Orders under section 17 of the Open Courts Act 2013

1. It is necessary in the interests of justice to anonymise the name of the respondent in these proceedings.
2. The applicant in this proceeding shall be referred to as INZ.
3. The publication of the report of this proceeding to the extent that it would disclose the name and address of INZ or the publication of any information derived from this proceeding which could reasonably be expected to enable such identification, is prohibited save and except on the Australian Health Practitioner Regulation Agency's Register of Practitioners.
4. These orders apply throughout Australia. The Tribunal's reasons for decisions are published on the AustLII website, which is accessible throughout Australia.
5. This order operates until the death of the respondent or further order.

Findings and orders under the Health Practitioner Regulation National Law (Victoria) Act 2009 (the "National Law")**

1. In relation to Allegation 1 the Tribunal finds under s.196(1)(b)(iii) of the National Law that the respondent engaged in professional misconduct.
2. In relation to allegation 2 the Tribunal finds under s.196(1)(b)(iii) of the National Law that the respondent engaged in professional misconduct.

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

1. INZ became an enrolled nurse in 1989. It was to her credit that she did so, having come from a background plagued with alcohol abuse and violence. She was a ward of the State by the age of 14, and had her first child by the age of 16. Her journey through life brought enormous challenges. Nevertheless the rock in her life, as she describes it, has been her nursing career. In 2000, she completed her Nursing Degree at Victoria University and thereafter went on to complete Postgraduate Training in Oncology and Palliative care. In the midst of these achievements, she struggled through difficult marriages followed by subsequent marriage breakdowns, the tragic death of her son in horrendous circumstances, and the death of other close family members in close proximity to each other. She has been involved in significant motor vehicle accidents, which required her to be hospitalised and has been plagued by a number of serious medical conditions. She has suffered periods of significant depression, made suicide attempts and misused drugs.
2. Perhaps unsurprisingly, her nursing career has been impacted by some of these events and she has during the course of her career had various conditions placed on her registration.
3. On 9 January 2014, the Nursing and Midwifery Board of Australia, ("the Board"), imposed conditions on INZ's registration following a health assessment conducted on 21 October 2013 by Dr Peter Smith. He had diagnosed INZ with mixed anxiety, depressive disorder and substance dependence (Benzodiazepine).
4. It is the breach of those conditions which has led to these proceedings.

1. On 15 January 2016, the Australian Health Practitioner Regulation Agency, ("AHPRA"), advised INZ that the Board had decided to take immediate action and suspend her registration and that the issue of her non-compliance would be referred for investigation.
2. The initial suspension remained in place after INZ then tested positive for opiates.
3. Section 193(1) of the National Law requires the Board to refer a matter to this Tribunal for hearing where it reasonably believes the practitioner has behaved in a way that constitutes professional misconduct.
4. On 24 February 2017, AHPRA referred the matter to this Tribunal pursuant to s. 193(1)(a)(i) of the Health Practitioner Regulation National Law (Vic) Act 2009 ("the National Law").
5. The hearing was listed to commence on 11 September 2017. However, the Board sought an adjournment of the proceeding because further material had come to its attention upon which it sought to rely. The hearing was accordingly adjourned with consequential orders and orders which clarified the dates of the allegations.
6. The hearing recommenced before us on 11 October 2017.
7. At the commencement of the hearing, INZ sought orders to protect her identity.
8. Having heard from the parties and read the material on file, we were satisfied that the interests of justice lay in the interim preservation of INZ's privacy.
9. We accordingly made orders under s.30 of the Open Courts Act 2013 (the "OCA"), closing the hearing room to all persons other than the parties, their legal representatives/personal supports and witnesses. We were mindful in doing so that we would be hearing highly personal details of INZ's traumatic background.
10. We informed the parties that we would give a further opportunity for them to make submissions at the conclusion of the hearing, as to whether additional orders should be made for the ongoing preservation of INZ's anonymity.
11. By the conclusion of the hearing we were satisfied that it was appropriate to make the orders sought, because we accepted that the material placed before us was intensely personal in nature. We accepted that publication of INZ's name could lead to re-traumatisation for her. The publication of reasons for decision in these matters is not intended to further punish an individual. The message which is conveyed to the public and other health practitioners, through the publication of these reasons for decision, is not lost through protecting the privacy of INZ.
12. We accordingly made the following orders under s.17 of the OCA:

