at paragraphs 21-25.[5] These standards are central to the ethical practice of medicine and all practitioners are required to be aware of, and observe, the principles that they set out.

1. The respondent did not attend the hearing before the Tribunal. His counsel advised the Tribunal that he was instructed to proceed in the respondent's absence.[6]

1. The respondent was born on 15 April 1976. He was aged 45 at the time of the misconduct. He was married with children. He had graduated with a degree in Medicine and Surgery in 2002 from Tanta University in Egypt. He was first granted limited registration in Australia in December 2018 and held limited registration as a general practitioner at the time of the conduct.
2. At the time of the misconduct, the respondent practised as a medical practitioner (subject to level 2 supervision) at a general medical clinic (Clinic).
3. The misconduct was first notified to the Board on 6 October 2021. On 15 November 2021, the Board (after following the required statutory process) took immediate action under s 156 of the National Law by imposing gender-based restrictions on the respondent's registration. Those restrictions are still in place. They prevent the respondent from seeing female patients or from practising by video or telephone consultation.

1. We are required to make findings on the balance of probabilities but, in doing so, we must have regard to the seriousness of the allegations and the potential consequences for the respondent. We also have regard to the respondent's unblemished previous disciplinary record.[7] We are comfortably satisfied of the findings we now make.
2. We make findings in accordance with the facts set out in the SOAF. Our additional findings, drawn from the evidence before us, will be evident from this decision. The salient features of the matter are as follows.
3. Patient EF attended the Clinic from May 2014 for general medical services. She first consulted the respondent on 25 August 2019. In early 2021, she sought the respondent's assistance with respect to emotional issues described hereunder. Between January and October 2021, she attended about 55 consultations with the respondent. She was a single mother, aged in her early thirties at the time of the respondent's misconduct.
4. [Edited]. EF was a highly vulnerable patient.
5. To the credit of the respondent, we note that he appropriately referred EF for treatment by a psychologist. Despite the respondent's efforts, there appears to have been unexplained delays before such treatment was started later in the year. It was also appropriate for the respondent to seek a psychiatric assessment.
6. In early 2021 the respondent referred EF to specialist psychiatrist, Dr Julian Toh, for assessment. Dr Toh's report to the respondent dated 18 May 2021[8] is significant. It ought, of course, to have guided the respondent in his professional relationship with EF.
7. In the report Dr Toh recorded that EF had a childhood history of pervasive and severe attachment traumas and household dysfunction.[9]
8. [The Tribunal then quoted passages from Dr Toh's report which outlined EF's vulnerabilities, particularly in respect of relationships, and that she:

admits to feeling intense attachments to those who help or support her, and when this occurs she will feel intense abandonment and separation anxieties if/when such people are out of her visual field].[10]

9. [Edited].
10. [Edited].
11. Significantly, in discussing a proposed treatment plan, Dr Toh stated:

Finally, I think it is a tribute to you that you have been providing supportive therapy for [EF]. This may over time contribute to the soothing of her internal self-critic, and in conjunction with cumulative and continued internalisation of corrective emotional experiences with each interaction, lead to the gradual formation of a core secure base. However, and you may already be aware, it is especially important in her case to ensure there are limits and boundaries present given her tendency to idealise caregivers, and possibly later devalue them. Such boundaries may include setting limits on frequency and duration of sessions, and also what you can and specifically cannot provide. ....[11]

12. The respondent first emailed the patient, using his personal email account, on 14 April 2021. Thereafter EF and the respondent communicated regularly by email, increasingly for non-therapeutic purposes.
13. Between 14 April 2021 and 2 October 2021, approximately 1800 emails passed between them.[12] The respondent did not respond to all the patient's emails, but at times he confirmed that he was reading her emails and that he did not mind if she kept writing to him if she felt she needed to.[13]
14. The respondent concealed the email communications by failing to include them or refer to them in the patient's clinical record.
15. The respondent sent numerous emails to EF which were inappropriate, personal and/or sexual.[14] In such emails, he:

(a) made comments about EF's physical appearance, including that he found her beautiful and thought she had an attractive figure.[15]

(b) asked EF about her sexual history or preferences, which questions were not relevant to her healthcare and/or without explaining why it was necessary to discuss such matters, including:

(1) whether she enjoys rough sex (including slaps on the body);[16]

(2) whether she has had experiences with masochism and sadism;[17]

(3) whether she can recall a situation in which she was physically abused by someone and enjoyed it;[18] and

(4) whether she felt sexually aroused by his touch;[19]

(c) referred to his personal views about sex;[20]

(d) discussed erotic movies and asked to borrow such movies;[21]

(e) suggested "I am very good at doing massage. Next time, just tell me and I'll be there in seconds. And don't worry, the first session will be free. Ha ha...don't worry I'm joking";[22] and

(f) made intimate and sexually suggestive comments to which we refer in detail below.

