With the respondent's agreement, the Tribunal finds that:

1. Dr Sevdalis engaged in professional misconduct within the meaning of the definition of professional misconduct in paragraphs (a) and (b) of section 5 of the Health Practitioner Regulation National Law (Victoria) (National Law), in that, between 1 December 2011 and 20 November 2012, Dr Sevdalis failed to demonstrate the standards of professional conduct expected of a registered medical practitioner by providing medical care to one or more close family members in circumstances that were avoidable. (Allegation 1)
2. Dr Sevdalis engaged in professional misconduct within the meaning of the definition of professional misconduct in paragraphs (a) and (b) of section 5 of the National Law in that, between 6 December 2011 and 1 November 2012, Dr Sevdalis' clinical management was not clinically justified and/or was not evidence-based and/or exposed patients to potential harm. (Allegation 2)

With the respondent's agreement, the Tribunal orders as follows:

1. Dr Sevdalis is reprimanded (section 196 (2)(a));
2. Dr Sevdalis' registration is suspended for a period of six months to commence 1 November 2018 (section 196 (2)(d)); and
3. Conditions are imposed on Dr Sevdalis' registration (section 196 (2)(b)), as follows:
4. Attend for mentoring

• 1.1. The Practitioner must be mentored by another registered health practitioner in relation to antibiotic use and selection, conflicts of interest and treatment of family members.
  • 1.2. For the purposes of this condition, 'mentoring' is defined as a relationship in which a skilled registered practitioner (the mentor) helps to guide the professional development of another practitioner.
    • (a) The mentoring must comprise a minimum of six sessions with each session being of one-hour duration occurring over a one-year period.
    • (b) Within one month of the notice of the imposition of these conditions, the Practitioner must, on the approved form (HPN16), nominate a person(s) to be approved by the Board to act as mentor. The Practitioner must ensure that the nomination is accompanied by acknowledgement, on the approved form (HPNA16), from the nominated person.
    • (c) Within one month of the notice of the imposition of these conditions the Practitioner must provide to AHPRA, on the approved form (HP16), acknowledgement that AHPRA may seek reports from the approved mentor on any or all of the following occasions:
      • (i) every three months;
      • (ii) at the conclusion of the mentoring relationship in order to confirm the outcomes of the mentoring
      • (iii) whenever the mentor has a concern or becomes aware of a concern regarding the Practitioner's conduct or professional performance, and
      • (iv) when otherwise requested by AHPRA or the Board.
    • (d) In the event an approved mentor is no longer willing or able to provide the mentoring required the Practitioner is to provide a new nomination in the same terms as previous nominations. Such nomination must be made by the Practitioner within 21 days of becoming aware of the termination of the mentoring relationship.
    • (e) Within one month of the conclusion of the mentoring the Practitioner must provide a report demonstrating, to the satisfaction of the Board, that he has reflected on the issues that gave rise to the condition requiring they attend for mentoring and outlining how the Practitioner has incorporated the lessons learnt in the mentoring into their practice.

• 2.1. The Practitioner must submit to an audit of their practice (the audit), including any supporting records, within two months of returning to practice and thereafter on a monthly basis for a period of six months, by permitting an auditor (the auditor) approved by the Medical Board of Australia (the Board) 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 treatment of family members and adherence to the Therapeutic Guidelines for Antibiotics (published by the National Health and Medical Research Council).
  • 2.2. Within one month of returning to practice, the Practitioner must provide to AHPRA:
    • (a) nomination, on the approved form (HPN12), of an auditor(s) to be approved by Board
    • (b) acknowledgement, on the approved form (HPN12), that AHPRA will seek reports from the approved auditor at the conclusion of each audit, and
    • (c) acknowledgement, on the approved form (HPNA12), from the nominated auditor.
  • 2.3. Within 7 days of the notice of the approval of the nominated auditor, the Practitioner is to provide a written audit plan, from the approved auditor, outlining the form the audit(s) will take and how the area of concerns for the Board will be addressed. The audit(s) will take the form determined by the auditor.
  • 2.4. In the event an approved auditor is no longer willing or able to provide the audit required, the Practitioner must notify AHPRA within fourteen days of becoming aware of this and provide a new nomination of a proposed auditor(s) to the Board in the same terms as the previous nomination of auditor(s).

