Nursing and Midwifery Board of Australia v Paterson [2020] SACAT 22

The Nursing and Midwifery Board of Australia brought a complaint against the respondent for conduct which the Board believed amounted to serious professional misconduct. Allegations were said to have occurred regarding:

• Falsification of required training certificates;
• Deceitful conduct towards patients in which records were altered, deleted or falsified;
• Prescriptions being made for an alias of the respondent;
• The creation of a false Medicare Health Plan.

The Tribunal found each allegation against the respondent to be proved. The totality of the respondents conduct over a sustained period of time amounted to serious professional misconduct. The Tribunal imposed a reprimand to a greater extent than what the Complainant sought. It imposed the following disciplinary action:

1. The respondent is reprimanded
2. The respondent is disqualified from applying for registration as a registered health practitioner for a period of 15 years
3. The respondent is prohibited from providing any health service for a period of 15 years
4. The respondent is to pay the complainant's costs of proceedings, to be agreed or fixed by the Tribunal.

Administrative and Disciplinary - Nursing and Midwifery Board of Australia - Nursing - Former registered nurse - Serious professional misconduct - Alteration of clinic records - Alteration of patient notes - Deletion of patient records - Creation of false prescriptions - Creation of a false Medicare plan - Deceit and untruthfulness in dealings with the Complainant and Tribunal - Serious character flaws inconsistent with a registered health practitioner - Failure to adequately address allegations - Non-participation in the hearing - Clear demonstration of being unfit for practice - Severe disciplinary action necessary to protect public and maintain the standards of the profession - Disqualification from applying to be a registered health practitioner for 15 years - Prohibition from providing health services for a period of 15 years - Tribunal reprimand greater to what the Complainant submitted

Health Practitioner Regulation National Law (South Australia) Act 2010 s 4

Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336

Law Society of SA v Jordan [1998] SASC 6809

Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630

NMBA v Kumar [2019] VCAT 1099

Psychology Board of Australia v King [2016] QCAT 140

NMBA v Rankine [2019] SACAT 57

NMBA v Williams [2013] SAHPT 1

HCCC v Day [2009] NSWNMT 5

NMBA v Morley [2014] SAHPT 17

NMBA v Jones [2017] SAHPT 4

NMBA v Rankine [2019] SACAT 57

Craig v MBSA [2001] SASC 169; (2001) 79 SASR 545

Mr S Ward, Piper Alderman Lawyers, for the Complainant

1. Pursuant to s 60 of the South Australia Civil and Administrative Tribunal Act 2013 the Tribunal prohibits the publication of the names of any patients referred to in the Complaint or any person who made notifications under the Act.

1. Tracy Paterson (the respondent) was formerly registered as an enrolled nurse under the provisions of the Health Practitioner Regulation National Law (the National Law).[1] She surrendered her registration on 21 January 2018.
2. Pursuant to s 193 of the National Law, the complainant (the Board) formed the view that the respondent had behaved in a manner that constituted professional misconduct. The allegations related to conduct in 2014 and 2015. The Board referred the allegations to the former SA Health Practitioners Tribunal. The matter was subsequently transferred to this Tribunal in August 2019 when the former Tribunal was dissolved, and its jurisdiction transferred to SACAT.[2]

Leave to proceed in the absence of the respondent

1. A hearing was conducted by this Tribunal on 28 October 2019. The respondent did not attend.
2. The original complaint and a subsequent amended complaint had both been served on the respondent. She had also been served with the Notice of Hearing and copies of the Book of Documents upon which the complainant intended to rely.
3. The respondent had acknowledged receipt of these materials. She was aware of the hearing date. She indicated that she did not intend to participate in the hearing (although she had been advised that she could do so personally or by telephone link). She indicated that she wished to admit the allegations, although her correspondence at times also disputed some aspects.
4. The Tribunal decided that it was appropriate to proceed in the absence of the respondent. Leave was given to proceed.

1. At hearing the complainant sought to amend some minor details in the complaint. The changes did not affect the substance of what was alleged in any significant way. The respondent had been served with a copy of the proposed amendments. The Tribunal gave leave for the amendment of the complaint as set out in the "Second Amended Complaint" exhibited to the affidavit of Simon Hayes Ward sworn on 18 October 2019.