1. Most, if not all, of these inappropriate emails were sent after the respondent had received the advice of Dr Toh.
2. The statement of EF[23] and the email exchanges set out in harrowing detail the inappropriate relationship as it developed between the respondent and EF. EF became highly dependent on the respondent. It must have been absolutely evident to the respondent that:

(a) the patient was confused and anxious concerning her relationship with him;

(b) she was often distressed by his email responses or by his lack of response;

(c) she had expressed concern and anxiety about his motives and intentions;

(c) she was frequently distressed and continued to have episodes of self-harm;

(d) she had developed an inappropriate and unhealthy emotional attachment to the respondent;

(e) she was anxious about the prospect of losing his support; and

1. In an email sent after midnight on the morning of 10 August 2021, EF outlined her feelings for the respondent. [The Tribunal quoted from the email].
2. Far from taking steps to terminate (or even to regularise) this unhealthy and unprofessional relationship, the respondent further crossed the borders of appropriate practice.
3. Despite Dr Toh's advice concerning the maintenance of clear boundaries, the respondent accessed the patient's clinical record and obtained her home address. He then drove past EF's home on more than one occasion. On 10 August 2021 the respondent advised EF that he had sat outside her home in his car because he was concerned about her. He said that ethically he should not do this, but he had done so because he cared about her. This caused EF to again become distressed and confused about the relationship.[24]
4. Subsequently, the respondent attended her home for personal and non-therapeutic purposes on approximately seven occasions, including on 15 August 2021, 16 August 2021, 23 August 2021, 2 September 2021, and 18 September 2021.[25]
5. The respondent concealed his visits to the respondent's home by failing to refer to them in her clinical record.
6. At EF's home, he engaged in inappropriate conduct, including:

(a) at his request, sitting on a couch with EF and sharing a blanket which was covering them;[26]

(b) holding hands, hugging and physically touching EF (including her lower back), placing her hand on top of his leg, stroking and rubbing her hands, and stroking and pinching the back of her neck;[27]

(c) borrowing erotic films from EF;[28] and

(d) making inappropriate personal comments to EF[29].

1. During the same period, the respondent made various intimate or sexually suggestive comments to EF by email as set out below.
2. On 19 August 2021, after EF had become dizzy at the end of an appointment, the respondent emailed her as follows:

Be careful on standing up. > > I thought you were going to faint. > > I was close to catch you, carrying you, and putting you on the bed. Luckily that didn't happen because I was feeling tired and I was probably going to lie next to you on the bed and I can't tell you what will happen next!!. Just kidding_[30]_

3. On the same day he emailed "I need massage" and "Massage all around. With my current aches, I would never say no to such a generous offer".[31]
4. During a consultation at the Clinic on 5 September 2021 (during which EF had disclosed that she had been touched by an alleged paedophile when 11 years old), the respondent tapped EF's knees with his fingers whilst sitting in front of her and then asked whether he could hug her before she left the consultation. When she consented, the respondent hugged her by squeezing her tightly and continuing to hold her when she went to release from the hug.[32]
5. On 9 September 2021 at 9.09pm the respondent emailed:

You also once told me that you have a high sex drive, but your anxiety stands between you and your desire**.** > > Is what I said above correct? > > And how do you think that can be fixed? > > Have you ever thought about acting out certain situations and imagining how to face them? I can do that with you. Of course, there will be romantic situations "including the non-gentle one" to cover every aspect. > > And ...I may or may not be joking > > This... You will never know > > Happy sweet dreams_[33]_

6. At 9.50pm the same evening the respondent emailed: "Did you feel sexually aroused to my touch?"[34]
7. On 10 September 2021 the respondent emailed at 6.18am:

I appreciate your honesty. > > And that is encouraging me to ask questions > > If you feel the questions are inappropriate or too much, then simply don't answer > > Now a new strong question > > Do you want to have ....... with me? > > Yes, that is the question. Fill the gap > > You are smart and I think you will be able to guess what is the missing word but I am ready to give you clue if you need to_[35]_