• 3.1. The Practitioner must undertake and successfully complete a program of one on one education, approved by the Board and including a reflective practice report, in relation to the Therapeutic Guidelines: Antibiotics. * (a) The education must consist of a minimum number of six hours; * (b) The Practitioner must complete the education within one year of the notice of the Board's approval of the education. * (c) Within one month of the notice of the imposition of these conditions, the Practitioner must, on the approved form (HPN11): * (i) nominate a person(s) to be approved by the Board to act as educator, and * (ii) provide acknowledgement that AHPRA will obtain a report from the approved educator at the conclusion of the education. * (d) 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. * (e) Within one month of the completion of the education, the Practitioner is to provide: * (i) Evidence of successful completion of the education. * (ii) A report demonstrating, to the satisfaction of the Board, that the Practitioner has reflected on the issues that gave rise to this condition requiring they undertake education and how the Practitioner has incorporated the lessons learnt in the education into the Practitioner's practice.
  • 3.2. The practitioner must undertake and successfully complete a program of one on one education, approved by the Board and including a reflective practice report, on the topic of ethical decision making and conflicts of interest, including with respect to the treatment of family members.
    • (a) The education must consist of a minimum number of four hours;
    • (b) The Practitioner must complete the education within one year of the notice of the Board's approval of the education.
    • (c) Within one month of the notice of the imposition of these conditions, the Practitioner must, on the approved form (HPN11):
      • (i) nominate a person(s) to be approved by the Board to act as educator, and
      • (ii) provide acknowledgement that AHPRA will obtain a report from the approved educator at the conclusion of the education.
    • (d) 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.
    • (e) Within one month of the completion of the education, the Practitioner is to provide:
      • (i) Evidence of successful completion of the education.
      • (ii) A report demonstrating, to the satisfaction of the Board, that the Practitioner has reflected on the issues that gave rise to this condition requiring they undertake education and how the Practitioner has incorporated the lessons learnt in the education into the Practitioner's practice.

• 4.1. Within 21 days of returning to practice 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, Owner, or equivalent (the senior person) at each a current place of practice. In providing this form, the practitioner acknowledges that AHPRA will contact the senior person and provide them with a copy of the conditions on the Practitioners registration or confirm that the senior person has received a copy of the conditions from the Practitioner, and the Practitioner will be required to provide the same form: * (a) within seven days of the commencement of practice at each and every subsequent place of practice, and * (b) within seven days of each and every notice of any subsequent alteration of these conditions.

5.1. All costs associated with compliance with the conditions on their registration are at the practitioner's own expense

Orders under the Open Courts Act 2013

Having regard to the presumption in favour of disclosure contained in s.4 of the Open Courts Act 2013 (Vic) (the Act), the Tribunal is satisfied that a proceeding suppression order ought to be made under s.17 of the Act on the grounds that such an order is in the interests of justice.

The making of an order is in the interests of justice given the personal nature of the content of the material in this proceeding and the evidence in the proceeding.

Protecting the privacy of patients named in the matter and their family members (other than Dr Sevdalis) is essential if the Board is to ensure that professional conduct issues can be properly investigated when they arise.

On its own motion, the Tribunal orders under s.17 of the Open Courts Act that:

1. Any report of the whole or part of these proceedings or information derived from this proceeding that might enable the patients the subject of these proceedings, any witness, and their family members (other than Dr Sevdalis) to be identified must not be published or otherwise disclosed.
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 patients and witnesses would be breached if persons living outside Victoria know or come to know their identity or that of members of their families (other than Dr Sevdalis).
3. This order operates until the later of the death of all of the relevant patients.