1. The complainant was required to prove its case. The appropriate standard of proof is proof on the balance of probabilities with due regard to the principles set out in Briginshaw v Briginshaw.[3]
2. The Tribunal noted the serious nature of the allegations and the very serious potential consequences of the proceedings for the respondent. With that in mind, the Tribunal has carefully considered and assessed the evidence and indicates that it is comfortably satisfied with respect to the findings set out below.
3. The allegations in the complaint are fully made out by the evidence which was tendered by the complainant. We accept that evidence. Insofar as the respondent has from time to time disputed some allegations, we do not accept her claims. Her denials are convincingly disproved, in our view, by the complainant's evidence. We do not have any confidence in assertions made by the respondent.
4. We find each of the matters alleged against the respondent to be proved. We find that her conduct as proved constitutes professional misconduct.
5. It is not necessary for present purposes to detail all the facts that were alleged and proved. They appear in the second Amended Complaint. It will suffice to summarise the misconduct and explain our approach to the imposition of disciplinary action.

1. In September 2014 the respondent was employed as an enrolled nurse by Adelaide Care Solutions trading as SACARE. She was requested by her employer to provide updated certificates to demonstrate that she had completed training in manual handling and first aid.
2. She provided two certificates that were false. She had personally altered old (out of date) certificates by substituting more recent dates in order to suggest that the certificates were current.
3. The evidence establishes that the respondent had not completed the training on the dates suggested by the false certificates.[4]
4. A notification was made to Australian Health Practitioner Regulation Authority (AHPRA). AHPRA wrote to the respondent seeking a response. On 10 November 2014 the respondent provided a written response.[5] She stated that she had been interstate as a result of a family emergency and death. She had asked her 12-year-old stepdaughter to find the certificates on her computer and send them to the employer. She stated that her stepdaughter had found old certificates and not the current ones. The respondent falsely claimed that the certificates had been altered by the stepdaughter without her knowledge and sent to the employer on her behalf. She claimed to have had no knowledge of this until receiving the letter from AHPRA. She claimed that she would never have altered the certificates herself. She claimed, or at least implied, that she did have current certificates. She expressed horror that her professionalism had been questioned.
5. This written response was untrue. The respondent had personally falsified the certificates. Her stepdaughter was not involved. The respondent did not have current certificates.
6. AHPRA decided to investigate further and appointed an investigator. The respondent was required to provide copies of her current certificates.
7. By email dated 18 December 2014, the respondent attached "my current and past first aid certificates and manual handling certificates". She re-iterated that her stepdaughter had been the cause of the problem.[6] This claim was false.
8. Two "current" certificates attached to the email were investigated further and found to be false. They had been personally falsified by the respondent in such a way as to appear current when they were in fact out-of-date certificates.[7] These were different falsifications from the certificates previously provided to the employer. The respondent had not completed training as stated in the two further certificates. No genuine current certificates were produced as to the required training.
9. On 14 May 2015 the respondent was required to attend an interview with the investigator concerning the allegations. She was warned that it was an offence to provide false or misleading information to the investigator.
10. Initially, at the interview, the respondent denied that she had falsified the certificates originally provided to the employer. She adhered to the claim that her stepdaughter had done so. She claimed that the certificates provided with her subsequent email were genuine.
11. Later in the interview, the untruthfulness of the respondent's account was demonstrated in relation to a purported certificate from Calvary Learning, Riverina.[8] She stated that she had worked at Calvary until 2012 when she moved to SA.[9] However, the investigator pointed out that the certificate purported to refer to training in 2014. Faced with this inexplicable contradiction, the respondent finally admitted that she had falsified the date on that certificate to make it appear current.[10] She eventually admitted that she had personally falsified the four certificates to make them appear current when they were not. She admitted that the falsification of the first two certificates was not done by her stepdaughter, but by her.[11]
12. It is fair to say that the truth was only acknowledged when the respondent was confronted by evidence for which she could give no explanation. She had continued lying for as long as she thought that she might be able to get away with it.

