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[2010] VCAT 534
Victorian Civil and Administrative Tribunal
2010-05-04
Original judgment source is linked above.
Occupational & Business Regulation List - psychologist - disciplinary proceeding -sexual relationship between patient and psychologist - Psychologists Registration Act 2000 sections 3, 6 and 141(1A) - Health Professions Registration Act 2005 s 169 - Victorian Civil and Administrative Tribunal Act 1998 s 146(4)(b)
Psychologists Registration Board of Victoria v Mair (Occupational and Business Regulation) [2010] VCAT 534
(i) pursuant to s 48(2)(c) of the Act the respondent is reprimanded.
(ii) pursuant to s 48(2)(g) of the Act the respondent is suspended from practising as a psychologist until 28 February 2011.
(iii) pursuant to s 48(2)(d) of the Act the respondent continue therapy at her own expense for a period of 12 months from this date by a clinical psychologist approved by the applicant Board and the clinical psychologist should provide quarterly reports to the applicant Board which state -
(a) a summary of treatment he/she is providing; and
(b) the respondent's capacity to work ethically and competently as a psychologist.
(iv) pursuant to s 48(2)(e) of the Act a condition is to be placed on the respondent's registration to the effect that at the time of the respondent commencing to practise, she is to be supervised, for a period of at least two years, by a psychologist approved by the Board at the expense of the respondent.
From on or about February 2006 until on or about June 2007, Ms Mair engaged in unprofessional conduct as defined in paragraphs (a) and/or (b) and/or (c) and/or (d) of the definition of 'unprofessional conduct' in section 3 of the PR Act, in that she engaged in an inappropriate sexual relationship and/or inappropriate social relationship with her
(b) former client, Mr X, within an inadequate period of time after the termination of her professional relationship,
thereby entering and engaging in a dual relationship and transgressing professional boundaries.
(The "Mr X" referred to in the letter of referral is known as "ON" for the purposes of this proceeding).
"unprofessional conduct" means all or any of the following -
(a) professional conduct which is of a lesser standard than that which the public might reasonably expect of a registered psychologist; or
(b) professional conduct which is of a lesser standard than that which might reasonably be expected of a registered psychologist by his or her peers; or
(d) infamous conduct in a professional respect; ...
Section 169 says ... that the Tribunal can only make those orders and decisions which would have been open in relation to conduct engaged in at the relevant time. The conduct relevant here is conduct that was during the earlier Act, so that throws the Tribunal back to the terminology and the concepts of the Psychologists Registration Act 2000_._
48. Findings and determinations of a formal hearing into conduct
(1) After considering all the submissions made to a formal hearing into the professional conduct of a registered psychologist the panel may find that -
(a) the psychologist has, whether by act or omission, engaged in unprofessional conduct of a serious nature; or
(b) the psychologist has, whether by act or omission, engaged in unprofessional conduct which is not of a serious nature; or
(c) the psychologist has not engaged in unprofessional conduct.
(2) If the panel finds that the psychologist has, whether by act or omission, engaged in unprofessional conduct of a serious nature, the panel may make one or more of the following determinations -
(a) require the psychologist to undergo counselling;
(d) require the psychologist to undertake further education of the kind stated in the determination and to complete it within the period specified in the determination;
(e) impose conditions, limitations or restrictions on the registration of the psychologist;
(f) impose a fine on the psychologist of not more than $2000;
(g) suspend the registration of the psychologist for the period specified in the determination;
(3) If the panel finds under sub-section (1)(b) that the psychologist has, whether by act or omission, engaged in unprofessional conduct which is not of a serious nature, the panel may make any determination which a panel at an informal hearing is able to make upon making such a finding.
I completed a Post Graduate Diploma in Applied Psychology at Monash University's Caulfield campus in 2001. I then completed two years of supervised practice with a supervisor, Gina Cidoni.
I finished supervised practice in early 2003. I became registered in June 2003.
I worked as a Community Corrections Officer with Corrections Victoria for a year and a half, from November 2000 - August 2002. My work involved supervising offenders who were on non custodial sentences or out on parole. This was a supervisory role as a case manager. I was not working as a clinician.
In August 2002, I left Corrections Victoria and worked externally as a probationary psychologist with an employment agency for about 10 months. I then worked briefly as a Project Development Officer at NorthWestern Mental Health for around 10 months. I then returned to work as a psychologist for Corrections Victoria. I have not checked my employment records, but believe this was in February 2004.
I advised my managers at the Corrections Victoria of my transgression and my application for the intervention order in August 2008.
My employer placed a condition on my employment at that time, which was not to have contact with any clients (offenders), or to supervise any staff. I was allowed to continue in the role of a Program Officer. I was provided with regular internal supervision. My employer is aware that I have also been engaged in regular external supervision and has supported me with this.
In December 2008, the Deputy Commissioner of Prisons and Transitional Services, Mr Rod Wise, issued me with a first and final formal warning in relation to departmental misconduct. I provided a letter by Dr List to confirm that I was attending regular counselling appointments to address the transgression. I accepted that I had transgressed the department's code of conduct.