Orders under section 17 of the Open Courts Act 2013

1. It is necessary in the interests of justice to anonymise the name of the respondent in these proceedings.
2. The applicant in this proceeding should be referred to as INZ.
3. The publication of a report of this proceeding to the extent that it would disclose the name and address of INZ or the publication of any information derived from this proceeding which could reasonably be expected to enable such identification, is prohibited save and except on the Australian Health Practitioner Regulation Agency's Register of Practitioners.
4. These orders apply throughout Australia. The Tribunal's reasons for decisions are published on the AustLII website, which is accessible throughout Australia.
5. This order operates until the death of the respondent or further order.
6. For the sake of clarity, we emphasise that the order does not apply to publication by AHPRA of INZ's name on the Register of Practitioners.
7. We take the opportunity to apologise to the parties for the delay in the publication of these orders and reasons for decision. The delay was caused because of the ill-health and travel commitments of panel member(s).

1. When hearing these types of matters, the Tribunal is required to determine:

(b) the appropriate characterisation of the conduct; and

1. INZ does not deny that she breached conditions placed on her registration. Rather, she sought to contextualise the breaches and persuade us that they did not warrant suspension of her registration.
2. We will address each of these considerations in turn.

1. The question before us on the facts was essentially whether, or to what extent, INZ's breaches of the conditions on her registration were deliberate.
2. INZ contends that the breaches were "unconscious breaches" during a difficult stage of her life. We were told that during the period of the breaches, INZ was intermittently caring for and supporting grandchildren, one of whom had significant behavioural problems; grieving the recent death of her mother and, in 2015, grieving the loss of her two sisters, in close proximity to each other, to cancer.
3. We will address the facts of each of the allegations in turn.

1. The Board alleged that on or about 27 August 2015, INZ attempted to deceive and/or mislead the Board and/or the AHPRA as to her whereabouts and/or the status of her employment in circumstances where it was a condition of her registration that she inform the Board of any changes of her employment status.
2. We received a statement from Mr Lam, AHPRA Compliance Officer, dated 28 April 2017, in which he discussed INZ's conditions. On 21 January 2014, he sent INZ a letter to notify her that he had been assigned to assist with future enquiries regarding the conditions on her registration.
3. The Board relied on the following particulars:

(i) On 27 August 2015, INZ spoke with Mr Lam, by telephone, and said words to the effect that she was on leave overseas with her family, that she did not have a definite date of return, that she would be overseas until at least 25 December 2015 and that she would advise AHPRA when she returned.

(ii) The employment records held by INZ's employer indicate that INZ worked various shifts between September 2015 and December 2015.

1. We received a copy of a contemporaneous file note made by Mr Lam, dated 27 August 2015, which he made when he spoke to INZ about her intended travel.
2. One of Mr Lam's roles as a compliance officer, was to monitor compliance with conditions placed on the registration of health practitioners.
3. INZ admits, and we are satisfied that INZ was not overseas at all during this period.
4. INZ further admits, and we are satisfied that, INZ in fact worked during this time, albeit with some periods of leave due to ill health. Indeed INZ acknowledged, having been shown employment records, that she worked the very day after having spoken with Mr Lam.
5. In her evidence before us, INZ oscillated between questioning the accuracy of Mr Lam's recollection of the call, to saying she could not remember whether she had said she was actually overseas to Mr Lam, to saying she would not have said she was overseas. She suggested that she had intended to travel but then changed her plans.

1. We did not accept INZ's evidence insofar as it suggested any inaccuracy in Mr Lam's recollection of his discussions with her. He made a contemporaneous note of those discussions. INZ did not seek to cross-examine Mr Lam. We accept the particulars of allegation 1, as being accurate.
2. In a telephone call made by AHPRA to INZ on 7 January 2016, INZ was also recorded as telling Mr Mark McPherson, the team leader of AHPRA Compliance, in the presence of Ms Shae Bradshaw, that she was overseas but returned to Australia when there was a sudden death in her family, [and also to work].
3. On 8 January 2016, Mr McPherson, in a detailed file note following a further telephone call, wrote that INZ advised amongst other things that "she came back from overseas early" to have operations in September 2015 and November 2015.

Did INZ change her mind and simply forget to tell the Board?