1. Between December 2013 and August 2015, the respondent was employed as an enrolled nurse at Ladywood Clinic, a general medical practice at Modbury Heights. She was known there as Tracy Gray.
2. We received two affidavits and some oral evidence from the practice manager.[12] We also received affidavit evidence from various medical practitioners working at the clinic,[13] and from a registered nurse.[14] We accept this evidence as reliable and true. We are comfortably satisfied of the allegations in the complaint to which it related.
3. It was proved that, during 2014 and 2015, the respondent on many occasions wrongly and deliberately deleted, or falsely altered, or made untrue entries in, patient notes and records held by the Clinic. The details of this conduct were set out in a table included in the complaint. They relate to 17 patients of the clinic.
4. Where the respondent deleted an entry, the effect was that that record was no longer visible within the normal access to the patient's records. A staff member accessing those records would be unaware of the deleted entry or the fact that it existed. It could be only accessed by other means that were only available to the practice manager conducting a special search.
5. The respondent had no authority to alter or delete any entry in the patient records. She was specifically instructed by the registered nurse in a meeting on 2 March 2015 that she should never do so.[15]
6. Further detail about changes made to the notes is set out below. It is apparent that some changes were clearly motivated by the respondent's desire to cover up errors she had made and to protect herself from possible allegations. Other changes were made in circumstances where no clear motive or reason is evident.

1. The conduct was discovered after the parents of a child patient UEC contacted the Clinic because they had received a letter from the National Immunisation Programme (NIP). This body administers the Australian Childhood Immunisation Register (ACIR). The letter stated that the child had not received the MMRII vaccination ("MMR"). The MMR vaccination for measles, mumps and rubella is required to be given when a child reaches four years of age. Another vaccination, Infanrix IPV vaccination (IPV) for diptheria, tetanus, pertussis and polio, was also due after a child turned four.
2. The child UEC had attended for a consultation with the respondent on 16 January 2015. The respondent administered the IPV to the child. She recorded this fact in the original consultation notes which were prepared on that day and the ACIR was advised accordingly. However, the entry made by the respondent in the separate Immunisation Record held by the Clinic for the patient wrongly stated that MMR had been given and not the IPV.
3. Subsequently, on 6 February 2015 the respondent again administered IPV to the child. Thus, the child had been given the IPV twice and had not been given the MMR. This is what had prompted the letter from the NIP to the parents. On accessing the records, the practice manager noted that the consultation record and Immunisation Records were inconsistent.
4. The respondent, when questioned in August 2015, could not explain the discrepancy. It was unclear on the state of the records whether the same vaccination had been wrongly given twice, meaning that the MMR had not been given. The respondent was instructed to clarify the discrepancy by checking the "blue book" held by the patient's parents.
5. The respondent instead falsified the records to cover up her own mistake. She deleted the consultation note for 16 January 2015 so that its existence was no longer visible in normal access to the notes. She substituted a new note, backdating it so that it appeared to have been contemporaneous with the consultation. The new note asserted that the MRR had been given on 16 January 2015. She entered a new note dated 5 August 2015, stating that she had been instructed to follow up the history and that MMR had been given on 16 January 2015. It stated that she had advised the Immunisation authorities to correct their record.
6. On discovering this, the Practice Manager requested the parents to bring in the blue book. The entries in this book (including batch numbers of the vaccinations administered) proved conclusively that the MMR had not been administered on 16 January 2015. The PIV had been wrongly given twice by the respondent. The respondent had falsified the records to cover up her own mistake and to make it appear the child had been properly immunised when that had not occurred. If the falsification had not been discovered, the child would have remained unprotected against the diseases that the MMR guards against. The child's parents would have been deceived into thinking that the child was properly immunised when that was not the case. The Government register would have been incorrect due to the false information provided by the respondent.[16]

