Health Practitioners - Complaint by the Medical Board of Australia - Professional misconduct - Inappropriate prescribing, inadequate record-keeping and inappropriate patient management or care - Registration suspended for 12 months, conditions imposed on registration and reprimand

Health Practitioner Regulation National Law (South Australia) Act 2010 s 193

South Australian Civil and Administrative Tribunal Act 2013 s 60

Medical Board of Australia v Tunbridge [2020] SACAT 34

Craig v Medical Board of South Australia [2001] SASC 169; (2001) 79 SASR 545

Medical Board of Australia v Singh [2017] WASAT 33 (S)

Order suspending a Practitioner's Registration; Order Imposing a condition on a Practitioner's Registration; and Order to Reprimand a Practitioner

Made under the Health Practitioner Regulation National Law (South Australia) Act 2010

1. This is the determination of a complaint filed with the Tribunal on 7 August 2019 by the Medical Board of Australia (the Board, the complainant) pursuant to s 193 of Schedule 2 to the Health Practitioner Regulation National Law (South Australia) Act 2010 (the National Law), concerning Dr Andrew Owen. The original complaint against Dr Owen had been made to the previous SA Health Practitioners Tribunal on 27 December 2018, and this complaint was subsequently transferred to the Tribunal with the transfer of the jurisdiction to this Tribunal.
2. The complaints alleged improper prescribing; deficient assessment of seven patients; and inadequate record keeping.
3. There have been numerous directions hearings convened by the Tribunal to assist in the movement of this matter to a full hearing. The complainant filed voluminous documentary material and an outline of submissions with the Tribunal on 18 November 2020. However, the full hearing convened for 25 November 2020 was vacated as a result of COVID-19 restrictions in South Australia.
4. On 7 December 2020, the day before the rescheduled date for the full hearing of the complaint, the parties filed an amended Agreed Statement of Facts and Findings, a further volume of documents, and agreed Draft Minutes of the Orders sought from the Tribunal. At the hearing the parties advised they had come to an agreement as to the proposed outcome. Other documents were provided at the hearing.
5. Accordingly, the Tribunal had before it three volumes of documents provided by the complainant; an Amended Agreed Statement of Facts and Findings; Draft Minutes of Order; an undated reflective letter from Dr Owen; emails from referees for Dr Owen, indicating they were familiar with the background facts of the complaint; and emails from Dr Roberts and Dr Flynn, indicating they were prepared to act as mentors for Dr Owen as proposed in the Draft Minutes of Order. The Tribunal takes all this material into account.
6. At the hearing Mr Cox QC sought to make two additions to the Draft Minutes of Order. The complainant did not oppose these proposed additions.
7. In the first place Mr Cox QC sought an addition to the Draft Minutes of Order concerning confidentiality, namely an order pursuant to s 60 of the South Australian Civil and Administrative Tribunal Act 2013 (the SACAT Act) prohibiting the publication of the names of the patients referred to in the Agreed Facts and Findings, or anything that may tend to identify those patients.
8. In addition, Mr Cox QC directed the Tribunal's attention to the fact that Dr Owen shared a common patient with another doctor the subject of other proceedings before the Tribunal in Medical Board of Australia v Tunbridge [2020] SACAT 34. This patient is referred to (in anonymised terms) in the Complainant's Outline of Submissions before the Tribunal. Mr Cox QC sought a confidentiality order in similar terms with respect to this patient.
9. Noting the complainant did not object to these applications and being satisfied such orders are appropriate, the Tribunal will make these orders.