After the issuing of the warning, my employers made a decision to allow me to return to clinical work. I will be allowed to work with clients and will be allowed to supervise staff if required. I intend to return to a clinical position in February 2009.
The first quarterly report will be provided by 30 April 2009.
24.4 If there are any changes to my employment with the Department of Justice or I leave the Department to engage in another position, I will immediately notify the Board. Consequently, the agreement will come back at that time to the Board for renegotiation.
24.5 Refrain from engaging in private practice.
I think it would have been in the latter third of the treatment period that ON made some advances towards me in therapy whereby he would try to hold my hand in therapy and he also discussed his intention or his desire to have a relationship with me after therapy had concluded. ...
Initially I rejected those advances and I tried to reiterate that we had a professional relationship, that we didn't have a personal relationship and I tried to re-explain the purpose of our professional relationship and that that behaviour wasn't acceptable.
... There was a time towards the latter part of therapy, probably around the same period where I started to feel some feelings towards him also.
... I think slowly I became less insistent that he for example stop holding my hand or stop making advances, I think I made more - I allowed that.
... He was trying to make physical contact with me and wanting to have a relationship with me.
.... Did it go beyond hand holding in therapy? No, it didn't.
I think it all came to a head one day when I saw him at his residence and he got upset with me and angry with me for taking a phone call and became abusive and threatening and he threw a clothes airer like towards me and it went across the other side of the room and broke the window.
... then he approached me and I thought that he was going to hit me but I managed to de-escalate the situation and managed to leave the premises and it was after that that I had decided for personal and professional reasons I couldn't continue with the relationship.
... In the back of my mind I knew what I was doing was wrong professionally and that started to I guess grate on my consciousness if you like more and more and the guilt - I was feeling a lot of guilt as well.
I think it might have been on the phone, um, that I explained to him that I couldn't continue with the relationship for um personal and professional reasons, um, and also because I - I had feared - I feared for my safety um after the incident at his residence.
I gave in and went to see him in Rye, where he was living with his mother and stepfather. Once again, part of me was trying to placate and pacify him. I had no intention of resuming a relationship with him, but he clearly had in mind that he wanted to resume the relationship. I had to consistently keep explaining to him that this wasn't going to happen. This went on for a few hours. He initiated sex with me that day, I did not want to have sex with him but I was too afraid to resist. I told him that I did not want to have sex, but he said something about having to wait for 8 months and I gave in. I did not want the intimacy to happen, but I did not try to stop him any further. That was the last time I was intimate with him.
ON kept trying to make contact with me after this. I kept re-iterating that a relationship could not happen. During one phone-call, he mentioned that he knew where my family lived. I took this to be a threat.
The phone calls then started at work. I told ON during one conversation that 'this has to stop, you can't call me at work anymore'. I suggested that he could go and see another doctor or psychologist if he needed further support, but that he could not talk to me. He would agree not to contact me again, but then a couple of months later, he would make contact again. This continued throughout 2007 and into 2008.
In August 2008, I was doing training for a week. ON contacted the office where I was working several times over the course of about two days. ON was becoming more persistent and erratic in his approaches. I was scared of him.
I applied for an intervention order. When I was at the counter at the Melbourne Magistrates Court applying for the order, I filled out the form explaining how I knew ON. At that point, I realised that I needed to come out with the entire truth and address it. I then rang the Psychologist's Registration Board from Court and said that I needed to speak to somebody about an ethical transgression. I spoke to the CEO and she requested that I put my concerns in writing, so I sent the letter dated 28 August 2008.
I disclosed all of the above to my employers yesterday. While agreeing that I have behaved in an unprofessional and unethical manner, they have decided to support my continued employment with the department, pending the outcome of the Board's decision. I am currently employed as a "Senior Programs Officer", which means that I have no direct client contact. My employers have stipulated that I should not have any client contact or act in a supervisory role. I have agreed to this.
I am gravely sorry for, and ashamed of, my behaviour. I have agonised over this situation for some time, but have struggled to find the courage to admit to my misconduct and face the consequences. I realise I have not only placed myself at risk, but also the organisation I work for, and the profession as a whole. I am prepared to accept whatever consequences the Board and my employer see fit. In the meantime, I acknowledge that I need to seek external supervision/counselling to address the reason why I made the decision I did. I intend to commence this as soon as possible. I have wanted to address this previously, but feared that I would be reported in the course of doing so. I believe I still have something to offer the profession, and I am hopeful that by addressing my own misconduct, that I will be better for it.
The Code of Ethics (1997) of the Australian Psychological Society includes Sections that specify restrictions on the types of non-professional relationships that psychologists may have with current and former clients. In drawing up these Guidelines, it was noted that psychiatrists in Australia are prohibited from having sexual relations with any clients, regardless of time elapsed since termination of the professional relationship. These Guidelines, developed for psychologists, proscribe sexual relations with current and former clients but take into account the diverse nature of professional relationships that psychologists may have with clients, and the broad definition of client provided in the Code of Ethics (the Code).
Two Clauses of Section B 'Relationships with Clients' are pertinent:
B7. Psychologists must avoid dual relationships that could impair their professional judgement or increase the risk of exploitation. Examples of such dual relationships include, but are not limited to, provision of psychological services to employees, students, supervisees, close friends or relatives.