1. These are professional disciplinary proceedings against a registered medical practitioner under the Health Practitioner Regulation National Law (Victoria) (National Law).
2. Dr Sevdalis admits that he engaged in professional misconduct in that:
   • between 1 December 2011 and 20 November 2012, he failed to demonstrate the standards of professional conduct expected of a registered medical practitioner by providing medical care to one or more close family members in circumstances that were avoidable (Allegation 1); and
   • between 6 December 2011 and 1 November 2012 his clinical management was not clinically justified and/or was not evidenced based and/or exposed patients to potential harm in that Dr Sevdalis administered to them, treatment with an intravenous injection of the antibiotic Keflin in a residential setting (Allegation 2).
3. Allegation 1 is constituted by the treatment of two close family members, avoidably, on 81 occasions and 60 occasions respectively amounting to 141 occasions over a period just short of 12 months.
4. Allegation 2 is constituted by the treatment of 23 patients with antibiotics intravenously in a residential setting over a period just short of 11 months;
5. The allegations and their particulars are set out in full below, as are the agreed statement of facts the parties provided, which include expert opinion on the risk of harm posed by the conduct.
6. To his credit, Dr Sevdalis has properly conceded that his conduct in relation to Allegations 1 and 2 constitutes professional misconduct. We were comfortably satisfied that it did so and made findings to that effect.
7. The parties also jointly submitted that the Tribunal should:
   • reprimand Dr Sevdalis (s196(2)(a) of the National Law);
   • suspend his registration for a period of three months (s196(2)(d); and
   • impose conditions on his registration (section 196(2)(b)), as set out in the Schedule.
8. We were not satisfied that a suspension of three months adequately addressed specific deterrence and general deterrence in this case and considered that six months suspension was necessary. We also considered that the conditions should include not only mentoring but more formal supervision.
9. The conduct in both allegations represented repetition of conduct for which Dr Sevdalis had previously been sanctioned. His inappropriate treatment of family members in this case commenced within months of him completing a reflective report of what he had learned from the counselling ordered by a previous Panel Hearing.
10. The conduct in allegation 2, regarding intravenous antibiotics, occurred despite sanction in 2001 and specific education conditions.
11. We had to conclude he had learned nothing from the previous education and that the previous sanctions had little or no impact on his understanding of and compliance with his professional responsibilities in these respects.
12. To his credit, Dr Sevdalis did not oppose the longer suspension period and the additional component of the conditions.

1. The following are the allegations admitted by Dr Sevdalis at the hearing.

1. That Dr Sevdalis engaged in:
   • (a) professional misconduct within the meaning of the definition of professional misconduct in paragraphs (a) and/ or (b) and/or (c) of section 5 of the Nation Law;

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

in that, between 1 December 2011 and 20 November 2012 Dr Sevdalis failed to demonstrate the standards of professional conduct expected of a registered medical practitioner by providing medical care to one or more close family members in circumstances that were avoidable.

(i) At all material times Dr Sevdalis was a registered medical practitioner;

(ii) With respect to VS:

• (A) VS is Dr Sevdalis's close family member;

  • (B) Dr Sevdalis' clinical records for VS record that between 1 December 2011 and 20 November 2012 VS consulted with Dr Sevdalis on 81 occasions;

(iii) With respect to AL:

• (A) AL is the practitioner's close family member;

  • (B) Dr Sevdalis' clinical records for AL record that between 1 December 2011 and 20 November 2012;

    • (I) AL consulted with Dr Sevdalis on 60 occasions; and
    • (II) AL presented on various occasions with complex clinical needs including but not limited to drug addiction and/or poor mental health; and

  • (C) AL's clinical care was or may have been compromised by reason of his familial relationship with Dr Sevdalis;

(iv) Good Medical Practice: A Code of Conduct of Doctors in Australia (1 July 2010) provides:

Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues. (Clause 3.14)

(a) professional misconduct within the meaning of the definition of professional misconduct in paragraphs (a) and/or (b) and/or (c) of 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 6 December 2011 and 1 November 2012, Dr Sevdalis' clinical management was not clinically justified and/or was not evidence-based and/or exposed patients to potential harm.