1. Similar conduct was discovered in relation to a child patient HJG. The child had a consultation with the respondent on 26 May 2014. The consultation notes produced at the time by the respondent stated that the child had been administered IPV only. This information was provided to the government register (ACIR). ACIR contacted the clinic in March 2015 as the child was not recorded as having received MMR. The respondent was requested to follow up with ACIR.
2. Instead of doing so, the respondent deleted the record made on 26 May 2014. She replaced it with a record, backdated to 26 May 2014 and appearing to be contemporaneous, which purported to record that the MMR had been administered as well as IPV. She left no note explaining that the record had been amended or why. The result of her conduct was that the Clinic could not be sure of the child's immunisation status.
3. Given the lapse of time between May 2014 and March 2015, the Tribunal finds on the balance of probabilities that the Clinic records (as amended by the respondent) are likely to have been incorrect and the original entry correct. Thus, the respondent had by her unauthorised amendment concealed the fact that the child had not been properly immunised.[17]

1. On 21 January 2015 the respondent made a record that she had administered IPV vaccine to the patient XAR on that day.
2. On 15 June 2015 the parents of CG contacted the respondent after being advised by ACIR that XAR had not been administered the MMR vaccine. The respondent noted that conversation.
3. The respondent then deleted her consultation note for 21 January 2015. She replaced it with a note stating that both IPV and MMR vaccines had been administered on that day. The replacement note was back-dated so as to appear that it was contemporaneous with the consultation.
4. In her note of 15 June 2015, the respondent recorded that she had called ACIR and advised them that both vaccines had been given and that she had advised XAR's parents that they would receive a new statement from ACIR.
5. The result of this conduct is that the Clinic was unable to be sure as to what vaccines were administered on 21 January 2015. Given the lapse in time between January 2015 and June 2015 the Tribunal finds it likely that the respondent's original record was correct, and the corrected record was incorrect. Thus, the child had not been properly immunised, and the records had been altered to conceal that fact. The parents were misled and the ACIR record was caused to be incorrect.[18]

1. IXB was an adult patient to whom the respondent administered an influenza vaccination on 24 April 2015 and a whooping cough vaccination on 29 April 2015. The respondent entered notes in relation to each consultation.
2. IXB subsequently contacted the surgery and the respondent rang her back. The patient stated that she had been in hospital due to developing an ulcer on the injection site following the second vaccination. She claimed that it was due to how the injection as given and stated that she was taking the matter further.
3. On 12 May 2015 the respondent deleted her earlier record of the consultation on 29 April 2015. She replaced it with a much more detailed record, including details of how she had washed her hands, removed a clean kidney dish from a cupboard, and that the correct vaccine was given as it was brought in by the patient from a pharmacy.
4. The batch number of the vaccine recorded by the respondent showed that it was from the Clinic stocks and thus the claim that was brought in by the patient from a pharmacy appears not to be correct.
5. On 29 May 2015 the respondent deleted her earlier record of the consultation on 24 April 2015. She replaced it with a more detailed record, including details of the respondent having washed her hands and cleaned the injection area with an alcohol swab.
6. On 18 May 2015 the respondent had used the practice management system to send a message to the practice manager following her telephone call with the patient. She stated that she was sorry and was not sure how this had happened. On 7 August 2015 the respondent deleted this message from the records.
7. The respondent made no note that any of the above records had been amended and no note explaining the reason for the amendments or deletions. The substituted notes were back-dated so as to appear to have been contemporaneous with the consultations.[19]

1. XVD was the husband of the above patient IXB. The respondent had administered a whooping cough vaccination to XVD on 29 April 2015. She made a contemporaneous record concerning the consultation.
2. After becoming aware of IXB's adverse reaction to her vaccination, the respondent on 1 June 2015 deleted her earlier record of the consultation with XVB and replaced it with a much more detailed record which specified additional details consistent with good practice, such as:
   • That the script had been previously prescribed and was brought in by the patient from a pharmacy
   • The batch number of the vaccine
   • That the vaccine had been immediately put in the vaccine fridge in the nurses' clinic
   • That she had washed her hands and removed a clean kidney dish from the cupboard; and
   • That post-vaccination she had requested the patient to wait in the clinic for 15 minutes for any post-vaccination issues.
3. The batch number of the vaccine recorded by the respondent showed that it was from the Clinic stocks and thus the claim that was brought in by the patient from a pharmacy appears not to be correct.
4. The respondent did not make any record of the fact that the notes had been amended or any explanation of the reason for the changes. The substituted note was back-dated so as to appear as though it was contemporaneous with the consultation.[20]