1. The parties provided the Tribunal with a detailed and extensive Statement of Agreed Facts, and the Tribunal adopts these, noting they are supported by the other evidence provided to the Tribunal
2. A brief summary of these Agreed Facts is as follows:
   • Dr Owen was first registered as a medical practitioner in January 1990, and was appropriately registered as a medical practitioner at all relevant times
   • Between 2 August 2003 and 15 September 2016 (the relevant period) he predominantly practiced as a medical practitioner in South Australia
   • Dr Owen obtained specialist registration with the complainant in the area of General Practice in July 2010.
   • During the relevant period he practiced from the Stirling Surgery in both traditional general practice and an "integrative" medical practice, treating a cohort of patients with a combination of conventional western medicine and complementary medicine and therapies, with a particular interest in treating anxiety and depression, including treatment with "vitamins", and Methyltetrahydrofolate reductase (MTHFR), "gene polymorphism" and "the potential benefits of Folinic acid"
   • From about March 2015 Dr Owen asked new patients to sign a "New Patient Agreement" that purported to limit his involvement in their medical management exclusively to issues relating to the MTHFR Gene (Anxiety and Depression) or any other conditions previously agreed with his reception staff.
   • In August 2014 a notification was referred to the complainant by a female patient (MR) concerning the administration of testosterone implants and steroid injections by Dr Owen to MR. The complainant commissioned an independent report into the matters notified and this report was provided to Dr Owen in June 2015 together with a confirmation that the complainant had formed the view that the way Dr Owen practiced "is or may be unsatisfactory", and a proposal to caution him and inviting a response. Dr Owen responded in July 2015 admitting some matters but stating that he disagreed with the assessment in the expert report obtained and other aspects of the report. In August 2015 the complainant decided to take no further action in relation to the notification, noting however that Dr Owen had provided an assurance to the complainant that his clinical notes would appropriately reflect any consent discussions in the future.
   • In May 2016 the Australian Health Practitioner Regulation Agency (AHPRA) received a notification from a notifier, CA, raising concerns about certain treatment allegedly provided to CA by Dr Owen, including the prescription of folinic acid, melatonin and methylcobalamin, as well as pathology testing for testosterone levels and MTHFR gene analysis. The complainant decided to commence an investigation.
   • As part of the investigation two independent experts were instructed to provide opinions about Dr Owen's treatment of seven patients. Reports were received from these experts and Dr Owen provided responses to the reports.
   • On 20 June 2018 the complainant referred Dr Owen's conduct to the SA Health Practitioners Tribunal (the former tribunal) and the complaint was filed with the former tribunal on 27 December 2018. Opinions were obtained from three further experts concerning Dr Owen's treatment of the seven patients. These opinions were provided to Dr Owen in September 2019. Those proceedings were transferred to this Tribunal on 9 August 2019.
   • The complaint before this Tribunal was amended in October 2019 alleging that Dr Owen had engaged in conduct that was (alternatively) professional misconduct, unprofessional conduct, and/or unsatisfactory professional performance, in three broad categories, namely, improper prescribing; deficient assessment; and inadequate record keeping.
   • Dr Owen has made the following admissions:
     • His prescribing of testosterone and oestradiol to four patients (SO, LS, JK and KF) in the relevant period was inappropriate in that there was no proper therapeutic indication for the prescribing; the Therapeutic Goods Administration had discontinued its registration of testosterone and oestradiol implants; there was no safety or efficacy data for the implants prescribed; the prescribing had the potential to increase risk to patients; he did not have personal endocrinology, clinical pharmacology or other specialist expertise; for three of the patients (SO, LS, and JK), he did not have advice from an appropriate specialist medical practitioner;
     • His prescribing of triiodo-1-thyronine (T3) on 1 July 2016 for LS was inappropriate because he did not satisfy himself there was sufficient evidence of hypothyroidism and a proper therapeutic indication for the prescribing of T3 to LS. Dr Owen prescribed T3 because it was a current medication and he considered there was "insufficient indication" for ceasing it at that time, but he now accepts it was unacceptable practice for him to prescribe T3 without undertaking and documenting a sufficient clinical examination or other investigation;
     • His prescribing of testosterone to two patients (MJ and GP) was inappropriate because (in relation to MJ) when MJ was referred to him by another medical practitioner he did not conduct an adequate physical assessment of MJ or take a sufficient history to satisfy himself that there was a proper therapeutic indication for prescribing testosterone; and in relation to GP, that before he prescribed testosterone, he did not conduct and document an appropriate diagnostic workup, make or conduct a diagnosis, have any specialist medical practitioner recommendation to commence treatment with testosterone before October 2015, or perform or document an adequate assessment or obtain a sufficient history to independently satisfy himself there was any proper therapeutic indication for prescribing testosterone;
     • He inappropriately prescribed or recommended supplements to the seven patients in that there was no therapeutic indication to justify this, and he did not have any personal endocrinology, clinical pharmacology or other specialist expertise;
     • In relation to the seven patients in the relevant period, he failed to undertake sufficient clinical assessments, tests and/or follow up appointments;
     • He failed to comply with professional obligations with regard to record keeping in relation to the seven patients during the relevant period, in particular in failing to keep accurate, up to date and legible records reporting all relevant details of clinical history, clinical findings, investigations, information given to patients, medication and other management, in a form that could be understood by other health practitioners; failed to create records sufficient to facilitate continuity of care for patients; and failed to document any informed consent that may have been given by patients in respect to the improper prescribing, despite having provided an assurance letter to the complainant stating he would ensure his critical notes would reflect any relevant discussions.
3. The Tribunal notes the agreed facts in the summary set out above, and accepts they reflect the circumstances of the complaint and Dr Owen's conduct, as well as the most serious of the criticisms of his conduct as set out in the independent expert opinions obtained by the complainant.