(i) At all material times Dr Sevdalis was a registered medical practitioner;

(ii) Patient 1 consulted Dr Sevdalis on 29 March 2012 and was treated with an intravenous injection of the antibiotic Keflin at her home;

(iii) Patient 2 consulted Dr Sevdalis on 7 October 2012 and was treated with an intravenous injection of the antibiotic Keflin at her home;

(iv) Patient 3 consulted Dr Sevdalis on 16 February 2012 and was treated with an intravenous injection of the antibiotic at his home;

(v) Patient 4 consulted Dr Sevdalis on 19 January 2012 and was treated with an intravenous injection of the antibiotic at her home;

(vi) Patient 5 consulted Dr Sevdalis on 17 May 2012 and was treated with an intravenous injection of the antibiotic at her home;

(vii) Patient 6 consulted Dr Sevdalis on 18 May 2012 and was treated with an intravenous injection of the antibiotic at his home;

(viii) Patient 7 consulted Dr Sevdalis on 1 November 2012 and was treated with an intravenous injection of the antibiotic at his home;

(ix) Patient 8 consulted Dr Sevdalis on 13 March 2012 and was treated with an intravenous injection of the antibiotic at his home;

(x) Patient 9 consulted Dr Sevdalis on 11 January 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xi) Patient 10 consulted Dr Sevdalis on 6 December 2011 and was treated with an intravenous injection of the antibiotic at her home;

(xii) Patient 11 consulted Dr Sevdalis on 19 October 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xiii) Patient 12 consulted Dr Sevdalis on 1 March 2012 and was treated with an intravenous injection of the antibiotic at his home;

(xiv) Patient 13 consulted Dr Sevdalis on 21 April 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xv) Patient 14 consulted Dr Sevdalis on 21 April 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xvi) Patient 15 consulted Dr Sevdalis on 27 February 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xvii) Patient 16 consulted Dr Sevdalis on 27 May 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xviii) Patient 17 consulted Dr Sevdalis on 26 February 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xix) Patient 18 consulted Dr Sevdalis on 8 July 2012 and was treated with an intravenous injection of the antibiotic at his home;

(xx) Patient 19 consulted Dr Sevdalis on 26 February 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xxi) Patient 20 consulted Dr Sevdalis on 17 June 2012 and was treated with an intravenous injection of the antibiotic at his home;

(xxii) Patient 21 consulted Dr Sevdalis on 25 March 2012 and was treated with an intravenous injection of the antibiotic at his home;

(xxiii) Patient 22 consulted Dr Sevdalis on 20 October 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xxiv) Patient 23 consulted Dr Sevdalis on 24 March 2012 and was treated with an intravenous injection of the antibiotic at her home;

(xxv) The treatment provided by Dr Sevdalis referred to in particulars (ii) to (xxiv):

• (A) was not in accordance with:
  • (1) the Therapeutic Guidelines: Antibiotic; and/or
  • (2) any other relevant evidence-based guideline or Outpatient Parental Antimicrobial Program or protocol;
  • (3) established principles of outpatient intravenous antimicrobial therapy; and/or
• (B) exposed patients to risk including but not limited to:
  • (1) Adverse effects of intravenous antibiotic therapy; and/or
  • (2) the development of antibiotic resistance; and/or
  • (3) an inability to adequately manage any hypersensitivity reaction to the intravenous agent

(xxvi) Good Medical Practice: A Code of Conduct of Doctors in Australia (1 July 2010) provides:

Maintaining a high level of medical competence and professional conduct is essential for good patient care. Good medical practice involves:

Considering the balance of benefit and harm in all clinical- management decisions (Clause 2.2.2).

