Medical Board of Australia v Watts (Review and Regulation) [2019] VCAT 1471

1. Dr Watts is reprimanded.
2. Dr Watts' registration is suspended for a period of 6 months from 20 September 2019.
3. The following conditions are imposed on Dr Watts' registration:

NOTE: ORDERS UNDER THE OPEN COURTS ACT 2013 ARE IN FORCE

On 6 December 2017, the Tribunal made the following orders:

1. The disclosure by publication or otherwise of any report of the whole or any part of this proceeding, or of any information derived from this proceeding, which identifies or has the effect of identifying the patients or the witnesses is prohibited.
2. This order applies throughout Australia.
3. This order operates until the death of all of the patients and witnesses.

1. Dr Christopher Watts is a 61 year old general practitioner who was first registered as a medical practitioner on 14 December 1981.
2. Dr Watts has spent most of his career working as a general practitioner in the community sector, and mostly at the Westgate Health Cooperative (Clinic) (formerly the South Kingsville Health Service), of which he was the chair between 1991 and 1993. He has also worked at the Braybrook Maidstone Community Health Centre, Victoria University Student Health, The Gathering Place in Maribyrnong (which is an indigenous health service) and Headspace in Sunshine.
3. The Clinic was originally established in 1985 by the Baptist Church, after it was identified that the Spotswood area had the least access to health care in Melbourne. After the Baptist Church withdrew its support, the Clinic converted to a cooperative structure.
4. Dr Watts gave evidence that the vast majority of the patients at the Clinic are people on low incomes that either receive social security benefits or work in local factories and abattoirs. Most have not completed secondary education. Dr Watts says that the patients generally present with a range of complex medical, social and psychological issues.
5. The allegations brought against Dr Watts relate to his prescribing of drugs, primarily opioids and benzodiazepines, to eight patients of the Clinic over an extended period. The longest was just short of 13 years between 25 October 2001 to 6 October 2014, in the case of patient 8. In nearly all cases, the patients were already or became, as a result of Dr Watt's prescribing, drug dependent. One patient (patient 3) was a child of thirteen when Dr Watts first prescribed diazepam and Tramal (a benzodiazepine and strong analgesic respectively).
6. In August 2013, Dr Watts appeared in the Magistrates' Court of Victoria in respect of charges relating to nine offences under the Drugs, Poisons and Controlled Substances Act 1981 (DPCS Act) in respect of his prescribing, some of which overlap with the allegations the subject of these proceedings. He was released, without conviction, on an undertaking to be of good behaviour for 12 months and agreement to pay prosecution costs.
7. The Medical Board of Australia (Medical Board) did not take immediate action in respect of the allegations against Dr Watts. He continued to practise until he received notice of the original hearing of this proceeding in September 2018, when he started to suffer from anxiety and was unable to sleep or get out of bed. He is now managing that anxiety, and has been seeing Dr Loyal, a psychiatrist. However, he has not yet returned to practice.
8. There is no evidence before the Tribunal of any repetition of any professional misconduct or unprofessional conduct while Dr Watts continued to practise over the period between October 2014 and September 2018.
9. As a result of his treatment with Dr Loyal, Dr Watts now recognises that his prescribing behaviours placed the patients concerned at risk, in terms of addiction, adverse drug effects and the potential for a fatal overdose.
10. He has also gained insight into why he has fallen into a pattern of excessive drug prescribing. As he put it in examination in chief:

I struggle when patient stress is not relieved, particularly if other family members are caught up ... I tend to focus on easing distress to the exclusion of other things ... I am vulnerable to missing out on compliance with permits or identifying drug dependency.