1. Mr Schatz emphasised to the Tribunal that although the parties had reached agreement on the facts and appropriate sanctions, it was for the Tribunal to make its own decision on these matters.
2. He told the Tribunal the Board accepted that Dr Owen has now demonstrated insight and remorse as demonstrated in his reflective letter provided to the Tribunal, but he noted this had been provided very late in the proceedings, only on the morning of the hearing. He told the Tribunal that until January 2020 when he filed a response in the Tribunal, Dr Owen had disagreed with and disputed all the expert opinions provided by the complainant. In his response of January 2020 Dr Owen had made only very limited admissions concerning the inadequacy of his record keeping, his failure to comply with his assurance to the complainant and some other matters, but continued to deny, or not admit, many of the key allegations.
3. With respect to the complaint of improper prescribing, Mr Schatz submitted that the decided cases and authorities suggested five unifying principles:
   • The proper handling and prescribing of drugs by medical practitioners is of greatest importance to the community
   • Inappropriate prescription of drugs where there is no therapeutic basis is a serious matter and amounts to professional misconduct
   • Choosing to practice outside the mainstream does not absolve a practitioner from practising in accordance with the relevant standards
   • Failure to keep adequate records, and/or failing to obtain informed consent in writing, can be a significant and aggravating feature
   • If a practitioner is found to have engaged in professional misconduct involving the inappropriate prescription of drugs then a range of disciplinary actions may be appropriate.
4. With reference to these principles Mr Schatz submitted Dr Owen's admitted conduct in relation to improper prescribing amounted to professional misconduct within the meaning of s 5 of the National Law, and submitted further this finding should be made on the basis of the evidence and opinion before the Tribunal, even had Dr Owen not made these admissions.
5. With respect to the complaint of deficient assessments, Mr Schatz submitted that Dr Owen had made admissions concerning deficient assessments of all seven patients on the relevant period. These admissions raise issues of informed consent as well as appropriate treatment. Mr Schatz told the Tribunal that a failure to obtain informed consent in writing has been considered by the Tribunal as an aggravating feature in particular where unproven and potentially harmful medications may be prescribed without appropriate warnings or advice to patients, and where the treatments are unconventional or of unproven benefit may exhibit a serious disregard for the requirements of professional practice. Those considerations are applicable in this matter.
6. In addition, he referred the Tribunal to the assurance letter Dr Owen had previously provided to the complainant concerning his clinical notes. Mr Schatz said the complainant had relied on Dr Owen's letter of assurance in deciding to take no further action with respect to the 2014 notification. He submitted that there was a reasonable expectation that Dr Owen would comply with the assurance he had given, and ethical conduct was a significant feature of professional conduct.
7. Mr Schatz submitted that Dr Owen's failure to obtain and document informed consent despite his earlier assurance constituted professional misconduct, and in addition ought be treated as an aggravating factor with respect to the improper prescribing.
8. In relation to the complaint of inadequate record keeping, Mr Schatz submitted Dr Owen had admitted that his record keeping was inadequate in relation to all seven patients. He submitted that the admitted inadequate record keeping could be characterised as unprofessional conduct if it occurred in isolation but amounts to professional misconduct as there was more than one instance, and in addition occurred in conjunction with the other admitted conduct.
9. Mr Schatz acknowledged the reflective letter provided by Dr Owen to the Tribunal. However, he referred again to the lateness of Dr Owen's admissions and his ongoing defence of his conduct for a significant period, with most admissions not made until just before this hearing. He submitted that Dr Owen's conduct clearly constituted professional misconduct and was sufficiently serious to demonstrate when it occurred that he was unfit to be registered as a medical practitioner under the National Law. While accepting Dr Owen's reflective letter, he emphasised to the Tribunal that it was for the Tribunal to be satisfied Dr Owen had demonstrated that he had obtained insight into his conduct and become a reformed person. Mr Schatz told the Tribunal the complainant accepted that Dr Owen's reflective letter demonstrated he is remorseful and has obtained insight into his conduct and its nature.
10. In this context Mr Schatz also noted the personal references provided on behalf of Dr Owen.
11. In conclusion, Mr Schatz submitted the Tribunal must consider the nature of Dr Owen's conduct at the time when it occurred, but in the light of Dr Owen's reflective letter the complainant accepted that cancellation of his registration was not a required sanction.