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

1.1 Dr Nicholas Sevdalis (Dr Sevdalis) was first registered as a medical practitioner on 6 January 1983.

1.2 The Medical Board of Australia (Board) was established on 1 July 2010 and replaced the previous state and territory boards (or participating jurisdictions and co-regulatory jurisdictions). Dr Sevdalis has been subject to the Health Practitioner Regulation National Law (Victoria) (National Law)[1], since that time.

2.1 On 12 November 2014, the Australian Health Practitioner Registration Agency (AHPRA) on behalf of the Board received a notification from [name and position] Professional Services Review. The Professional Services Review Scheme is established under the Health Insurance Act 1973 (Cth) (HIA) to enquire into the provision of Medicare services by practitioners. In 2013, Professional Services Review Committee Number 855 (Committee) was convened to investigate whether Dr Sevdalis had engaged in inappropriate practice in providing particular services under the Medicare Benefits Schedule between 1 December 2011 and 20 November 2012.

2.2 {The] notification was made in reliance upon sections 106XA(2)(b) and 106XB(2)(d) of the HIA. In this case, a Statement of Concern was prepared by [name and position on Committee], and received by AHPRA on behalf of the Board on 12 November 2014. The Statement of Concern brought to the attention of the Board a range of matters, not all of which form part of the referral. Relevantly, the Committee was concerned that Dr Sevdalis:

(a) was using intravenous antibiotics outside of therapeutic guidelines; and

(b) was frequently and regularly treating immediate family members (his close family members) as their regular general practitioner.

2.3 At the conclusion of its investigation in 2014, the Committee found that Dr Sevdalis had engaged in inappropriate practice within the meaning of the HIA. The inappropriate practice related primarily to his attendances on patients outside his consulting rooms and his record-keeping. On 12 May 2015 Dr Sevdalis was reprimanded and counselled, disqualified from rendering services under the Medicare Benefits Schedule for a period of two years, and ordered to repay Medicare benefits in the amount of $453,656.75 to the Commonwealth. Appeals in relation to the findings were concluded on 31 January 2017.

3.1 On 8 January 2015, the Notifications Committee of the Board (Committee) decided, pursuant to section 160(1)(a) of the National Law, to commence an investigation into Dr Sevdalis' conduct.

3.2 Dr Sevdalis provided a written response to the issues for investigation on 26 May 2015. Relevant to the Notice of Allegations, Dr Sevdalis:

(a) in relation to the treatment of family members, provided detailed reasons as to why he did this and confirmed that he had transferred their care now to another general practitioner; and

(b) in relation to the alleged failure to formulate and implement a suitable management plan for the 23 patients to whom intravenous injections of the antibiotic Keflin were administered during home visits, provided a detailed account of the treatment he provided, including a justification for the IV administration of Keflin to each patient in the patient's home.

3.3 On 8 December 2016, the Board considered the investigator's detailed report, and decided under section 193(1) of the National Law to refer the matter to VCAT, having formed the reasonable belief that Dr Sevdalis has behaved in a way that constitutes professional misconduct.

4.1 In preparing the referral the Board requested, on 5 October 2017, and obtained two independent expert opinions.

4.2 In relation to Allegation 1, Dr Mark Overton, General Practitioner, in his report dated 31 October 2017, expressed the opinion that:

(a) whilst it may be appropriate in an emergency or isolated situation to treat a family member, generally it is difficult for a doctor to maintain objectivity when treating family members, and:

(i) it may be difficult to explore sensitive areas such as sexual health which can lead to misdiagnosis;

(ii) there can be a conflict of interest when writing a report for family members; and

(iii) it can be easy to acquiesce to inappropriate requests from family members;

(b) in relation to treatment of close family member 1, Dr Sevdalis' clinical notes show that:

(i) his decision making departed from the standards expected of him by the public and his peers including because:

(A) taking on the role of GP for his close family member would be regarded by the body of other GPs and the general public to be unacceptable, which was compounded by [an identifying fact];

(B) his close family member could have been treated by another GP in Melbourne;

(C) his objectivity appears to have been compromised in that Dr Sevdalis may have been over-servicing the family member (for example, because he consulted the family member 20 times in the month of December 2011);

(D) he may have been overinvolved in his close family member's issues including by inappropriate analgesic use, acceding to requests for repeated intramuscular injections of Toradol and providing intravenous antibiotics for sinusitis;

(ii) he exposed his close family member to potential harm including by:

(A) Recurrently using intramuscular injections of Toradol for back pain which may have exposed his close family member to a risk of renal damage, raised blood pressure and/or gastrointestinal bleeding; and

(B) failing to engage other services for his close family member (such as physiotherapy, hydrotherapy, pain management services, psychologist) may have meant the family member did not have the opportunity to improve their situation; and

(c) in relation to the treatment of his close family member 2, Dr Sevdalis' clinical notes show that:

(i) his decision making departed from the standards expected of him by the public and his peers including because:

(A) taking on the role of GP for his close family member would be regarded by the body of other GPs and the general public to be unacceptable;

(B) his close family member could have been treated by another GP in Melbourne;

(C) his objectivity appears to have been compromised in that Dr Sevdalis may have been over-servicing him (for example, because he consulted him 18 times in the month of October 2012), sometimes for multiple items;

(D) he may have been overinvolved in his close family member's issues and the family's issues and was mixing these with his professional duties (for example, by Dr Sevdalis' recording in his close family member's clinical notes that his close family member offered to repair his mobile phone charger);

(ii) he exposed his close family member to potential harm such as by:

(A) providing him with intramuscular injections of Toradol;

(B) providing him with intramuscular injections of Toradol; prescribing Naloxone for presumably ice and cannabis abstinence, which is in fact indicated for opiate and alcohol dependence; and

(C) being over-involved in family matters, which is likely to have meant he was less effective than if he had not been related to him and was able to treat him in an objective way.

4.3 In relation to Allegation 2, Professor Tony Korman, in his report dated 29 December 2017, expressed the opinion that:

(a) Dr Sevdalis's approach to patient management by administering intravenous Keflin to patients in their homes was not appropriate and within the standards or conduct of a registered medical practitioner because:

• (i) he did not adhere to the Australian Antibiotic Guidelines treatment recommendations for Community Acquired Pneumonia;
• (ii) treatment was not in accordance with evidence-based guidelines or Outpatient Parenteral Antimicrobial Program Protocols;
• (iii) the use of Keflin is not mentioned as a treatment option for Community Acquired Pneumonia; and
• (iv) Cafealotin (for which Keflin is the brand name) does not have activity against atypical respiratory infections;

(b) the treatment of 23 patients with Keflin in their homes was substantially below the standard reasonably expected of a practitioner with his level of training and/ or experience because:

(i) of a lack of an indication for the use of antibiotics, the particular drug and the dosing schedule adopted;

(ii) treatment was not supervised by an established Hospital in the Home program;

(iii) it exposed patients to a risk of adverse effects of the intravenous therapy and antibiotic resistance; and

(iv) the first dose should have been administered in a hospital or established clinical setting in case an anaphylactic reaction occurred which required emergency treatment.

6.1 Dr Sevdalis admits that he engaged in the conduct particularised in the Notice of Allegations, as revised and set out in paragraph 5.1 above.

6.2 Dr Sevdalis admits that the conduct set out in Allegation 1 and Allegation 2 constitutes professional misconduct within the meaning of paragraph (a) and/or (b) of the definition of professional misconduct contained in section 5 of the National Law.