1. MYU was a child patient, to whom the respondent administered a Vaxigrip flu vaccine on 29 May 2015. As MYU was over three years of age, the correct dosage was 0.5ml. However, the respondent recorded that she had administered a dose of 0.25ml.
2. On 6 July 2015 the respondent made a note in the records that Dr Chiu had spoken to her about the incorrect dose given on 29 May 2015, but that she did not understand.
3. On 6 July 2015 the respondent deleted her earlier record of the consultation on 29 May 2015 and replaced it with a record that did not state the dosage given. The replacement record was back-dated so as to appear contemporaneous with the consultation. The respondent made no record that the notes had been amended or as to the reason for the changes.
4. On 7 July 2015 the respondent then deleted the note about her conversation with Dr Chiu. She made no record that the note had been deleted or why.
5. One result of the changes was that the records then failed to reveal that the wrong (inadequate) dose had been given.[21]

1. The respondent administered vaccinations to the patient VWU on 5 March 2015 and 11 June 2015. She made contemporaneous records of those consultations.
2. On 6 August 2015 the respondent deleted both of those records and replaced them with more detailed records of the consultations, recording that she had washed her hands, got a clean kidney dish from the cupboard, removed the correct vaccines from the vaccine fridge, checked the age of the patient and checked whether the patient had had any previous post-immunisation issues.
3. The respondent did not make any record of the fact that the notes had been amended or any explanation of the reason for the changes. The substituted notes were back-dated so as to appear as though they were contemporaneous with the consultations.
4. The respondent did not have authority to make any of these changes to the records. She had been instructed that she should not do so.[22]

1. On 23 May 2015 the respondent deleted records concerning the patient VEU which related to consultations on 28 April and 14 May 2015. The latter record concerned the administration of three vaccines to the patient by a medical practitioner at the Clinic.
2. On 12 August 2015 the respondent deleted consultation notes in respect of consultations with the patient VEU on 16 December 2013, 16 January 2014, 23 May 2014 and 12 August 2014. A vaccine was administered on one of these occasions according to the original note.
3. The respondent made no record that the notes had been deleted or as to why. The result of these deletions was that the original notes would not have been available (and their existence would not have been apparent) to health workers at the Clinic who were accessing the practice management system for the purpose of treating the patient.[23]

1. On 30 April 2015 the respondent deleted a consultation note made by another practise nurse, concerning a consultation with patient FHM on 2 March 2015. The note included information as to vaccinations given to the patient and advice to the patient about health issues.
2. The respondent made no record that the notes had been deleted or as to why. The result of these deletions was that the original notes would not have been available (and their existence would not have been apparent) to health workers at the Clinic who were accessing the practice management system for the purpose of treating the patient.[24]

1. The respondent made a record on 30 July 2014 of administering two vaccines to the patient BRU. On 2 June 2015 the respondent deleted that record. The respondent made no record that the note had been deleted or as to why. The result of the deletion was that the original notes would not have been available (and their existence would not have been apparent) to health workers at the Clinic who were accessing the practice management system for the purpose of treating the patient.[25]

1. On 25 May 2015 the respondent deleted the entire medical records of seven patients having the same surname. This was the same surname as the respondent's previous husband although the evidence does not demonstrate whether these patients were connected to the respondent in this way. There is no explanation for the deletion of the records. On discovering the respondent's conduct, the practice manager was able to retrieve these records. Otherwise the Clinic would have been left with no records pertaining to these patients.[26]

1. We should mention that the affidavit of the practice manager outlined the action subsequently taken by the Clinic in conjunction with government authorities and the patients concerned to ensure as far as possible that any uncertainty concerning vaccinations of patients was followed up and addressed appropriately. One patient has not been re-immunised.[27]