1. Dr Watts says that, given his 'propensity to struggle with such patients', he will need (and intends) to 'hand them over to colleagues' and 'accept that [he] cannot take responsibility for every patient'.
2. The Medical Board sought, and Dr Watts consented to, findings of professional misconduct and unprofessional conduct against Dr Watts under:
   • (a) the Medical Practice Act 1994 (MPA), applicable to his conduct between October 2001 and June 2007;
   • (b) the Health Professions Registration Act 2005 (HPRA), applicable to his conduct between July 2007 and June 2010; and
   • (c) the Health Practitioner Regulation National Law (Victoria) (National Law), applicable to his conduct between July 2010 and October 2014.
3. Those findings were set out in paragraph 296 of an Agreed Statement of Facts, Findings and Determinations dated 28 August 2019 (Agreed Statement). They differ slightly from the allegations which had originally been made by the Medical Board and the submissions filed by the Medical Board before the hearing. However, counsel for both the Medical Board and Dr Watts confirmed that the findings agreed were those set out in the Agreed Statement and no issue was taken with any of the differences to the allegations or submissions.
4. Having regard to all the material filed, including the affidavits of Ely Finch[1] (a drugs and poisons field officer at the Department of Health and Human Services) and Chad Saunders[2] (an investigator at the Australian Health Practitioner Regulation Agency (AHPRA)), and the expert opinion of Dr Cameron Loy,[3] we had no difficulty in making those findings (with some slight modifications around timing), as set out in [37] below (with the patient names de-identified in line with the orders made under the Open Courts Act 2013).
5. In terms of determinations, the Medical Board sought, and Dr Watts consented to:
   • (a) a reprimand;
   • (b) suspension for 6 months; and
   • (c) a number of conditions on Dr Watts' registration.[4]
6. Save for one matter relating to the conditions, discussed below, we agreed that the proposed determinations were appropriate and made orders in the terms sought.
7. Below we set out the applicable law, the findings made, and the reasons for the determinations.

1. The allegations relate to offending over an extended period, during which the regulatory regime for medical practitioners was subject to change, with the MPA applicable up to June 2007, the HPRA applicable between July 2007 and June 2010 and the National Law applicable from July 2010. The relevant conduct definitions and the available determinations differ to some extent between those regulatory regimes.
2. Nevertheless, as explained in the letter dated 15 November 2017 from the Victorian Government Solicitor's Office referring the matter to the Tribunal, the transitional provisions set out in the National Law and associated regulations permitted the Medical Board to conduct the investigation of Dr Watts' conduct prior to July 2010, and allow the Tribunal to hear and make determinations on that conduct under the MPA and HPRA as applicable.

1. Under section 45A of the MPA, determinations can be made where a practitioner engages in unprofessional conduct.
2. The phrase 'unprofessional conduct' is defined in section 3(1) of the MPA, including:
   • (a) professional conduct which is of a lesser standard than that which the public might reasonably expect of a registered medical practitioner; or
   • (b) professional conduct which is of a lesser standard than that which might reasonably be expected of a medical practitioner by her or his peers; or
   • (c) professional misconduct; or
   • (d) infamous conduct in a professional respect; or
   • (e) providing a person with health services of a kind that is excessive, unnecessary or not reasonably required for that person's well-being; or

(h) a finding of guilt of -

• (i) an indictable offence in Victoria, or an equivalent offence in another jurisdiction; or
• (ii) an offence where the practitioner's ability to continue to practise is likely to be affected because of the finding of guilt or where it is not in the public interest to allow the practitioner to continue to practise because of the finding of guilt; or
• (iii) an offence under this Act or the regulations; or
• (iv) an offence as a medical practitioner under any other Act or regulations; or

1. In Vissenga v Medical Practitioners Board of Victoria,[5] then President Morris observed that there 'is a great deal of overlap between the various paragraphs'.
2. The term 'professional misconduct' is not defined in the MPA, however in Campbell v Dental Board of Victoria,[6] Mandie J approved of the following description by Thomas J in Adamson v Queensland Law Society Incorporated:[7]

The test to be applied is whether the conduct violates or falls short of, to a substantial degree, the standard of professional conduct observed or approved by members of the profession of good repute and competency.

1. The determinations which can be made depend on whether or not the unprofessional conduct is of a serious nature. In Kozeniauskas v Dental Practice Board,[8] then President Morris indicated that the difference goes to 'the gravity of the conduct', and depends on the facts and the assessment of the conduct in the context of professional practice generally.
2. Where a finding of unprofessional conduct of a serious nature is made, the available determinations include requiring the practitioner to undergo counselling, cautions and reprimands, education and conditions on registration, fines, suspension or disqualification.[9]
3. By contrast, if the unprofessional conduct is not of a serious nature, then the determinations are limited to counselling, education, caution and reprimand.[10]