1. In submissions filed on behalf of INZ prior to the hearing, it was suggested that INZ had intended to travel overseas to America in August 2015. Those submissions stated that at the last minute INZ was unable to do so because she was required to have a number of gynaecological operations in August, November and December. The submissions said that while she did work between those operations, she did not travel and that in the stress and disappointment of that period of her life, she did not think to inform the Board that her plans had changed.
2. The submissions about the last minute changes were broadly consistent with an explanatory email, sent by INZ to the AHPRA investigator, on 7 March 2016. However, they differed in terms of what she was actually doing with herself around that time. INZ said:

I did not think to inform the Board that I was not travelling. There had been a death in the family and I was unwell. I'm sorry, it just didn't cross my mind. In hindsight I know I should have informed the board. At that time I was not working at all and was not sure if the restriction still applied.

1. In another email, dated 11 April 2016, whilst making reference to a death in the family, INZ gave yet another explanation, saying:

I did not go overseas as planned. This is mainly due to the fact that I had finally been employed after so many knock backs and I did not want to jeopardise my employment.

1. We are satisfied that INZ consciously and deliberately attempted to mislead the Board as to her whereabouts and the status of her employment.
2. We did not accept her evidence that she was not telling deliberate lies but "may have said things wrong" or later, was in "survival mode", or may have "put her head in the sand", or that she did not want to tell Mr Lam the details of her surgery.
3. INZ ultimately accepted under cross-examination that she knew that by telling Mr Lam that she was away, she would avoid the drug screens. She said she wished to do so because her surgery would result in a positive drug test result. She said she did not wish to tell Mr Lam about her surgery because of its private nature. INZ denied that she was on drugs or suicidal or had any other relevant issues of concern to the Board in her life.
4. INZ was aware that if she was not within the jurisdiction, and was not working as a nurse, that she would not need to comply with the conditions on her registration.
5. In his statement, Mr Lam discussed the ability of health practitioners to be granted leave from compliance with the drug and alcohol screening conditions on their registration when travelling interstate or overseas. He explained that, during his time as a compliance officer, as long as the practitioner advised verbally with sufficient notice that he would generally approve their requests to be granted leave from screening.
6. We are further satisfied that the rationale for misleading the Board was in order to enable her to avoid compliance with the conditions on her registration.

1. The Board alleged that INZ breached conditions of her registration between December 2014 and 4 January 2016, with multiple failures to:

- keep the Board informed of her return to and place of work and authorise her employer to communicate regarding workplace performance;

1. Failure to keep the Board informed of return to and place of work and authorise employer to communicate regarding workplace performance. The conditions on INZ's registration required her to:

- inform the Board within 7 days of a return to practice and to inform the Board of each of her employers' details;

- inform the Board within 7 days of any change in place of practice; and

- authorise AHPRA and her employer(s) to communicate regarding her workplace performance and any concerns identified.

(a) Between 8 December 2014 and 12 July 2015, INZ failed to provide the Board with details of her employer.

1. INZ accepts this to be the case.
2. INZ agreed that on 8 December 2014, she commenced casual employment as a registered nurse. It was not until 13 July 2015, that INZ sent an email to Mr Lam in which she stated that she was working and provided the address and contact details of her employer, as well as her manager's name.

(b) From 8 December 2014, INZ failed to inform the Board of a change in her place of practice.

(c) Between 8 December 2014 and 12 July 2015, INZ failed to authorise AHPRA to communicate with her employer regarding her workplace performance and any concerns identified.

1. Once again, INZ accepts this to be the case.
2. We agree with the submissions made on behalf of INZ that (a), (b) and (c) above, are essentially all allegations arising from one (ongoing) omission - the failure by INZ to inform the Board that she was working.
3. INZ sought to persuade us that her omission was motivated by desperation rather than malice, because she needed to work. Essentially she asked us to accept that, despite having sought employment, she found that she could not work with the conditions attached to her registration, She gave evidence that she wanted to prove herself as a nurse to her employer. She said that she would have told her employer of her conditions earlier, but during the period of her employment, her manager changed, such that she needed to reprove herself, thereby delaying notification to the Board.
4. We are satisfied that INZ deliberately failed to keep the Board informed of her return to and place of work and authorise her employer to communicate regarding her workplace performance.