1. Mr Cox QC for Dr Owen told the Tribunal that although it was for the Tribunal to make its own findings and determine appropriate sanctions, it should take into account a properly negotiated agreed outcome, which he told the Tribunal was the case in the material presented at the hearing of this matter, which represented an extended and detailed agreement concerning the facts and appropriate outcome.
2. Mr Cox QC referred the Tribunal to Dr Owen's reflective letter, which he said represented a humbling process for Dr Owen. He said Dr Owen now deeply regrets his earlier responses to the complaints and the material provided by the Board in its investigation, and the letter demonstrates his acknowledgement of his conduct and his understanding of his deficiencies in his practice.
3. Mr Cox QC said that Dr Owen had ceased prescribing testosterone in May 2020 and had now moved to a group practice location so he is no longer isolated in a sole practice. He has frankly acknowledged his need for mentoring and education and acknowledged the efficacy of the proposed conditions on his future registration.
4. Mr Cox QC also referred to the personal references provided in support of Dr Owen. He told the Tribunal they were each from persons of known integrity and established judgment and suggested the Tribunal could feel confident that the referees were exercising their judgment and taking care in giving their opinions on Dr Owen's character. He accepted Mr Schatz' view however that the Tribunal should place its primary reliance on Dr Owen's own reflective letter in making an assessment of his position now concerning the complaints.

1. Section 196 of the National Law governs the Tribunal's determination in this matter. There are two matters to be determined: the characterisation of Dr Owen's conduct; and the appropriate disciplinary sanction to be imposed.
2. Section 196(1)(b) of the National Law empowers the Tribunal to decide one or more of the following as the appropriate characterisation of the practitioner's conduct:

(i) the practitioner has behaved in a way that constitutes unsatisfactory professional performance;

(ii) the practitioner has behaved in a way that constitutes unprofessional conduct;

(iii) the practitioner has behaved in a way that constitutes professional misconduct;

...

1. Professional misconduct is defined in clause 5 of Schedule 2 of the National Law as follows:

professional misconduct, of a registered health practitioner, includes -

(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.

1. The Tribunal notes Dr Owen was a registered health practitioner within the meaning of the National Law at all relevant times.
2. With respect to the issues of the appropriate characterisation of Dr Owen's conduct, and the appropriate sanction to apply, the parties have reached agreement and jointly proposed an outcome to the Tribunal. Regardless of these agreements, it is for the Tribunal to consider and determine these matters.
3. The Tribunal accepts Mr Schatz' summary of the unifying principles underlying decisions concerning matters amounting to professional misconduct, namely, that proper handling and prescribing of drugs by medical practitioners is of greatest importance to the community; inappropriate prescription of drugs where there is no therapeutic basis is a serious matter and amounts to professional misconduct; choosing to practice outside the mainstream does not absolve a practitioner from practising in accordance with the relevant standards; failure to keep adequate records, and/or failing to obtain informed consent in writing, can be a significant and aggravating feature; and if a practitioner is found to have engaged in professional misconduct involving the inappropriate prescription of drugs, then a range of disciplinary actions may be appropriate. In assessing the appropriate characterisation of Dr Owen's conduct the Tribunal takes these into account.
4. Having considered the material and submissions before the Tribunal, including the Amended Agreed Statement of Facts and Dr Owen's reflective letter, we are satisfied of the following:
   • that Dr Owen prescribed various drugs and supplements inappropriately and without sufficient therapeutic indication, without the conducting or documentation of appropriate diagnostic tests and, in prescribing testosterone to women, lacking the appropriate knowledge and expertise to do so safely;
   • that his assessment of the seven patients was deficient in various respects, including inadequately purporting to limit the scope of his medical management of some new patients; diagnosing patients as presenting with deficiencies without sufficient scientific or clinical basis; undertaking inadequate pathology assessments; and failing to conduct adequate physical examinations, obtaining adequate patient histories, formulating and implementing appropriate management plans, practicing within the limits of his competence, appropriately consult with or refer patients to other specialist practitioners, and obtain fully informed consent;
   • that Dr Owen's record keeping for the seven patients was inadequate.
5. On this basis the Tribunal is satisfied that all three elements of the complaint against Dr Owen are established.
6. We note that Dr Owen has admitted that the totality of his admitted conduct constitutes professional misconduct within the meaning of the National Law, in that together it amounts to conduct substantially below the standard expected by the National Law.
7. The Tribunal is satisfied that the findings above and Dr Owen's admissions support a finding professional misconduct by Dr Owen.
8. The further issue to be considered by the Tribunal is the appropriate sanction to be applied to Dr Owen. We note the parties have made proposals as to what they consider to be appropriate, taking into account Dr Owen's admissions and reflective letter, as well as the requirements and purpose of the National Law, and we take these into account in our considerations.
9. The central issue in relation to sanction is an assessment of the risk to the public, and in considering this the Tribunal must bear in mind the purpose of such sanctions under the National Law. These general principles are set out in the judgement of Doyle CJ in Craig v Medical Board of South Australia [2001] SASC 169; (2001) 79 SASR 545 at 553:

The purpose of a disciplinary sanction is to protect the public and not to punish a practitioner in the sense in which punishment is administered pursuant to the criminal law. A disciplinary tribunal protects the public by making orders that will prevent persons who are unfit to practice from practising, or by making orders that will secure the maintenance of proper professional standards. A disciplinary tribunal will also consider the protection of the public, and of the relevant profession, by making orders that will assure the public that appropriate standards are being maintained within the relevant profession.

At the same time, the disciplinary action must be proportional and appropriate to all the circumstances of the case.

1. These principles are widely accepted and applied in the case law, recognising that the purpose of disciplinary proceedings is to protect the public, maintain proper professional standards, and to assure the public that proper standards are being maintained in the relevant profession. A disciplinary sanction also assists in upholding the public trust and confidence in the profession, bringing home to the practitioner the seriousness of their conduct, deterring the practitioner from any future departures from appropriate standards, deterring other members of the profession from acting in a similar manner, and imposing restrictions on the practitioner's right to practice so as to ensure the public is protected.
2. The Tribunal notes that the parties have agreed on sanctions proposed to be applied to Dr Owen, including a 12-month suspension of his registration and conditions to be imposed on his future registration. Such agreement between the Board and the practitioner obviously is useful for the Tribunal to take into account in considering an appropriate sanction as it demonstrates the sanction that the Board considers appropriate to effectively address the objects of the National Law to protect the public and maintain professional standards and confidence in the profession, as well as demonstrating that the practitioner recognises and appreciates the deficiencies in his conduct and its inappropriate nature and is taking responsibility for it.
3. Nevertheless, the Tribunal must be satisfied as to the appropriate sanctions to apply to achieve these ends in the particular case before it. Accordingly, to adopt the sanctions proposed and agreed by the parties, the Tribunal must be satisfied they address the concerns of the National Law, of protecting the public, and maintaining professional standards and confidence in the profession.
4. In making an assessment of the risk Dr Owen's future medical practice might pose in respect of these concerns, both parties directed the Tribunal to the 12 points identified in Medical Board of Australia v Singh [2017] WASAT 33 (S), as relevant in considering the issue of risk. The Tribunal adopts the considerations articulated in Singh as appropriate in this matter, although it appreciates they are neither prescriptive nor necessarily exhaustive.
5. These factors are as follows:
   • Any need to protect the public against further misconduct by the practitioner.
   • The need to protect the public through general deterrence of other practitioners from similar conduct.
   • The need to protect the public and maintain public confidence in the profession ... [including] an emphatic indication of ... disapproval.
   • In the case of conduct involving misleading conduct, including dishonesty, whether the public and fellow practitioners can place reliance on the word of the practitioner.
   • Whether the practitioner has breached any (a) Act; (b) Regulations; (c) Guidelines or Code of Conduct...; and (d) whether the practitioner has done so knowingly.
   • Whether the practitioner's conduct demonstrated incompetence... .
   • Whether or not the incident was isolated... .
   • The practitioner's disciplinary history.
   • Whether or not the practitioner understands the error of his ways, including an assessment of any remorse and insight (or lack thereof) ... .
   • The practitioner's personal circumstances at the time of the conduct and at the time of imposing the sanction.
   • ... other matters relevant to the practitioner's fitness to practice and other matters which may be regarded as aggravating the conduct or mitigating its seriousness.
6. In considering these factors in relation to Dr Owen, the Tribunal notes that there is clearly a need to protect the public against any further professional misconduct by Dr Owen, but in this context also notes that Dr Owen has acknowledged that his practice demonstrated a deficient approach to evidence based medicine which can present significant risk to the public. The Tribunal accepts Dr Owen has significantly altered his medical practice to address some of the issues in his conduct, including ceasing to prescribe testosterone, and moving to a multi person practice, and he has also accepted the conditions proposed on his registration, which are designed to provide protection to the public by limiting some aspects of his medical practice and providing opportunities and requirements for mentoring, education and reflection on aspects of his practice. There has been no suggestion of dishonesty in this matter, but it is clear that Dr Owen has acted in breach of the Code of Conduct. The proposals for a reprimand, a twelve month suspension, and the payment of the Board's costs, in the Tribunal's view, operate as emphatic indications of disapprova,l supporting public confidence in the profession, and also provide significant deterrence to other practitioners as well as Dr Owen. In terms of Dr Owen's own conduct, the Tribunal notes his professional misconduct occurred over some years and in relation to multiple patients, but the Tribunal accepts that he has come to appreciate the professional misconduct involved in his prescribing and other aspects of his practice, and that he has experienced considerable remorse and concern about the consequences of his professional misconduct, including the risk to which his patients were exposed and the consequential loss of confidence in the profession. We note Dr Owen has acknowledged there were some elements of incompetence, in particular relating to the issues of consent and inadequate documentation. The Tribunal also notes there was a previous disciplinary notification made concerning Dr Owen in 2014, although there was no further action taken in relation to that complaint. In relation to his failure to adhere to his earlier assurance provided to the Board, the Tribunal also notes Dr Owen's disclosure in his reflective letter that he has dyslexia, affecting his capacity to create medical records, and he has now adopted software which should assist with this issue. The Tribunal is of the view that this development, along with mentoring and auditing his practice, should address and manage this issue, minimising public risk in this respect.
7. Taking these considerations into account the Tribunal is satisfied that the sanctions proposed and agreed by the parties are appropriate to address the concerns of the National Law, that is, of protecting the public, and maintaining professional standards and confidence in the profession. The Tribunal's view is that these sanctions sufficiently and proportionately address the consequences of Dr Owen's professional misconduct, and in particular appropriately protect the public by managing any future risk in Dr Owen's practice through limitation, mentoring and education, oversight and review; constitutes a deterrence to both Dr Owen and other practitioners through the suspension of his registration and the obligations and costs imposed on him; and addresses the issue of public confidence in the profession by these means and the reprimand issued.
8. Accordingly, the Tribunal will make orders reflecting these findings and incorporating these sanctions.