1. Under section 77 of the HPRA, determinations can be made where a health practitioner engages in professional misconduct or unprofessional conduct.
2. The phrases 'professional misconduct' and 'unprofessional conduct' are each defined in section 3 of the HPRA.
3. Situations in which conduct amounts to professional misconduct includes where it:
   • (a) ... involves a substantial or consistent failure to reach or maintain a reasonable standard of competence and diligence [or]
   • (b) ... violates or falls short of, to a substantial degree, the standard of professional conduct observed by members of the profession of good repute or competency ...
4. Situations in which conduct amounts to unprofessional conduct include if it:
   • (a) ... is of a lesser standard than a member of the public or the health practitioner's peers are entitled to expect of a reasonably competent health practitioner of that kind [or]
   • (b) ... [where the person's] professional performance ... is of a lesser standard than that which [his or her] peers might reasonably expect ...
5. The Medical Board notes that in Omarjee v Medical Board of Victoria,[11] Hayne J endorsed an approach that involves considering the conduct as a whole, rather than breaking the conduct into fragments and applying the definition to each fragment.
6. Irrespective of how the conduct is characterised, the Tribunal can make a range of determinations, including counselling, cautions and reprimands, education and conditions on registration, fines, suspension or cancellation of registration, supervision, requiring the practitioner to do or refrain from doing something in his or her practice, etc.[12]

1. Under section 196 of the National Law, the Tribunal may make findings that a practitioner has engaged in unprofessional conduct or professional misconduct.

1. Situations in which conduct amounts to professional misconduct includes where it involves:
   • (a) unprofessional conduct by the practitioner ... 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 ...[13]
2. Unprofessional conduct is defined in section 5 of the National Law as meaning 'professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner's professional peers'. It includes 'conviction of the practitioner for an offence under another Act, the nature of which may affect the practitioner's suitability to continue to practise'.
3. Irrespective of how the conduct is characterised, the Tribunal can caution or reprimand, impose conditions on registration, fine, suspend or cancel the registration of a practitioner.[14]

1. The Tribunal makes the following findings:
   • (a) Between November 2001 and March 2002, Dr Watts engaged in behaviour which constituted unprofessional conduct, as defined in sub-paragraph (b) of the definition of "unprofessional conduct" in section 3 of the MPA, not of a serious nature in that the medical records kept in respect of Patient five were inadequate.
   • (b) Between 25 October 2001 and 30 June 2007, Dr Watts engaged in unprofessional conduct of a serious nature, as defined in sub-paragraph (c) of the definition of "unprofessional conduct" in section 3 of the MPA in that:
     • (i) his prescribing of drugs of dependence to Patients two, three, five and eight was clinically inappropriate;
     • (ii) he inappropriately managed the conditions of Patients two, three, five and eight;
     • (iii) he failed to devise a treatment plan for Patient three; and
     • (iv) he failed to implement an appropriate treatment plan for Patient two.
   • (c) Between 1 July 2007 and 30 June 2010, Dr Watts engaged in behaviour that constituted unprofessional conduct as defined in sub-paragraphs (a) and/or (b) of the definition of "unprofessional conduct" in section 3(1) of the HPRA in that:
     • (i) he failed to notify a drug dependent person contrary to former section 33(3) of the DPCS Act in respect of Patients one, two, three_,_ four, six, seven and eight; and
     • (ii) the medical records kept were inadequate in respect of Patients six, seven and eight.
   • (d) Between 1 July 2007 and 30 June 2010, Dr Watts engaged in behaviour that constituted "professional misconduct" as defined in sub-paragraphs (a) and (b) of the definition of section 3(1) of the HPRA in that:
     • (i) his prescribing of drugs of dependence to Patients one to eight was clinically inappropriate and / or excessive;
     • (ii) he inappropriately managed the conditions of and/or did not take appropriate or adequate steps to assess Patients one to eight;
     • (iii) he prescribed Schedule 8 poisons (as defined in section 4 of the DPCS Act) without a permit to a drug dependent person contrary to section 34B(a) of the DPCS Act in respect of Patients one, four, five, six, seven and eight;
     • (iv) he prescribed Schedule 8 poisons to Patient five in respect of whom a Schedule 8 permit had been issued other than for the period specified in the permit / after expiration of the permit contrary to section 35(a) of the DPCS Act; and
     • (v) he prescribed Schedule 8 poisons to Patient five in respect of whom a Schedule 8 permit has been issued in excess of the quantity specified in the permit contrary to section 35(b) of the DPCS Act.
   • (e) For the period between 1 July 2010 and 6 October 2014, Dr Watts engaged in behaviour that constituted "unprofessional conduct" as that term is defined in section 5 of the National Law, in that:
     • (i) he failed to notify a drug dependent person contrary to former section 33(3) of the DPCS Act in respect of Patient one, two, three, four, six, seven and eight.
   • (f) For the period 1 July 2010 and onwards, Dr Watts engaged in "professional misconduct" as defined in sub-paragraphs (a) and/or (b) of the definition of "professional misconduct" in section 5 of the National Law in that:
     • (i) his prescribing of drugs of dependence to Patients one, two, three, four, five, seven and eight was clinically inappropriate and/or excessive;
     • (ii) he inappropriately managed the condition and/or did not take appropriate or adequate steps to assess Patients one, two, three, four, five, seven and eight;
     • (iii) he prescribed Schedule 8 poisons without a permit to a drug dependent person contrary to section 34B(a) of the DPCS Act in respect of Patients one, four, six, seven and eight;
     • (iv) he prescribed Schedule 8 poisons to Patients four, five, seven and eight in respect of whom a Schedule 8 permit had been issued other than for the period specified in the permit / after expiration of the permit contrary to section 35(a) of the DPCS Act;
     • (v) he prescribed Schedule 8 poisons to Patients five and seven in respect of whom a Schedule 8 permit had been issued in excess of the quantity specified in the permit contrary to section 35(b) of the DPCS Act; and
     • (vi) Dr Watts pleaded guilty in relation to criminal charges laid against him, being 7 'between dates' and 2 single instance counts reflecting multiple separate instances of prescribing contrary to the DPCS Act.