8. Despite the respondent's submissions to the contrary, we consider that the respondent was, in these emails, propositioning EF for sex or for a sexual encounter. He followed up with home visits on 11 and 12 September 2021 when he initiated physical conduct in various ways,[36] clearly suggestive of his romantic or sexual interest.
9. We have no doubt that he was motivated at this time by his own desire for sexual gratification and that he paid no real regard to the actual and potential harm he was causing EF.
10. The respondent was clearly aware that his conduct was unprofessional. He had concealed the emails, the home visits and the relationship.
11. He told EF on 11 September 2021 that he had a request for her. He reaffirmed that he had deleted her emails and said that he needed her to do the same thing for him. He explained that professional boundaries may have been crossed. EF responded by saying that she had expressed her concern previously that one day he would say the relationship was wrong and he would leave, and she would end up hurt. His response was to say again that she needed to delete his emails. She said they would need to have a difficult conversation about that.[37]
12. The respondent emailed her that evening.[38] He repeated the request for deletion of emails. He also said that he would no longer communicate with her through email and would only see her at the clinic. However, he attended her home the following day and the emails continued.[39]
13. On the following day (12 September 2021), they sat together under the blanket with legs touching and watched a movie. The respondent then told EF that their relationship was "flaring her symptoms". He also told her that he did not mind her being attached to him. He said that it was okay and that he liked it. He stroked her neck and hugged her tightly.[40]
14. She had an appointment the next morning (13 September 2021). The respondent held her hands and offered to visit her at home on Friday (17 September 2021). When she became dizzy, he grabbed her and hugged her tightly. He rubbed his hands up and down her back, then moved them down to her hips. He then moved one hand across her stomach. He offered to take her home, but she said she would be okay.[41] EF states that she was "really confused about what had happened". She was "upset that Dr Moussa was behaving in a way that suggested he had his own feeling for me but wasn't telling me". She felt anxious and afraid.[42]
15. At 8.29am on 14 September 2021 the respondent responded to early-morning emails from EF to say:

I'm not sure what I will say here is going to be of value to you or not (because you already mentioned it in your email) but I care and I'll be here to help and support > > The only thing is that it has become a bit codified. Perhaps this change is because our "relationship" is now the major issue that all evolve around. > > It was supposed to help but instead of being helpful it creates a crisis. > > We need to sit together and set lines. > > Nothing is bad. We will set lines to help to restore the good of it.[43]

16. The following day (15 September 2021), the respondent ordered and paid for a take-away meal and had it delivered to EF.[44]
17. The relationship continued and he again visited her home for non-therapeutic purposes on 18 September 2021.[45]
18. On 20 September 2021 the respondent advised EF by email that she should not hesitate in expressing her feelings and sending them to him at any time. [46]
19. On 22 September 2021 she sent the respondent an email stating that she intended to kill herself. He arranged an appointment for that afternoon. She attempted to email again and found that his account had been deactivated. At the appointment, the respondent told her he could not email her any more, and could not visit her at home. He suggested that he had just discovered that use of his personal email was inappropriate.[47] He said it was okay to visit a patient at home but, in this case, it was causing too much harm.[48]
20. The respondent said he would make a weekly appointment for her. He would not abandon her care.
21. Importantly, the respondent told EF that she needed to delete all of his emails. He said that a doctor-patient relationship was built on trust and, if she did not comply and delete all emails, he won't be able to trust her and would no longer see her. She told him not to threaten her.[49]
22. On 27 September 2021 EF told the respondent that she had been advised the relationship was very inappropriate and that he could get into a lot of trouble if she reported it. She told him she didn't want to report it. He asked if she had deleted the emails as he had told her to do. She said she hadn't, and that it was hard for her to do so.[50]
23. On 29 September 2021 EF discovered that she had been blocked by the respondent from making an appointment on HotDoc. She called the Clinic and was unable to make an appointment with the respondent. She became distressed and foreshadowed that, if she couldn't talk to the respondent, she would make a report to the Board. In a subsequent call on 30 September 2021, she again became upset and disclosed the inappropriate relationship. She was asked to make a report in writing. She was told that appointments with the respondent should stop immediately.
24. That evening she received emails from the respondent. He suggested that everything he had done was to help her. He effectively accused her of ingratitude and disloyalty. He said she was pointing a gun at his face and squeezing the trigger. He said: "Is that the way you pay me back".[51]
25. He stated that she was putting him in "enemy category". He said:

You opened your fire on me at first change. My reputation has been damaged and everyone involved is thinking and looking to me as a bad doctor who manipulated a patient. .... > > To be honest with you, I can't see you any more as a doctor. It is not in my hand any more. > > But it is in your hand now to continue our relation as friends or get this one destroyed as well.[52]

26. Significantly, he stated: "We need to talk. We need to contain this."[53]
27. The respondent's final email to EF on 2 October 2021[54] is far more measured. He acknowledges her right to complain. He says that he developed emotional feelings for her and the relationship was "inappropriate between a doctor and a mental health patient". He apologises.
28. However, he also asks her to delete the email.