1. It was also proved that on or about 14 April 2015 the respondent knowingly created and printed a prescription for the S4 classified drug phentermine (Duromine) for an alleged patient named Tessa 'Tracy' Douglas. The Tribunal is satisfied that this is an alias for the respondent. The prescription was issued in the name of DWG, a practitioner working at the clinic. When DWJ left the Clinic for lunch, his computer remained "logged-on" and the respondent used it to create and print the prescription.[28] The respondent made a note in the records, claiming that she printed the prescription by mistake whilst checking her immunisation history. She stated that she had put it in the bin for shredding. We find on the totality of the evidence that the respondent's explanation for this conduct is unconvincing and implausible.[29] On the balance of probabilities, we find that the respondent printed the prescription for her own use.
2. It was proved that on the 12 May 2015 the respondent gained access to the computer and log-in of RJS, a locum medical practitioner at the practice. After RJS had left for the day, the respondent created and printed a prescription for Duromine in the name of Tessa Douglas (an alias for the respondent). The respondent later deleted the consultation note relating to the prescription.[30]
3. On 6 August 2015 the respondent used RJS computer and log-in to create and print two prescriptions for Duromine in the name of Tracie Murray. The Tribunal finds that this is also an alias used by the respondent. The respondent had created a patient file for Tracie Murray on 12 May 2015, about 20 minutes after printing the prescription referred to in the previous paragraph.[31]
4. On 7 August 2015 the respondent gained access to the computer and log-in of LYJ, another medical practitioner at the Clinic. She created and printed two prescription for Duromine in the name of "Tessa Ann Handley". We are satisfied on the evidence that this is another alias used by the respondent.[32] The respondent had created the file for Tessa Handley on 6 August 2015. After printing the two prescriptions, the respondent deleted the consultation records in relation to those prescriptions.[33]
5. The respondent had no authority to create any of these prescriptions. They were not created or authorised by the respective practitioners in whose names they were created. The Tribunal is satisfied that the respondent printed the prescriptions for her own use.

1. On 20 or 25 May 2015 the respondent used the computer and log-in of NNE, another locum medical practitioner at the Clinic to create a Medicare Health Care Plan for herself in the name of Tracy Ann Gray. NNE was not on duty at the Clinic on the relevant dates. (It was later discovered that the respondent had NNE's password written in her notebook.[34]) The plan purported to have been created by NNE. The respondent forged the signature of NNE on the plan and an accompanying letter to the Bounceback Health and Wellness Clinic. The plan was entered into the medical records of Tracie Murray, the file created by the respondent as referred to above. This conduct enabled the respondent to gain access to a government funded course of treatment by an allied health provider. The respondent later deleted the records concerning the creation of the health Care Plan.[35]
2. The respondent was dismissed from her employment at the Clinic in August 2015.

1. Considering the totality of the above conduct, the Tribunal has no doubt that it amounts to serious professional misconduct. The respondent has demonstrated in various ways and over an extended period of time that she has serious character flaws that are inconsistent with the requirements of a registered practitioner. She cannot be trusted to act with honesty and integrity in the performance of her professional duties. She is unfit to be registered.