1. As noted in Medical Board of Australia v Jansz:[15]

Determinations consequent upon adverse findings in relation to members of a profession are intended to maintain proper ethical and professional standards, primarily for the protection of the public, but also for the protection of the profession, in the sense of maintaining its stature and integrity in the eyes of the public.

1. While the power to make determinations is not intended to be punitive, specific and general deterrence, and the facilitation of rehabilitation will be relevant.[16]
2. Relevant factors to be considered by the Tribunal include the nature and seriousness of the conduct, evidence of contrition, the need or otherwise for specific deterrence, other disciplinary findings, evidence of character, evidence of rehabilitation, any delay between the start of the investigation until the completion of the Tribunal hearing and other mitigating factors.[17] Also relevant is the degree of insight that the practitioner has into his or her offending conduct.[18]
3. Where there has been agreement between the regulator and practitioner regarding the appropriate determination, it is a 'significant matter' to which 'weight can and should be given' by the Tribunal.[19]
4. Penalties which have been 'imposed in other cases involving similar or analogous conduct will be a useful guide to proportionality', although this does not 'override the need to consider the unique facts and circumstances of the case at hand'.[20]
5. Below, we consider each of the agreed determinations and set out our decisions in relation to the appropriate determinations to be made in relation to Dr Watts.

1. We agree that a reprimand is appropriate in this case.
2. A reprimand is not a trivial determination, rather it a strong censure of the practitioner for falling below the standards expected of that practitioner.