1. It is important to note the profound effect of the respondent's misconduct on EF. This is outlined in detail in her statement and her victim impact statement.[55] We have had regard to the entirety of that material, understood as it should be in the context of EF's pre-existing mental health issues and vulnerabilities. We highlight some aspects.
2. As was entirely foreseeable, EF developed a very strong and unhealthy attachment to, and dependency on, the respondent.
3. The involvement with the respondent aggravated her condition. She states:

Dr Moussa's conduct while treating me left me increasingly anxious, confused, embarrassed and scared. I spent six months in a constant state of panic never knowing if his conduct - from personal comments, emails, and home visits to physical touching and sexualised behaviour - would impact me. I never knew if my extreme distress or increasing self-harm - triggered by his behaviour - would be received by my GP and handled with professional clinical judgement or if it would be met with a personal response from someone who had feelings for me. This left me feeling insecure, unsettled and very unsafe.

4. This confusion about the relationship was completely understandable given the behaviour of the respondent as revealed in the evidence. It is no surprise at all that the relationship, as the respondent eventually acknowledged, seriously aggravated her condition. The respondent was aware from the emails that the relationship was causing her distress. He was aware that she continued to self-harm regularly. Far from establishing any clear and definite boundaries for the relationship, his response was to blur the boundaries even further.
5. When the respondent's support was withdrawn, EF was devastated. She felt manipulated, used and discarded.[56] [The Tribunal then quoted from a statement of EF].
6. EF also describes the effect on her child and on relationships with family members. She states that she now finds it really difficult to trust medical and mental health practitioners. She describes having panic attacks before appointments. She states that a new female GP has been helpful, but she does not feel comfortable allowing this GP to touch her body.
7. A recent report from the current general practitioner[57] suggests that EF has received psychological treatment over the last two years and her condition is slowly improving.

1. We have no hesitation in finding that the respondent's behaviour, in relation to each allegation, constituted professional misconduct.

1. EF was an extremely vulnerable patient. She trusted the respondent with her deepest thoughts and emotions. He was well aware of her vulnerabilities. He must have been keenly aware of the risks to EF if an inappropriate relationship was allowed to develop. If any further warning was required, EF's vulnerabilities and his responsibilities were spelt out to the respondent by Dr Toh. That warning went unheeded. The respondent proceeded for a long period to act in a manner which caused actual and serious harm to EF.
2. Eventually he sexualised the relationship and prioritised his own sexual gratification over the needs and safety of the patient. Despite saying on 12 September 2021 that their relationship was flaring her symptoms, he said that it was okay for her to be attached to him and that he liked it. Despite acknowledging on 14 September 2021 that the relationship was "creating a crisis", he said he would continue to see her and failed to terminate the improper relationship at any point before a verbal report was made to the Clinic. Even then, he suggested that their friendship could continue. This was professional misconduct of a most serious kind.

1. The respondent concealed the emails and the home visits by failing to record or refer to them in the clinical notes. He concealed the relationship as he knew it to be unprofessional. He deleted emails from his devices.
2. When he became fearful of discovery, he told EF he would continue to see her, but he asked and encouraged EF on various occasions to delete the emails. He asked her to do so three times on 11 September 2021.
3. On 22 September 2021, he told her that she needed to delete all of his emails. He said that a doctor-patient relationship was built on trust and, if she did not comply and delete all emails, he would not be able to trust her and would no longer see her. In our view, this was clearly an attempt to manipulate her into deleting the emails. The respondent was aware that EF was terrified of losing his support. He used this vulnerability in an attempt to manipulate her. On 27 September 2021, he asked again whether she had deleted the emails.
4. On 30 September 2021, after she had made her verbal report to the Clinic, he accused her via email of disloyalty and ungratefulness and suggested that it was up to her whether their friendship could continue.[58] The suggestion was that she should stop being disloyal if she wanted this to happen. We infer that he still hoped she might comply with his deletion request and not pursue any complaint.
5. On 1 October 2021 the respondent emailed EF and said: "We need to talk. We need to contain this between us."
6. The respondent's attempts to manipulate EF and to involve her in the deletion or concealment of evidence are particularly serious. Deletion of the email evidence was not in the best interests of EF. It could have made her complaint extremely difficult to investigate and prosecute. It would have directed focus to EF's credibility as a witness. The respondent's actions in concealing the relationship and his attempts to have the emails deleted by EF constitute professional misconduct of a serious kind. It is the type of conduct which must be deterred if the profession is to be adequately regulated.