(d) INZ failed to provide reports from her employer, on 8 March 2015 and 13 October 2015, in breach of a condition on her registration that required her to provide employer reports satisfactory to the Board every 3 months and meet the Board's specific requirements in relation to this upon her return to practice as a registered nurse.

1. INZ agreed that she failed to provide the reports.
2. We find that INZ failed to provide the reports and her conduct was deliberate.
3. This is a serious matter. It was not for INZ to wait until she could ensure a good report would be forthcoming from her employer.
4. On 15 July 2015, a report was provided by her employer to AHPRA. It was a positive report about her performance.
5. The Board further alleged that:

(e) INZ failed to provide reports from her treating general practitioner, psychologist and psychiatrist (the treating practitioners) on a periodic basis as required by the conditions on her registration.

1. INZ agreed that a condition applied to her registration between October 2014 and January 2016, that required her to attend the treating practitioners for regular sessions at a frequency determined by the treating practitioners and to meet the Board's specific requirements in relation to this, namely to provide reports from the treating practitioners satisfactory to the Board every three months (or more frequently if the Board deemed necessary).

Did INZ believe the condition would automatically lapse?

1. INZ initially contended that she thought she did not have to provide the reports on an ongoing basis. We heard detailed submissions and extensive evidence on this point. Initially INZ sought to persuade us that she was under the impression that her conditions would lapse after 1 year. Reference was made to earlier (interstate) conditions automatically lapsing and some confusion when the Board did not promptly respond to correspondence from INZ in which she alluded to the conditions lapsing.
2. We were, however, satisfied that INZ was well aware that the conditions and her duty to comply with those conditions, was ongoing.
3. We were shown the original letter, dated 13 January 2014 from AHPRA advising INZ of the conditions on her registration.
4. The letter says:

The conditions will be reviewed in 12 months from date of imposition. During the review period the conditions cannot be changed or removed unless there is a material change in circumstance.

1. The letter does not state that the conditions will be removed after 12 months. We do not accept that there was a lack of clarity about this.
2. On 31 March 2015, Mr Lam sent INZ a letter reminding her of the conditions on her registration and the necessity of compliance with them. Presumably in response to that letter, INZ contacted Mr Lam by email dated 5 April 2015 and said:

I thought that once the 12 months were up I didn't have to have urine test [sic] anymore. I am away into the last week of April so will contact you when I return. Could you please inform me how to apply to have the conditions lifted.

1. On that day, Mr Lam contacted INZ by telephone.
2. In his statement Mr Lam states:

I recall contacting [INZ] by telephone and advising her that all conditions on her registration would remain in place until they were removed by the Board. I recall finding a copy, on AHPRA's file for [INZ], of the original letter sent to [INZ] on 21 January 2014. I referred [INZ] to this letter and the statement in the letter that all requests for review, change or removal of conditions must be forwarded to the Board, in writing, in the form provided on the Board's website. I advised [INZ] that all requests for removal of conditions must be made to the Board in writing. I recall [INZ] stating words to the effect of "I'll have to look into it". She also told me that she would make contact with me again on her return to Melbourne. I do not believe that I made a file note of this conversation with [INZ].

1. It is clear that by this stage, INZ was well aware that the conditions were not lifted and that she would need to take positive steps to have them lifted. Her non-compliance nevertheless continued.
2. During this period, INZ was not being frank with the Board. Despite INZ telling Mr Lam in her email, that she was away, we note that she in fact worked during that week.
3. On 13 July 2015, when INZ finally advised AHPRA that she was working, she again said:

.. I also understood that the conditions on my registration would be lifted after 12 months which is long past.... Could you please let me know what I have to do to get the conditions lifted?

1. INZ attempted to push responsibility onto the Board for not providing greater clarity surrounding her conditions. We do not accept that there were any shortcomings attributable to the Board. The onus lies on INZ to ensure she understood the conditions and to ensure they were complied with.
2. Self-serving emails suggestive of ambiguity could not override that responsibility.
3. If INZ had any confusion with respect to her conditions, it was for her to clarify that confusion. We note that when INZ had had conditions imposed on her registration previously, she did ensure that she understood them.
4. In any event, during the course of her evidence, INZ ultimately conceded that she knew the conditions on her registration were probably ongoing. She said in her evidence that "deep down" she knew the conditions would not be just lifted. Later in her evidence she said that she may have known the conditions still applied, but that she had more important issues in her life at that time and that the conditions took a back seat to that. She said if she had her time over again, she would act differently.
5. INZ, in her evidence, repeatedly bemoaned the fact that she had "paid for" her mistakes.
6. We were satisfied that INZ did understand her conditions would be ongoing.