1. The Medical Board and Dr Watts have agreed that a suspension period of 6 months is appropriate.
2. In terms of parity, this is between the three month suspension period imposed on the practitioners in Medical Board of Australia v Sosnin[21] and Medical Board of Australia v Griffiths,[22] and the lengthier period of 12 months imposed on the practitioner in Medical Board of Australia v Fox.[23]
3. Each of those cases involved similar issues associated with inappropriate prescribing to drug dependent patients. At the extreme end, Dr Fox's prescribing involved 18 patients, conviction on 58 charges and findings in respect of 115 allegations. Dr Griffith's matter involved a similar number of patients as this proceeding (9) and a similar period of offending (1999 to 2015). However, one factor that lead the Tribunal in that case to impose a suspension period of 3 months, rather than 6 months as sought by the Medical Board, was the fact that Dr Griffiths was a rural practitioner working in a small local community, with specialised skills, such that the public interest was properly served by allowing him to continue to practise with safeguards in place.
4. In contending for a suspension period of 6 months, Mr Ihle (counsel for Dr Watts) says that his client has shown remorse and insight, and has never 'eschewed responsibility for his actions or sought to minimise the seriousness of them'.[24] He also observes that Dr Watts 'made full admissions in respect of the charges (some of which overlapped with allegations before this Tribunal) before the Magistrate[s'] Court'[25] and points to the lengthy delay between the last offending and the hearing as a 'powerful mitigating factor'.[26]
5. There are some aspects of Dr Watts' offending that caused us particular concerns, including that one of the patients involved was a minor, that Dr Watts had previously received a caution for similar offences in 2005 and that the offending continued despite a visit from the drugs and poisons unit (DPU) of the Department of Health and Human Services in 2011.
6. Dr Watts gave evidence on each of these matters, which (for the reasons given below) has helped to allay our concerns.
7. In relation to patient 3, Dr Watts evidence is that he had first met the patient when she was 12. The patient came from a broken family, had a stormy relationship with her mother and had been thrown out of the home of her grandparents (who had custody of her). She was traumatised by her circumstances, but had been making efforts, with support from her school, the government and accommodation services, to get her life back on track and attend school. The patient presented with distress, suicidal thoughts and depression. While Dr Watts admitted that he realised she was drug dependent, he viewed that drug taking in the context of her distress and that the prescriptions of benzodiazepines 'did seem to help her anxiety and severe depression'. Dr Watts accepts that 'in hindsight', he was 'naïve', but at the time it was 'hard to know what else to do'.
8. In relation to the events in 2005, Dr Watts indicated that following the caution, he had worked with a couple of drug and alcohol specialists, and attended a course on prescribing run by Turning Point. However, the problem 'was not an issue of knowledge as to what is appropriate', but rather a 'psychological thing'. He prescribed drugs 'hoping to improve' the situation for a patient 'in pain or in trouble', and then increased the medication when that did not work. In so doing, he admits he became 'overly focussed on distress and lost sight of other issues'.
9. Dr Watts said that, following his consultations with Dr Loyal, he feels that he has 'a much better understanding as to why the situations come about and repeat', and that because he is 'more aware now', he will be able to 'take action to prevent' it happening again. This would involve indicating to patients of concern that he 'can't continue' with them, and passing them to others in the Clinic. While he had always had support from others in the Clinic, he says he is 'more ready now to call on it'.
10. In relation to the visit from the DPU in 2011, Dr Watts said that he had 'tried to tighten up on prescriptions', as well as talking to other doctors in his practice to 'see if they could help with patients'. He also 'tried to be more diligent on permits', but said it was 'hard to keep track because [the Clinic] used a paper system' at the time.
11. We consider that the evidence given by Dr Watts demonstrates insight as to how he gets into situations resulting in the offending conduct and contrition as to the risks that he exposed the patients to. He is clearly a caring doctor who focuses on patient need; in our view, the difficulty he demonstrates is in showing a sufficient level of professional detachment and knowing when he can no longer help and needs to extricate himself from the doctor patient relationship.
12. Notwithstanding his insight, we would have concerns if Dr Watts was to resume practice, without appropriate and quite extensive supports in place, at the end of any period of suspension. However, with those supports (discussed in relation to the conditions on his registration), we consider that a suspension period of 6 months is appropriate.
13. In our view, this period of suspension achieves an appropriate balance in all the circumstances, in terms of general deterrence, specific deterrence and rehabilitation.

1. As indicated earlier in these reasons, the Medical Board had originally proposed conditions relating to education and audit. However, following the evidence given by Dr Watts and the indications of the Tribunal's areas of concern, the Medical Board proposed (and Dr Watts agreed to) additional conditions relating to:
   • Where he could work.
   • Supervision of his work.
   • Prohibitions on prescribing Schedule 8 poisons (as defined in the DPCS Act) and benzodiazepines during the period of supervision.
   • Continuing to consult with Dr Loyal or another approved psychiatrist.
2. We consider that these conditions are necessary and appropriate for the protection of the public, while offering Dr Watts the opportunity to return to practice and rehabilitate his professional career in a controlled manner.
3. We did consider whether it was appropriate for an additional condition to be imposed to require Dr Watts to have an independent mentor (ie. outside of the Clinic) in place to be able to speak to on a regular basis about clinical matters. While we remain of the view that this would be of benefit to Dr Watts, we decided not to impose it as an additional condition given the danger of imposing insurmountable barriers to Dr Watts' return to practice.