1. Practitioners are required to cooperate with investigations into their professional conduct.[36]
2. The events at SACARE and Ladywood Clinic were the subject of separate notifications to AHPRA. Investigations proceeded over a significant period. The respondent participated in the investigation of the SACARE matters, albeit that she persisted for a long time in claims that were not truthful.
3. She was required to attend for interview concerning the Ladywood Clinic matters in May 2017.[37] The respondent replied by email dated 16 May 2017.[38] She stated that, as she had previously advised AHPRA, her husband had been posted to Malaysia from January 2017 to January 2018 and she had accompanied him. They had no mail and limited internet. She stated that AHPRA could have arranged an interview before they left. She indicated that she would advise AHPRA when they returned to Adelaide in January 2018.
4. In this email, the respondent addressed some of the allegations. She stated that they all related to the time after new management had taken over the Clinic. She claimed they were trying to get rid of staff. She suggested that the changing of notes could have been done by someone else using her log-in. She kept her password in a notebook next to her workstation.
5. She claimed that she had no motive to create a Health Care Plan for herself as she had top health insurance cover. She stated that she did prepare the plan but left it in a tray for the doctor to sign. She denied printing the prescriptions.
6. The Tribunal is comfortably satisfied on the totality of the evidence that these denials are false. The evidence of the practice manager leads to the inevitable conclusion that the respondent was responsible for the changes to the records. The respondent did print the prescriptions. She forged the doctor's signature on the Medicare Health Plan. The Tribunal is satisfied that the allegations against the respondent are in no way due to any desire of the "new management" to get rid of staff. The respondent's denials do not have credibility.
7. On 18 December 2017 AHPRA advised the respondent by letter that it had decided to refer the matter to the Tribunal.[39] The respondent replied by email dated 21 January 2018 with letter attached.[40] She stated that her husband's posting had been extended for another four years. She stated that she was handing in her registration as an enrolled nurse. She said "... I would like to say how sorry I am if I did do anything to cause anyone pain or issues as that is not the kind of person that I am." However, the respondent essentially repeated the denials and explanations from her previous correspondence.
8. On 24 January 2018 AHPRA emailed the respondent concerning service of the Tribunal proceedings.[41] She was asked to provide her address in Malaysia. The respondent did not reply and process servers in Malaysia were instructed. They reported in October 2018 that the respondent could not be located in Malaysia. Local investigation services were then instructed and reported in February 2019 that they had located the respondent living in Tindal, Northern Territory. She had not advised APHRA of her return to Australia.
9. On 12 April 2019 a process server served a copy of the Amended Complaint personally on the respondent at an address in Katherine, Northern Territory.[42]
10. After receipt of this document, the respondent emailed the SA Health Practitioners Tribunal and the complainant's solicitors on 3 June 2019.[43] She indicated that she was moving the following Friday to Kalkapringi to take up a position as a station cook for six months.
11. In this email the respondent indicated that she pleaded guilty to all charges. She claimed to be under treatment for mental health problems and to be on strong medication for depression. She stated that she had been self-medicating and using alcohol over the period that the accusations had been made. She now realised that she was mentally unstable at the time. She indicated that she had no recall in relation to most of the allegations. She concluded:

"I accept and acknowledge that the way that I acted and the things that I am accused of doing make me not a good person to hold my nursing registration. So I am admitting my guilt to all of the accusations. I acknowledge that I acted in ways that constitute professional misconduct and I truly apologise. I am very sorry."

1. On 1 October 2019 the respondent emailed this Tribunal with a letter attached.[44] In the email she stated: "My address is on the station for 6 weekly stints". In the letter she stated:

"I am working with Aboriginals here on a station and we go into town about every six weeks for supplies."

1. In this same letter the respondent claims that she had been previously addicted to over the counter medications and alcohol. She has since received counselling that has assisted her. However, she goes on to reiterate some of the denials previously made concerning her alleged conduct. She reiterated that anyone could have used her password. She stated that: ".. writing over patient notes and changing notes I know I did not do." She denied creating the prescriptions.
2. The evidence of the process server[45] demonstrates that the claim of the respondent to be working remotely on a station is not true. She was employed at the relevant time by a business in the town of Katherine. Documents were served on her in Katherine on 12 April 2019, 20 September 2019 and 21 October 2019, and her continuing employment in that location was also confirmed on 4 October 2019 and 24 October 2019.[46] Documents emailed to her on 16 October 2019 were downloaded promptly.[47]
3. Sadly, it is impossible to escape the conclusion that the respondent continues to be untruthful in her dealings with this Tribunal and the complainant. The Tribunal has grave concerns about her general credibility and does not accept her written evidence where it consists of denials or explanations of the alleged conduct. The Tribunal notes that her claims as to the existence of medical conditions and resultant treatment are not supported by any corroborative medical evidence. The Tribunal cannot be satisfied as to the truth or accuracy of those claims.

1. The matters proved to our satisfaction demonstrate serious character flaws which are inconsistent with the duties of a registered health practitioner. The respondent did not participate in the hearing although she was given the option of participating by telephone. She has failed to address the allegations in a way that gives the Tribunal any confidence for the future.
2. In Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 at page 637, the Court of Appeal stated:

"In cases such as this, the Tribunal and this Court should not assume that the doctor has become a reformed person. As Walsh JA said in Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448 at 46; 84 WN (NSW) (Pt 2) 275 at 286:

"...Reformations of character and of behaviour can doubtless occur but their occurrence is not the usual but the exceptional thing. One cannot assume that a change has occurred merely because some years have gone by and it is not proved that anything of a discreditable kind has occurred. If a man has exhibited serious deficiencies in his standards of conduct and his attitudes it must require clear proof to show that some years later he has established himself as a different man.'