1. After the notification was made to the Australian Health Practitioner Regulation Agency (AHPRA), the respondent admitted his misconduct and cooperated with the investigation. He did not deny what was alleged. This is to his credit. Nonetheless, we observe that the email evidence was damning. Given that EF had retained that email evidence, it would have been foolish to deny the relationship.
2. The respondent has also cooperated with respect to the proceedings before the Tribunal. He has admitted professional misconduct and agreed the principal facts. EF has been spared the additional trauma of giving evidence. We take this into account in the respondent's favour.
3. These matters indicate a degree of remorse and insight on the respondent's part.
4. When the Board proposed immediate action in November 2021, the respondent provided a personal reflection.[59] He admitted that he had crossed professional boundaries and hurt his patient by irresponsible behaviour. However, there are aspects of the reflection which we do not accept. The respondent stated:

But, fortunately, I suddenly realised that I was doing the wrong thing. That is not the appropriate way to manage a patient. That suddenly flashed through my mind and the decision was taken: "I should stop whatever the cost" and I decided to take the initiative and put an end to this fault relationship. That made the patient feels the change and submits a complaint. > > I do not blame her at all, it is all my mistake, she has every right to do so. > > That might surprise you, but I feel somewhat relieved in spite of the situation I am in. Maybe because I made the right "courageous" decision in a unique moment that things would have gone so worse had I not corrected myself. > > This is a kind of consolation to me that I have come to the conclusion that what I was doing was wrong and I took a pause at a "precise" "crucial timing". It is also a consolation to me that I took the initiative to identify the flaw in this relationship and took the lead in ending the relationship. (Emphasis in original document)

5. Despite acknowledging that EF had mentally and psychologically suffered due to his conduct, the respondent says little more about this in his reflection. Far more attention is paid to the effect of his conduct on his relationships and his reputation, particularly with his family, employer, colleagues and staff. The reflection was in no way an adequate expression of remorse or insight.
6. We do not accept that the respondent was largely unaware of his wrongdoing until a moment of epiphany when all became clear. He knew from the early stages that it was wrong to communicate by personal email without any record in the clinical notes. He knew it was wrong to access the address of the patient and drive past (or sit outside) her home, again making no record. He knew that the unrecorded home visits were unprofessional. He knew that he was acting in the very manner Dr Toh had warned him about, the very manner which gave rise to extreme risks for the patient. There could have been no doubt in his mind about the inappropriateness of the relationship when he propositioned EF for sex and followed up with home visits for obviously non-professional purposes. We note that he attempted almost simultaneously to progress the relationship sexually whilst seeking to persuade EF to delete the emails.
7. Nor do we consider that the respondent made a "courageous" decision. It is true that he suggested that the unrecorded emails and home visits should stop. However, he did not follow through consistently on that. More particularly, he proposed that the treating relationship would continue and made efforts to conceal what had occurred, which clearly was not in EF's best interests. He was simultaneously saying that the relationship was causing her harm and creating a crisis, whilst proposing that he continue to treat her. His proposed course would continue to expose EF to harm, whilst effectively concealing the truth and denying her referral to other practitioners who could address the crisis he had caused. His conduct, in our view, was directed not by the needs of the patient, but by his desire to conceal the relationship and protect his reputation.
8. The respondent provided a further reflection for the purposes of this hearing.[60] Coming almost four years after the misconduct (and in preparation for the Tribunal hearing), it is a far more adequate expression of remorse and insight. The respondent states:

The mentoring and psychological assessment I have undergone have been instrumental in helping me to understand the profound gravity of my actions.[61]

9. In this reflection, dated 30 August 2025, the respondent speaks of his shame for the damage his actions have caused. He describes his behaviour as exploitative. He acknowledges that he knowingly engaged in behaviour he knew to be wrong and took steps to conceal it. He acknowledges that he was motivated by his own infatuation and sexual curiosity, describing his conduct as "a catastrophic failure of my ethical and professional integrity".[62]
10. We accept that the reflection indicates increased insight and remorse. The respondent did not seek to personally address the Tribunal concerning such matters.[63]
11. In February 2024 the respondent commenced supervision by Dr Glynn Kelly, a general practitioner. By reference to Dr Kelly's brief reports,[64] there were two sessions in February 2024 and one in August 2025. Dr Kelly reports that the respondent was proactive in the sessions and reflective concerning his misconduct.
12. The respondent was examined on 5 June 2025 and 25 July 2025 by Dr Loraine Lim, Forensic Psychologist, for the purpose of an expert assessment and report. Her report dated 7 August 2025[65] is instructive. The respondent advised Dr Lim that his initial motivation was to ensure the patient's emotional and physical safety, but he developed a "morbid sense of curiosity in relation to her disclosures of sexual trauma and past experiences". This led him to ask inappropriate sexual questions of her and to develop an intense emotional "bonding" with her. He agreed that this could be described as an "infatuation" and said, "I feel I over-empathised with her and I also started to be sexually attracted to her ...Because sometimes, she'd present in a glowing attractive way to the clinic." Dr Lim stated:

Dr Moussa acknowledged that it was, ultimately, his infatuation and sexual attraction towards [EF] that has largely accounted for the professional boundary violations and the professional misconduct alleged by the Board on this occasion. He also admitted that he had failed to disclose the private email correspondence during his supervision meetings at [the Clinic] and that he attempted to conceal this behaviour to avoid detection, stating this was because he "always knew [his] behaviour wasn't appropriate.[66]