1. We accept that during the relevant period, the Board only received one of the required reports from INZ's treating general practitioner. That was on 15 July 2014. AHPRA did not receive a report in October 2014, (3 months later as required by the condition), January 2015, April 2015, July 2015, October 2015 and January 2016.
2. We do accept that INZ nevertheless consistently engaged with her general practitioner throughout this period. We also accept that she continued to be fully engaged with treatment on a regular basis and is so engaged despite the inconvenience of travel associated with those attendances. We further accept that she has made excellent progress in her abstinence from benzodiazepines and narcotics. We do not however accept that her doing so is indicative of her efforts to co-operate with the Board. We consider it much more likely that she simply recognised the good sense in doing so. We stress that it was not for her to dictate the terms to the Board.
3. We accept that during the relevant period, the Board only received one of the required reports from INZ's psychologist dated 5 January 2015. AHPRA did not receive a report in April 2015, (3 months later as required by the condition), July 2015, October 2015 and January 2016.
4. Once again, we do however accept that INZ has consistently engaged with her psychologist throughout this period. We read a report from psychologist Jeannie Dougall, dated 31 May 2017. We also heard evidence from Ms Dougall. We accept that INZ has attended very regular counselling over a prolonged period. She participates in cognitive behavioural therapy. She also works on techniques to manage stress and anxiety and to develop and implement strategies in support of an effective return to work. We accept that she has made significant progress and that there has been a notable improvement in her depression, stress anxiety and symptoms of post-traumatic stress disorder.
5. We accept that during the relevant period, the Board only received one of the required reports from INZ's psychiatrist. AHPRA did not receive a report in March 2015, June 2015, September 2015 and December 2015.
6. The Board further alleged that:

(f) INZ failed to attend random drug urinalysis in accordance with the Board's protocol and meet the Board's specific requirements in relation to this between 10 February 2015 and 4 January 2016 in breach of a condition on her registration between February 2015 and January 2016 that required her to do so.

1. The protocol and specific requirements with which the Board requires practitioners to comply in relation to random drug urinalysis is outlined in AHPRA's and the Board's specific Requirements for Urine Drug Screening Documents (RUDS Protocol).
2. The RUDS protocol states that:

- the health practitioner will be designated to a testing group which determines the frequency of testing required

- the health practitioner is required to telephone a random drug screening number each weekday to ascertain whether a drug screen is required that day for the designated testing group

- if a drug screen is required then the health practitioner must present for screening that day

- it is the health practitioner's duty to arrange for the screening laboratory to forward the results of urinalysis to AHPRA and to the health practitioners treating practitioner

- where conditions or undertakings are in place, registered health practitioners are required to present for UDS screening whether or not they are working as a registered health practitioner.

1. The dates on which each testing group is required to attend for drug screening is determined in advance by AHPRA. On 21 January 2014, INZ was informed by AHPRA that for the purposes of random drug urinalysis, she was allocated to Testing Group 5.
2. We were provided with the AHPRA records which disclosed the designated testing dates for Group 5 in the relevant period. INZ did not attend for screening on 10 February 2015, 24 February 2015, 10 March 2015, 24 March 2015, 12 May 2015, 28 May 2015, 3 June 2015, 17 June 2015, 2 July 2015, 14 July 2015, 13 August 2015, 27 August 2015, 8 September 2015, 23 September 2015, 7 October 2015, 23 October 2015, 4 November 2015, 18 November 2015, 10 December 2015, 29 December 2015 and 4 January 20.
3. We accept that INZ did not undergo the required screening.
4. We accept that she has, following her suspension, recommenced urinalysis and that she has not returned any positive samples. We note, however, that it is not the same random screening as required under the conditions. Once again, we reiterate that it is not for INZ to dictate to the Board the manner in which she will comply with conditions on her registration.