Annexure - Conditions on Dr Watt's registration (order 3)

1. The Practitioner must undertake and successfully complete a program of education, approved by the Medical Board of Australia (Board) or the Australian Health Practitioner Regulation Agency (AHPRA), and including a reflective practice report, in relation to the prescribing of medication including in accordance with the Drugs and Poisons legislation, record keeping and training in relation to the Code of Conduct for doctors in Australia. 2. Within twenty-eight (28) days of the lifting of the suspension, the Practitioner must, on the approved form (HPN24), nominate for approval by the Board or AHPRA an education course, assessment or program (the education) addressing the topics required. The Practitioner must ensure: 1. The nomination includes a copy of the curriculum of the education. 2. The education consists of a minimum of six (6) hours and covers the topics of prescribing of medication including in accordance with the Drugs and Poisons legislation, record keeping and training in relation to the Code of Conduct for doctors in Australia.

1. The Practitioner must complete the education within six (6) months of the notice of the Board's or AHPRA's approval of the education.

1. Within fourteen (14) days of the completion of the education, the Practitioner is to provide: 1. Evidence of successful completion of the education. 2. 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.
2. Undertake an audit of practice

1. The Practitioner must submit to an audit of their practice (the audit), including any supporting records, within four (4) months of successful completion of the education and thereafter on two further occasions, at least three (3) months apart, by permitting an auditor (the auditor) approved by the Board or AHPRA to attend any and all places of practice (public and private) for the purpose of the audit and by permitting the auditor to provide a report in relation to the findings of the audit. The audit and the audit report are to focus on record keeping, the Practitioner's prescribing practices including the Practitioner's use of Schedule 4 and 8 poisons and whether the Practitioner is complying with Drugs and Poisons legislation, and must include, at a minimum, an audit of the Practitioner's patient records. 2. Within one (1) month of the completion of the education conditions, the Practitioner must provide to AHPRA: 1. nomination, on the approved form (HPN12), of an auditor(s) to be approved by the Board or AHPRA, 2. acknowledgement, on the approved form (HPN12), that AHPRA will seek reports from the approved auditor at the conclusion of each audit, and 3. acknowledgement, on the approved form (HPNA12), from the nominated auditor.

1. Within fourteen (14) 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.

1. In the event an approved auditor is no longer willing or able to provide the audit required, the Practitioner must notify AHPRA within fourteen (14) days of becoming aware of this and provide a new nomination of a proposed auditor(s) to the Board or AHPRA in the same terms as the previous nomination of auditor(s).
2. Work only in workplaces approved by the Board

Upon return to practice, the Practitioner may practise only in place(s) of practice approved by the Board or AHPRA**.**

For the purposes of this condition, 'practise' is defined as any role, whether remunerated or not, in which the individual uses their skills and knowledge as a medical practitioner in their profession. It is not restricted to the provision of direct clinical care and includes using the knowledge and skills of a medical practitioner in a direct non-clinical relationship with a client, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that impact on safe, effective delivery of services in the medical industry.

1. Upon return to practice, the Practitioner must be supervised by another registered health practitioner (the supervisor) when practising as a general practitioner**.** For the purposes of this condition, 'supervised' is defined as: The Practitioner must consult with the supervisor who is always physically present in the workplace and available to observe and discuss the management of patients and/or performance of the Practitioner when necessary and otherwise at weekly intervals. 2. No less than twenty eight (28) days before the Practitioner returns to practice, the Practitioner must, on the approved form (HPN10), nominate a primary supervisor and at least one alternate supervisor to be approved by Board or AHPRA. The Practitioner must ensure that each nomination is accompanied by an acknowledgement, on the approved form (HPNA10), from each nominated supervisor that they are willing to undertake the role of supervisor and are aware that AHPRA will seek reports from them.

1. In the event that no approved supervisor is willing or able to provide the supervision required the Practitioner must cease practice immediately and must not resume practice until a new supervisor has been nominated by the Practitioner and approved by the Board or AHPRA.