13. We agree with the view expressed by Dr Lim that the respondent's actions "were not due to any lack of understanding of professional expectations or [EF's] mental health complexities, but rather a profound lapse in his ethical integrity and personal accountability at the time".[67]
14. Dr Lim noted that the respondent had commenced supervision with Dr Kelly, had studied the Code of Conduct, and had completed targeted education through his medical indemnity provider. She noted that the respondent had not sought psychological support but encouraged him to do so.
15. Dr Lim summarised her views as follows:

Dr Moussa appears to have developed a meaningful degree of insight and remorse regarding his misconduct since 2021. During the current assessment, he spoke openly and candidly about his actions, acknowledged the inappropriateness of his behaviour, and demonstrated an evolving awareness of the power imbalance that exists within the doctor-patient relationship. He acknowledged that his actions were "abusive", and he was also able to clearly articulate a recognition of the broader harm his conduct may have caused to [EF], including the potential erosion of her trust in medical professionals and the destabilising effect on her mental health, her parenting capacity, and her functional ability to engage in employment. He also expressed sustained shame and guilt towards his own family, particularly in the light of the distress and strain that his actions have caused to his wife and children. Critically, he has also acknowledged the breach of trust inherent in his conduct and expressed a willingness to accept the consequences of his actions.[68]

16. The respondent's remorse and increasing insight is highly relevant to the issue of specific deterrence and future risk, but of more limited relevance to questions of general deterrence and public confidence in the regulation of the profession.
17. Dr Lim opined:

I believe that Dr Moussa's overall prognosis is a positive one. He does not currently present with enduring psychopathology, antisocial traits, or sexual preoccupations that would place him at elevated risk of repeated boundary transgressions. At present, he appears to be functioning well across occupational and interpersonal domains and has reestablished emotional stability within his marriage and family life. Consequently, I am of the opinion that his risk of engaging in similar boundary violations or professional misconduct in the future is reasonably low, provided that appropriate monitoring and support structures remain in place. Specifically, while certain underlying vulnerabilities in Dr Moussa's personality profile, namely his discomfort with assertive boundary-setting and his tendency to over-identify with distressed patients (ie., counter-transference) may persist as potential risk factors, I believe these could be potentially managed over the foreseeable future through regular clinical supervision, structured opportunities for personal reflection, and ongoing education regarding ethical practice and professional boundaries.[69]

18. We accept that the prognosis for the respondent's future conduct is positive but guarded. The respondent does not dispute that a period out of practice is appropriate, given the seriousness of the misconduct. Any future return to practice will need to be carefully managed, having regard to circumstances existing at the time of such re-entry.
19. With respect to Dr Lim's recommendation for psychological support, it is submitted by the respondent that he commenced counselling in mid-August 2025 with Mr Phillip Isaac, a Clinical Counsellor and Psychotherapist located in Egypt. No reports were tendered.

1. The appropriate principles for the imposition of disciplinary sanctions are well known. They are summarised in this Tribunal's decision in Pharmacy Board of Australia v Roberts.[70] We apply those principles, without repeating them here.
2. A succinct and pertinent statement is to be found in the judgement of Bleby J in Maroulis v Psychology Board of Australia.[71] His Honour stated:

The protective purpose of disciplinary proceedings continues to be emphasised. In Health Care Complaints Commission v Do, the [NSW] Court of Appeal observed: > > 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 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 practice.[72]

3. We consider it appropriate to impose a global sanction covering both findings of professional misconduct.
4. The Board proposes that the Tribunal impose the following sanctions:

(d) prohibition from providing any health service and from using the titles "doctor" or "Dr" until re-registered.