1. We are satisfied that each of the allegations have been established in accordance with our above findings.
2. We find that INZ deliberately failed to inform the Board of her employment in order to prevent her employer becoming aware of the conditions on her registration.
3. We find that INZ worked during the second half of 2015, without making any effort to comply with the conditions on her registration despite having been informed by email on 14 July 2015, that the conditions remained in place.
4. We accept that her other explanations for the failure to comply, namely that she did not wish to tell her employer of the conditions, is the most likely explanation. In submissions and in her evidence, INZ stated that she had missed out on a number of jobs due to the conditions on her registration.
5. It is an explanation consistent with deliberate endeavours to avoid the consequences of those conditions.

The appropriate characterisation of the conduct

1. The question before us in terms of characterisation of the conduct was whether the conduct constituted unprofessional conduct or professional misconduct.
2. INZ contends that because:

- she made attempts to comply with the conditions;

- her conduct was not in the context of treatment of a patient; and

that the appropriate characterisation is one of unprofessional conduct.

1. The Board emphasised the importance of compliance with conditions placed on the registration of nurses, in order to effectively regulate the large and diverse body of nurses under its control. It pointed to the multiplicity of breaches over a prolonged period and emphasised the purpose of conditions as being to ensure the safety of patients and the public. The Board urged us to make findings that the conduct amounted to professional misconduct.

1. Under section 196(1)(b)(ii)/(iii) of the National Law it is (relevantly) open to the Tribunal to find that INZ has behaved in a way that constitutes unprofessional conduct/professional misconduct as defined in section 5 of the National Law.
2. Unprofessional conduct is relevantly defined in s.5(b)(i) 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, including a contravention by the practitioner of a condition to which the practitioner's registration was subject.

1. Professional misconduct is defined in s. 5 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;

(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. We are satisfied that allegation 1 is professional misconduct within the meaning of paragraph (a) of the definition of professional misconduct in the National Law.
2. We have found that INZ's conduct was deliberate.
3. INZ's attempt to mislead the Board was successful for some months. It resulted in INZ working for months without any of the protections which the conditions on her registration are intended to provide for her and her patients and the wider community.
4. We agree with the submission of the Board that the Board must be able to place reliance on things told to it by nurses, particularly in relation to compliance with conditions. Much of the regulatory system is dependent on frank and open communication.
5. We agree with the submissions of the Board that professional misconduct is not confined only to conduct involving clinical care or decision-making.
6. INZ's conduct related directly to her duty as a registered nurse. The Board is her regulator. Honesty is a fundamental requirement for a health professional dealing with their registration Board, as the Board carries out its public protection function. Her attempts to mislead the Board are very serious and reflect seriously on her character.
7. We agree with the submissions of the Board that any attempt to deceive the Board is a serious matter.
8. INZ's conduct is substantially below the standard reasonably expected of a registered nurse of equivalent training/experience.
9. We are satisfied that allegation 2 is professional misconduct within the meaning of paragraph (b) of the definition of professional misconduct in the National Law.
10. INZ failed to comply with multiple conditions placed on her registration on multiple occasions. Each failure constituted unprofessional conduct, but when considered together, we are satisfied that the multiple instances of unprofessional conduct amount to conduct substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience.
11. INZ deliberately practised as a nurse for an extended period without complying with conditions.
12. It will never be known whether compliance with the drug screening would or would not have disclosed an issue. Thankfully, there is no evidence of actual harm caused by INZ to a patient. That however is not to the point. Conditions are imposed in order to ensure the safety of patients. Failure to comply with conditions potentially places patients at risk.
13. The failure is rendered more serious by the fact that INZ continued her failure to comply with multiple conditions on multiple occasions, even after it was confirmed to her in writing that the conditions were still in place.
14. We also agree with the submission of the Board that is not to the point in terms of the characterisation of the conduct that INZ had previously complied with the conditions on her registration. We agree that previous compliance cannot excuse subsequent non-compliance. Similarly, continuing to see her GP and Psychologist on her own terms does not equate to compliance with conditions.