1. The applicable principles are well-established.[2] The primary purpose of determinations is to protect the public not to punish the practitioner. That primary purpose, together with protection of the reputation of the medical profession in the eyes of the public, is achieved by ensuring that proper ethical and professional standards are maintained.
2. As the Tribunal observed in Honey v Medical Practitioners Board of Victoria [2007] VCAT 526, [14]:

It is of prime importance in assessing the appropriate sanction that we bear in mind that the purpose of the determination is not to punish ... Our aim must be to protect the public, and we achieve that aim by imposing sanctions aimed at regulating professional performance of the particular individual under consideration and also by way of general deterrence to the profession as a whole.

1. With that protective focus in mind, the Tribunal considers a range of factors including any need to deter the individual practitioner from repeating the conduct. Called specific deterrence, this involves an assessment of any ongoing risk posed by the practitioner such as:
   • whether they have demonstrated insight into the seriousness of the conduct and how and why it occurred;
   • whether they have shown genuine remorse and have taken independent steps to reduce the risk of repetition; and
   • whether they have any past disciplinary history, which in turn may suggest that stronger penalties may be required to deter them in future.[3]
2. The Tribunal will also consider how serious the conduct is and whether there is a need to signal to other members of the profession that adverse consequences will follow such conduct, and so deter them from the same conduct. This is called general deterrence.
3. In Honey v Medical Practitioners Board of Victoria [2007] VCAT 526 at paragraphs 41 to 61, the Tribunal discussed the difference between the determinations of suspension and cancellation and stated as follows:

The major difference between a suspension and cancellation is that once the doctor's registration is cancelled, he must reapply after the period specified. It is not guaranteed that he will be so re-registered. He must satisfy the Board that registration is appropriate and that he fulfils the qualifications for general registration...

Cancellation of registration sends a clear message of unsuitability to practice. Suspension may be thought to indicate confidence in the doctor's future ability to practice once the period of suspension is served. [our emphasis]

There are some cases in which it is abundantly clear that deregistration is the only option available to protect the public from a miscreant doctor.

This is apparent in situations in which the practitioner does not accept the inappropriateness of his conduct or has been shown to be a serial offender.

1. Whilst the Tribunal may be assisted by submissions as to the submitted appropriate sanction, it is ultimately in the discretion of the Tribunal as to the appropriate sanction in any given case.[4]
2. Determinations in other cases of similar or analogous conduct will provide useful guidance. Consistency and proportionality are important. But every case is different, with its own combination of facts and relevant factors, including the degree of seriousness of the conduct, the length of time the practitioner engaged in the conduct, the number of patients impacted by the conduct, and the circumstances involved.
3. The parties jointly submitted that the appropriate determinations in this matter were:
   • (a) that Dr Sevdalis be reprimanded (section 196 (2)(a));
   • (b) that Dr Sevdalis' registration be suspended for a period of six months to commence 1 November 2018 (section 196 (2)(d)); and
   • (c) that condition (s) be imposed on Dr Sevdalis' registration (section 196 (2)(b)), as set out in the attached Schedule.
4. We agree with the Board's submissions that Dr Sevdalis' conduct is objectively serious and therefore warrants a period of suspension and the conditions sought for the following reasons:
   • the conduct the subject of the allegations was persistent, extended over a significant period and was in clear breach of his professional obligations where:
     • in less than 12 months Dr Sevdalis treated two family members on a total of 141 occasions including 18 times in one month and 20 times in another month. It should have occurred to him that this conduct was clearly out of step with clause 3.14 of the Good Medical Practice: A Code of Conduct of Doctors in Australia (1 July 2010) which requires that whenever possible, a doctor should avoid providing medical care to anyone with whom they have a close personal relationship.
     • in less than 12 months Dr Sevdalis treated 23 individuals inappropriately with intravenous antibiotics and thus exposed a significant number of patients to a risk of harm including antibiotic resistance and adverse effect where there was no clinical setting to manage emergency treatment for anaphylactic reaction.
   • the conduct was contrary to clause 2.2.2 of The Code of Conduct of Doctors in Australia (1 July 2010) which provides:

Maintaining a high level of medical competence and professional conduct is essential for good patient care. Good medical practice involves:

Considering the balance of benefit and harm in all clinical-management decisions;

• Dr Sevdalis had previously received training in 2001 related to the administration of intravenous antibiotic treatment, specifically regarding appropriate dosage and indicated use;
• Dr Sevdalis had previously received training in 2011 in respect of treatment of family members and reported to the Board that he had acquired insight into the reasons why this is to be avoided;
• Dr Sevdalis' conduct has the capacity to undermine the regard in which the profession is held by members of the public, such that there is a need for specific and general deterrence; and
• a period of suspension in this case is responsive to the ongoing and serious nature of the conduct, the need for general deterrence, the need for specific deterrence in view of Dr Sevdalis' previous training, repetition of like conduct and the significance of the risk of harm to which he exposed a large number of patients.

1. We were not satisfied that a suspension of three months sufficiently addressed both specific and general deterrence. We considered six months to be the minimum necessary to address specific and general deterrence.
2. To his credit Dr Sevdalis said through his Counsel that he would accept six months. He asked that the suspension not commence until 1 November 2018, which we have ordered.
3. We were particularly concerned that the conduct represents repetition of conduct for which Dr Sevdalis had previously been sanctioned, including that the treatment of family members commenced within months of a reflective report on what he had learned from the counselling ordered by the Panel who heard the previous allegations. Further, the conduct in allegation 2 occurred despite sanction in 2001 and specific education conditions.
4. It appeared that Dr Sevdalis had learned nothing from the previous education, and that the previous sanctions had little or no impact on his understanding of and compliance with his professional responsibilities in relation to the administration of intravenous antibiotics and treating family members.
5. We also considered that in addition to mentoring and one on one education (and in view of the failure of counselling and education in the past), an additional condition was required to ensure that an approved practitioner would be able to review patient records. We considered that a six-month period and once a month review would be sufficient. After the hearing the Board provided a proposed agreed wording which we adopted. We also set the review period for the conditions at 12 months rather than 18 months as proposed.
6. On his behalf, his Counsel submitted that the Professional Services Review process and determinations had had an impact.
7. We accept that the HIA process, in a different context, resulted in sanctions on him[5] which will have had an impact on Dr Sevdalis.
8. Counsel submitted that "what has finally hit home" is that instead of trying to decide whether it is appropriate in the particular circumstances to treat family members, he must not do so at all. Further, Dr Sevdalis acknowledges that his prior education failed and has already engaged in more targeted education.
9. We understand the Board has received one notification which has not yet been investigated but there have been no disciplinary findings since the conduct occurred and no evidence of further repetition.
10. We considered however that specific deterrence is of much greater importance as a result of the repeated conduct, maintained reservations as to insight, and considered that general deterrence remains important.
11. We have, however, limited the suspension to six months taking into account delay and the fact that Dr Sevdalis admitted the allegations and cooperated in these proceedings.
12. We have also taken into account the character references provided but note that although four out of the five writers were aware of the allegations in these proceedings, none indicated they were aware of the previous disciplinary proceedings nor that they involved the same conduct.

[1] The text of the National Law is in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).

[2] See for example Ha v Pharmacy Board of Victoria [2002] VSC 322, [97]; Medical Board of Australia v Janz [2011] VCAT 1026, [358]-[373]

[3] See for example Medical Practitioners Board of Victoria v Grolaux (No 2) [2009] VCAT 978 in relation to assessment of insight.

[4] Chinese Medicine Registration Board v Woo (Occupational and Business Regulation) [2010] VCAT 753 at [46].

[5] His Medicare provider number was withdrawn for a period of two years expiring in March 2019.