1. The Tribunal makes the following orders in relation to this application:

1. Pursuant to s 196(2)(a) of the National Law, the respondent is reprimanded.

1. Pursuant to s 196(2)(d) of the National Law, the respondent's registration is suspended for 12 months, with that suspension to commence 1 month from the date of this Order.
2. Pursuant to s 196(2)(b) of the National Law, and commencing on the expiry of the suspension of registration, the following conditions (the Conditions) will be imposed on the respondent's registration, such that he:

(a) Only practice in a group practice with a minimum of four medical practitioners;

(b) Only practice in a location/practice approved by the Board;

(c) Not prescribe or administer testosterone (in any form) to male or female patients;

(d) Not provide treatment for anxiety and depression by reference to the MTHFR genotype using methyl B12, folinic acid and/or MTHFR;

(e) Undergo education in relation to record keeping and evidence-based medicine in general practice for 12 hours, in addition to providing a reflective report in relation to that education

(f) Undergo mentoring for a period of 12 months requiring monthly meetings of one hour with his mentor. The scope and focus of the mentoring to be agreed.

(g) Undergo quarterly audits of his practice for a period of 12 months having specific regard to record keeping and scope of practice;

(h) Meet the cost of compliance with these Conditions.

The review period for the Conditions is after they have been operating for 12 months.

1. The parties are to provide to the Tribunal a final Schedule of Conditions that formalises the Conditions, including necessary compliance and ancillary conditions to give them effect.
2. Pursuant to s 60 of the SACAT Act, the publication of the names of the patients referred to in the Agreed Facts and Findings or anything that may tend to identify those patients, is prohibited.
3. Pursuant to s 60 of the SACAT Act, the publication of the name of any other patient of the respondent referred to in these proceedings, or anything that may tend to identify any other patient of the respondent, is prohibited.
4. The respondent pay the complainant's costs of and incidental to the proceedings as agreed with the complainant or, failing agreement, as determined by the Tribunal.