1. No less than twenty-one (21) days before the Practitioner returns to practice, the Practitioner is to provide to AHPRA, on the approved form (HP10) acknowledgement that AHPRA may: 1. obtain information from relevant authorities (such as but not limited to Medicare), and 2. obtain a report from the approved supervisor on a monthly basis. 2. The Practitioner is to ensure reports are provided to the Board or AHPRA as follows: 1. at the conclusion of the minimum period of supervision prescribed in the conditions on the Practitioner's registration; 2. at any later time that the Practitioner requests the Board to consider reviewing the supervision condition; 3. whenever the supervisor has a concern or becomes aware of a concern regarding the Practitioner's conduct or professional performance; and 4. when requested either verbally or in writing by AHPRA or the Board; otherwise 5. on a monthly basis unless otherwise advised by the Board. 3. The Practitioner is to ensure reports provided in accordance with this condition include: 1. the format, date, time and length of each supervision session that has occurred since the previous report; 2. the supervisor's opinion as to whether the Practitioner has satisfactorily participated in and understood the focus of the supervision; and 3. the Practitioner's own reflections on the supervision (unless the report is for the purpose of the approved supervisor raising concerns about the Practitioner).
2. Limitation on prescribing

The Practitioner is not permitted to prescribe Schedule 8 poisons or benzodiazepines for the period of supervision unless this condition is otherwise amended or removed by the Board.

1. Treatment with a psychiatrist
   1. The Practitioner must undertake treatment with Dr Sarabjit Loyal or other Psychiatrist approved by the Board (the treating practitioners) and attend at a frequency directed by Dr Loyal or other approved treating psychiatrist.
   2. Within twenty-eight (28) days of the notice of the imposition of these conditions, the Practitioner must provide the following to AHPRA:
      1. The contact details, on the approved form (HPF3), of the treating practitioners.
      2. Acknowledgement, on the approved form (HPF3), from the treating practitioners that AHPRA may seek reports from the treating practitioner(s) on a 3-monthly basis.
      3. Confirmation, on the approved form (HPNA3), from the treating practitioner(s) that they have seen a copy of the conditions on the Practitioner's registration.
2. General conditions

1. Within 21 days of the imposition of these conditions the Practitioner must provide to AHPRA, on the approved form (HPC), the contact details of a senior person, such as the Director of Medical Services, Director of Nursing, Senior Practice Manager, Senior Manager, Senior Partner, Proprietor, Owner, or equivalent (the senior person) at each current place of practice. In providing this form, the practitioner acknowledges that: 1. AHPRA will contact the senior person and provide them with a copy of the conditions on the Practitioner's registration or confirm that the senior person has received a copy of the conditions from the Practitioner, and 2. The Practitioner will be required to provide the same form: 1. within seven days of the commencement of practice at each and every subsequent place of practice, and 2. within seven days of each and every notice of any subsequent alteration of these conditions. 2. All costs associated with compliance with the conditions on their registration are at the Practitioner's own expense.

1. The review period is 18 months from 20 September 2019.

[3] By letters dated 20 July 2018, 25 July 2018 and 16 September 2018.

[4] Originally the conditions related to education and audit, but during the hearing additional conditions were agreed in relation to where Dr Watts could work, imposing restrictions on his prescribing, requiring Dr Watts to be supervised for a period and to continue consulting with Dr Loyal or another approved psychiatrist.

[5] [2004] VCAT 1044 [30].

[6] [1999] VSC 113 [23]-[24].

[7] [1990] 1 Qd. R. 498 at 507.

[8] [2005] VCAT 1058 [7].

[11] Unreported, Supreme Court of Victoria, 7 December 1992.

[15] [2011] VCAT 1026 [362].

[17] Medical Board of Australia v Griffiths [2017] VCAT 822 [43].

[18] Williams v Medical Practitioners Board of Victoria [2008] VCAT 1784 [99].

[19] Medical Board of Australia v Griffiths [2017] VCAT 822 [57].

[21] [2018] VCAT 221.

[22] [2017] VCAT 822.

[23] [2016] VCAT 408.

[24] Outline of Submissions on behalf of Dr Watts dated 20 September 2019 (AOS) [11].

[26] AOS [16], citing Stirling v Legal Services Commissioner [2013] VSCA [121].