1. Under section 196(2) of the National Law the Tribunal may impose one or more of the following determinations:

(d) suspend INZ's registration for a specific period and/or

1. INZ submitted that she poses no future risk in the practise of her nursing and that she should be permitted to return immediately to practice. INZ stressed that she has never posed a risk to the community and that any further impact on her registration would be punitive in its nature. She contends that the appropriate outcome of the case is a caution.
2. The Board urged us to indicate in our reasons that the conduct warranted a period of suspension on INZ's registration of 12 months.
3. The Board acknowledged that INZ has already effectively served (greater than) such a suspension and is not, on the evidence before us, presently unfit to practise. In those circumstances, the Board agreed that we should make no formal order for a (further) suspension. The Board, however, contended that we should impose a suite of determinations including a reprimand and the imposition of conditions.
4. For the reasons that we have already articulated, we agree that the conduct is blameworthy and deserving of more than passing censure. Because of her previous history, INZ was well placed to know and appreciate the importance of strict compliance with the conditions on her registration. Her conduct was prolonged and deliberate. We agree with the submissions of the Board that, for reasons of specific and general deterrence and the protection of public confidence in the regulatory system, a determination needs to be imposed which sends a strong message to INZ, her peers and the public. We note in this respect that, but for the fact that INZ has already served an effective period of suspension, we would have been minded to impose a suspension on INZ's registration.
5. Determinations are imposed to protect the public and the standards of the profession.
6. Specific and general deterrence have already been achieved by the period of suspension already completed, which is now effectively 2 years. We are satisfied that the protracted nature of these proceedings have had a salutary impact which will provide an appropriate safeguard for the future.
7. We are also mindful that the community was protected by the conditions imposed on INZ for a lengthy period of time and that there was substantial compliance with the main protective conditions imposed on her registration for over five years. Throughout, INZ attended upon both her general practitioner and psychologist regularly.
8. More significantly, INZ has made considerable progress in her treatment. INZ has now obtained negative urine samples over a prolonged period. She has done so despite the fact that her registration has been suspended for two years. We accept that she has remained abstinent from drugs and continued to engage with health practitioners. She is currently well. There is no reason to believe that she will not remain drug-free and well into the future.
9. We note in this regard, the opinion of Ms Dougall that INZ's current level of well-being should continue to be stable into the future. She further opines that INZ presents "in no way a danger to her patients". Ms Dougall does not consider this would change if INZ returned to nursing. We accept Ms Dougall's opinion.
10. The Board urged us to impose ongoing conditions on INZ's registration, including drug screening and attendance upon treating practitioners.
11. We will not, however, impose any further conditions on INZ's registration.
12. We consider that to do so would now be punitive and would not achieve any further purpose. A significant time has elapsed since INZ breached the conditions on her registration.
13. We accept that INZ will, of her own volition, continue to engage with her trusted health practitioners. There is no need to impose a condition on her registration requiring her to do so.
14. There is no evidence that INZ has, during the long stressful delay, relapsed into drug use. Although, we are mindful that there were, some years ago, gaps in the urinalysis, there is no positive evidence of any drug use for nearly 5 years. There have been negative results for over two years. We accept that INZ is drug free. There is no need, in these circumstances, to impose a condition on her registration to require her to continue drug and alcohol screening.
15. The Board submitted that we should impose a limitation on INZ's practice that she only practise in places of practice approved by the Board. We consider such a condition to be unnecessarily restrictive. Sanctions are not imposed in order to punish a practitioner. We remain mindful that there is no evidence before us that INZ has, in actual fact, ever placed a patient at risk. Conditions were placed on her registration and her registration was suspended because of concerns about her drug use and psychological state.
16. We do not, however, consider that a caution alone would reflect the nature and seriousness of the conduct.
17. We will instead reprimand INZ.
18. In Peeke v Medical Board of Victoria (unreported, Supreme Court of Victoria no 10170 of 1993, 19 January 1993), His Honour Justice Marks observed that a reprimand being a serious form of censure and condemnation "does not trivialise a serious lapse of professional standards and has the potential for serious adverse implications".
19. We do not consider that any further orders are necessary. We will make the following findings and orders under the National Law.

Findings and orders under the Health Practitioner Regulation National Law (Victoria) Act 2009 (the "National Law")

1. In relation to Allegation 1 the Tribunal finds under s.196(1)(b)(iii) of the National Law that the respondent engaged in professional misconduct .
2. In relation to Allegation 2 the Tribunal finds under s.196(1)(b)(iii) of the National Law that the respondent engaged in professional misconduct.

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

[1] Frequently in disciplinary matters, findings of fact are made and delivered before the parties are expected to address the Tribunal on the appropriate characterisation and/or determinations in relation to the conduct.