1. The respondent proposes that a suspension for a period of less than 12 months would be proportionate (perhaps with conditions applying on return to practice).
2. We take into account the fact that the respondent has been subject since November 2021 to the gender-based conditions of practice. This has been a restriction on his practice and earning capacity.
3. We have regard to the respondent's unblemished disciplinary record, his early admissions and cooperation, his remorse and increasing insight, and his efforts at rehabilitation. To the extent appropriate,[73] we have regard to the respondent's personal circumstances, including his role as sole breadwinner for his family.
4. The respondent submitted that, as a general practitioner, he should not be judged as harshly as a psychologist or psychiatrist due to their specific mental health training. We have regard to the respondent's more limited training, but we have already found (and the respondent has largely acknowledged) that the conduct in question was primarily due to his own "catastrophic failure of ... ethical and professional integrity" rather than any deficit of knowledge or skill.
5. Mental health patients are commonly treated by general practitioners and EF, like many such patients, was particularly vulnerable. The respondent had been warned of her vulnerabilities, and reminded of his responsibilities, and yet over an extended period he did what he knew to be wrong, putting his own interests ahead of the welfare and safety of his patient. His conduct was abusive, manipulative and disgraceful. It put his patient at significant risk and (as was clearly foreseeable) it caused great harm.
6. We note, of course, that the respondent did not actually engage in sexual intercourse with the patient. He did not kiss the patient or touch intimate areas of EF's body. However, it would be an error in this case to focus simply on the physical acts. The gravamen of the misconduct was the respondent's emotional abuse of the patient, against which background he propositioned her for sexual contact and gave her every opportunity to engage in such contact. We consider that his misconduct was far more serious than many cases where intercourse did occur. It was more serious due to the extreme vulnerability of the patient, the obvious risk of serious harm (whether intercourse occurred or not) and the significant harm which did occur.
7. We give weight to the view expressed by the professional regulator as to the sanctions that are required to protect the public. In the end, however, the Tribunal must impose the sanctions it considers appropriate. We do not consider that the sanctions proposed by the Board sufficiently provide for the protection of the public.
8. We impose a reprimand. We consider that it is appropriate and necessary to cancel the respondent's registration. We impose a disqualification for a period of two years. We prohibit the respondent from providing any health service, and from using the titles referred to, until he again becomes registered as a health practitioner.
9. We consider that these sanctions are appropriate and necessary for the following reasons:

(a) It is necessary to emphasise to the respondent and to other health practitioners, and to reaffirm to the public, that this conduct falls abysmally short of the required and accepted standard and will not be tolerated. Cancellation of registration highlights that the conduct is inconsistent with fitness to practice and a two-year disqualification underlines the seriousness of the departure from the required standard.

(b) The sanctions reassure the public not only that standards will be maintained and enforced, but also that vulnerable patients will be protected from manipulation and abuse. We consider that the sanctions will assist in maintaining public confidence in the profession and the regulation of the profession.

(c) If appropriate standards are to be maintained, it is essential to deter other health practitioners who may be disposed to commit serious boundary violations and to pursue their own interests (and sexual gratification) without due regard for the welfare and safety of their patients. We consider that these sanctions will achieve that purpose.

(d) As stated above, the respondent's attempts to have the emails deleted by EF constitute professional misconduct of a serious kind. It is the type of conduct which must be deterred if the profession is to be adequately regulated. We consider that the sanctions will also achieve that purpose.

(e) We accept that the respondent's prognosis (in terms of future conduct) is positive but guarded. We have reservations concerning his current fitness to practise. At best, it is conditioned upon a raft of protective conditions and safeguards. The sanctions will enable him to apply for registration after the period of disqualification has elapsed. That is some time into the future. It is appropriate that the Board then consider his fitness and propriety in the light of circumstances pertaining at that time. If the respondent is re-registered, the Board can impose conditions as appropriate to the circumstances then existing.

(f) The prohibition from providing any health service is necessary, in our view, to prevent potential circumvention of the Tribunal's order (and consequential negative impact on public confidence) if the respondent was to secure work in an allied health field during the period of his non-registration. The prohibition will serve to protect the public from any unethical conduct that might otherwise occur in such context prior to the respondent establishing his fitness to practice unconditionally.

(g) In considering the appropriate sanctions, we have considered the various authorities referred to by the parties. They are of limited assistance as each matter turns on its own facts and the outcomes are extremely varied. We have been referred to various cases where the sanctions imposed were far more lenient than the sanctions we have imposed. We consider, however, that the sanctions we have imposed are broadly in line with those imposed in Medical Board of Australia v Moodley [2025] SACAT 20 (disqualification for two years), Medical Board of Australia v Foroughi (Review and Regulation) [2024] VCAT 575 (disqualification for six years), Psychology Board of Australia v Holmes [2020] SACAT 122 (disqualification for five years), Psychology Board of Australia v Meulblok (Review and Regulation) [2020] VCAT 579 (disqualification for two years), Nursing and Midwifery Board of Australia v Monteduro [2020] SACAT 27 (disqualification for 10 years), Psychology Board of Australia v Brideson (Review and Regulation) [2021] VCAT 899 (retired from practice, but prohibition order for three years), Nursing and Midwifery Board of Australia v Arbon [2021] SACAT 43 (disqualification for two years), Nursing and Midwifery Board of Australia v Lawless (No 2) [2025] SACAT 29 (disqualification for three years), Psychology Board of Australia v Angelakis [2025] SACAT 72 (disqualification for three years), Nursing and Midwifery Board of Australia v Shepherd [2021] SACAT 46 (disqualification for two years), Medical Board of Australia v Brown (Review and Regulation) (Corrected) [2023] VCAT 1075 (disqualification for 18 months), and Psychology Board of Australia v Maroulis [2019] SACAT 69 (disqualification for three years).