1. In the present case, there has been no convincing evidence of the respondent successfully addressing her character flaws. To the contrary, there is evidence that those flaws have continued to manifest themselves many years later. There is no convincing evidence that anything has been done to address the problems or that anything is planned for the future.
2. The respondent continues to be unfit to be registered and it appears highly unlikely that this will change in the future. Orders are required that will effectively protect the public from the conduct of the respondent, whether that be in the nursing profession or the provision of any other health service.
3. The respondent has not been registered since 20 January 2018. This Tribunal has power to impose a disqualification from applying for registration for a specified period under s 196(4) of the National Law. Under that same provision the Tribunal may also prohibit the respondent either permanently or for a specified period from providing any health service.[48] The respondent was made aware in advance of the hearing that the complainant would be seeking substantial orders of that nature. At the hearing the complainant sought disqualification and prohibition for periods of 10 years.
4. The Tribunal has had regard to various comparative cases.[49] Whilst they provide valuable guidance, the Tribunal is required in the end to impose the disciplinary action required to secure the protection of the public in the unique circumstances of this case. As indicated in the matter of Craig v MBSA,[50] the action required to protect the public may well have a greater adverse effect on the practitioner than what might be warranted if punishment was the relevant consideration.
5. The Tribunal finds itself assessing this matter in much the same way as did the former SA Health Practitioners Tribunal in the matter of Jones.[51] There have been grave departures from the appropriate standards of conduct, occurring in various ways and over a substantial period. They include actions which suggest an indifference to patient care[52]. The underlying character flaws continue to be demonstrated some years later. There is no adequate evidence of insight or willingness to address the issues. Everything suggests that the respondent cannot be trusted. There is an overriding need to protect the public as well as the integrity of the profession. The Tribunal considers that this case requires measures going beyond what was submitted by the complainant.
6. The Tribunal imposes the following disciplinary action:
   • (a) The respondent is reprimanded.
   • (b) The respondent is disqualified from applying for registration as a registered health practitioner for a period of 15 years.
   • (c) The respondent is prohibited from providing any health service for a period of 15 years.
7. The respondent will be ordered to pay the complainant's costs of the proceedings to be agreed or fixed by the Tribunal.

[1] The Health Practitioner Regulation National Law (South Australia) is incorporated as part of the law of this jurisdiction by s 4 of the Health Practitioner Regulation National Law (South Australia) Act 2010. The National Law is to be found in schedule 2 to the Act.

[2] Statutes Amendment (SACAT) Act 2019 s 112.

[3] [1938] HCA 34; (1938) 60 CLR 336 at pages 361-362.

[11] BD 169; more generally pages 153-174.

[12] BD 175-195, Second Affidavit sworn 28 October 2019.

[13] BD 364-366, 377-379,394-397, 407-411.

[36] Law Society of SA v Jordan [1998] SASC 6809 at [45].

[46] See affidavit of Lorna Hart sworn 25 October 2019.

[48] NMBA v Kumar [2019] VCAT 1099; Psychology Board of Australia v King [2016] QCAT 140; NMBA v Rankine [2019] SACAT 57.

[49] NMBA v Williams [2013] SAHPT 1; HCCC v Day [2009] NSWNMT 5; NMBA v Walker [2016] SAHTP 2; NMBA v Morley [2014] SAHPT 17; NMBA v Jones [2017] SAHPT 4; NMBA v Rankine [2019] SACAT 57; NMBA v Heaft SAHPT Decision 18 June 2019.

[50] [2001] SASC 169; (2001) 79 SASR 545 at [43] - [44].

[51] [2017] SAHPT 4. It is noted that this decision pre-dated the judgement in Marin v Chiropractic Board of Australia [2019] SADC 17 where it was held that a disqualification could not be imposed permanently.

[52] See also NMBA v Rankine [2019] SACAT 57.