The sanctions in this last case were affirmed on appeal to the Supreme Court[74] with Bleby J stating:

Cancellation of registration and a considerable period of disqualification are commonly deployed in response to breaches of the professional boundary by sexual contact. The question of the appropriate sanction in any given case directs attention to what, in the Tribunal's assessment, is necessary to protect the public in the particular circumstances, having regard to the historical course of sanctions for broadly comparable transgressions.[75]

1. It is appropriate to order that the respondent pay the Board's costs of the proceeding to be agreed, or in default of agreement, to be determined by the Tribunal.
2. Our formal orders are:

(1) The Tribunal decides that the respondent has behaved in a way that constitutes professional misconduct.

(2) The Tribunal imposes the following disciplinary action:

1. The respondent is reprimanded.
2. The registration of the respondent is cancelled.
3. The respondent is disqualified from applying for registration as a registered health practitioner for a period of two years from the date of this order.
4. The respondent is prohibited from providing, in any capacity (including as an employee, contractor, manager, or volunteer), and whether directly or indirectly, any health service until such time as he is again registered as a health practitioner under the National Law. (The term "health service" has the meaning it bears in the National Law).
5. The respondent is prohibited from using the titles "doctor" or "Dr" until such time as he is again registered as a health practitioner under the National Law.

1. The respondent must pay the costs of the Board to be agreed or fixed by the Tribunal.

By order made on 27 August 2024 pursuant to s 60 of the South Australian Civil and Administrative Tribunal Act 2013, the Tribunal prohibited the publication of the name of, or any material tending to identify, the person referred to in this Statement of Reasons by use of the pseudonym "EF". That order remains in force.

[1] The National Law is to be found in schedule 2 to the Health Practitioner Regulation National Law (South Australia) Act 2010.

[6] There was a discussion about establishing a video link to allow the respondent to participate, but neither party requested this.

[7] Nursing and Midwifery Board of Australia v Hissey [2020] SACAT 80 at [6] - [8].

[11] A1 pages 1767-1768 (emphasis added).

[13] See, for example A1 pages 1192-1193 (18 May 2021), 948-949 (31 May 2021), 1020-1021 (17 June 2021), 906-908 (18 June 2021), 1233-1234 (4 July 2021), 1111 (9 July 2021), 1284 (4 September 2021).

[14] For example, A1 pages 1108-1109 (2 July 2021), 795 (28 July 2021), 871 (19 August 2021), 1117 (10 September 2021), and 1163-1164 (17 September 2021).

[15] A1 pages 1338 (4 July 2021), 1254-1255 (17 August 2021), and 919-120 (27 August 2021).

[17] A1 pages 1164-1165 (17 September 2021).

[20] A1 pages 416-417 (20 July 2021), 1164-1165 (17 September 2021), 1132 (7 September 2021).

[21] A1 pages 1187-1188 (28 August 2021), 1132 (7 September 2021), 914 (15 September 2021), and 1165-1166 (17 September 2021).

[24] EF Statement (EFS): A1 page 83-84, paras 86 and 89.

[25] EFS: A1 pages 85-97, paras 94-96, 103-104, 114, 122, 124 and 131.

[27] EFS: A1 pages 86-95, paras 96, 103-104, 122 and 124.

[29] EFS: A1 page 86, para 96; A1 pages 93-94, para 122.

[30] A1 pages 869-870 (19 August 2021) emphasis added.

[32] SOAF para 4.8; A1 pages 91-92, para 116.

[33] A1 pages 1131-1135 emphasis added.

[36] See para 31 above; A1 pages 93-94, paras 122-124.

[47] He would eventually admit that he always knew his behaviour to be wrong.

[48] A1 pages 97-99, paras 134-139; pages 1059-1060.

[52] A1 pages 1250-1251 (emphasis added).

[55] A1 page 106; A2 pages 2279-2283 (victim impact statement).

[63] The possibility of establishing a video link, so that the respondent could participate in the hearing, was discussed but the respondent did not seek that, even though he was available.

[70] [2022] SACAT 111 at [38]- [46].

[71] [2021] SASC 16.

[72] [2021] SASC 16 at [39], citing Health Care Complaints Commission v Do [2014] NSWCA 307 at [35].

[73] Cf Medical Board of Australia v Tunbridge [2020] SACAT 34 at [23]; citing Craig v Medical Board of South Australia [2001] SASC 169; (2001) 79 SASR 545 at page 556; Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 at page 637; and Medical Board of Australia v Singh [2017] WASAT 33.

[74] Maroulis v Psychology Board of Australia [2021] SASC 16.

[75] Maroulis v Psychology Board of Australia [2021] SASC 16 at [57].