B8. Psychologists must not exploit their professional relationships with clients sexually or otherwise.
In the case of sexual relationships, the restriction on psychologists engaging in sexual relationships with clients (Clause B8, and see below Clauses B9 to B12) is part of the broader restriction on psychologists engaging in dual relationships with clients (B7). There are also relevant specific issues related to psychologist-client physical contact (see guidelines relating to procedures/assessments that involve psychologist-client contact) and broader issues related to boundaries in professional relationships (see Guidelines on managing professional boundaries and multiple relationships).
Sexual relationships are not just relationships involving sexual intercourse but are construed more broadly.
The restrictions on sexual relationships with current and former clients (as defined below) are set out in the Code, Section B 'Relationships with Clients':
B9. Sexual relationships between psychologists and current clients must not occur. When a therapeutic procedure entails some level of physical intimacy with a client, informed written consent must be obtained from the client or the client's legal guardian prior to the introduction of that procedure.
B10. No psychologist may engage in a sexual relationship with a former client when less than two years have expired since the ending or termination of the professional relationship.
Ms Mair learned many intimate things about ON during therapy, including
b. not feeling validated by his family and his history of neglect
c. the divorce of his parents before he was a teenager
g. cognitive distortions that he might form in relation to women to whom he was attracted
k. his tendency to manipulate people and situations to try to retain control over situations he experienced as threatening
l. his difficulties in managing his emotions by putting up fronts, being very closed and having low self-esteem
n. his having suffered various traumas to his head.
Ms Mair was conscious of the potential for ON to have a Borderline Personality Disorder, underlying dysphoria and a potential brain injury. She also formed the view that he might have or be developing problematic drinking behaviour, as well as having an anger management problem. He was significantly labile in his moods.
.... I have been providing psychological services to Ms Michelle Mair since September 2008.
Ms Mair initiated contact with me in August 2008 following her admissions to the Board and Corrections Victoria regarding her ethical transgression ...
Ms Mair has regularly attended all her appointments and demonstrated a willingness to address difficult and confronting issues. She recognises that she has compromised her own professional code of conduct as well as the reputation of the department she is employed by. She has demonstrated insight into her behaviour at the time of transgression, and has demonstrated a preparedness to pursue a sometimes rigorous self-examination with my assistance. I am also aware that she is being provided with supervision in her workplace, which she has reported as being very helpful.
I believe that her initiative in notifying the Board and the Department, and her engagement in professional therapy since this time, are strong indicators that she is taking this issue seriously with integrity. Based on our discussions, my observations, and my experience with these matters, I do not see any benefit in the withholding, or the withdrawal, of Ms Mair's clinical practice. In my opinion, the professional risk posed is minimal. Given that her registration is still active and that she is engaged in supervisory process externally and internally, I have no concern about her resumption of her clinical activities in the interim prior to the eventual VCAT hearing.
... there is no aspect of her presentation that has caused me concern in relation to her competence.
Insofar as I am aware, her previous professional history is without ethical blemish and she has reportedly initiated (and has maintained) full disclosure to her employer.
... Ms Mair has accepted full responsibility of her past behaviour and the resultant consequences, and has been open to feedback and guidance. She has been consistently open, honest and forthcoming with information, even when this has clearly been difficult. She worked through significant experiences of personal and professional shame and remorse (both of which must be appropriately managed so as not to become risk factors in and of themselves) and she has shown a clear understanding of the impacts of this situation on others, including her former client, the organisation generally, her family, and her direct managers.
I recommend that Ms Mair is given opportunity to demonstrate her capacity to practice ethically and competently over the next 12 months, with additional supervisory and oversight arrangements in place and a continuation of her work with Dr List as an additional support.
Overall, Ms Mair has been engaged, open and able to explore a range of issues within the context of her own functioning, personally and professionally, and her clinical practice, both current and historical.
I continue to be of the opinion that Ms Mair's risk of future inappropriate and harmful behaviour in a clinical context is no more than that of any of the employees in Clinical Services, or indeed elsewhere. In fact, it may be less, given the events of the past 18 months, in particular the intensive self-exploration and therapy/supervision she has received around this issue from a variety of different people. She is possibly more informed and more aware of her vulnerabilities and of the situations and warning signs that might indicate she is at risk of inappropriate behaviour than many of her peers, given the dedicated work she has done on understanding her professional misconduct and her functioning more generally.
When giving evidence, the respondent admitted that the making of the confession at that time was because her affair with ON was likely to be public. The intervention order was the occasion for her making the confession, in fact she wanted to make the confession in addition to clear her conscience and unload herself from the burden that the affair had caused.
We accept the respondent's version of events surrounding her confession relating to the relationship with ON. That is, the respondent made her confession in part because she thought her relationship with ON would become public as a result of the intervention order and the matter had been weighing upon her for a period of time, and she wanted to confess to the situation because she knew she had done the wrong thing.
Dr List stated that in his long experience including his experience as past President of the applicant Board, he had never known any other psychologist to confess to a sexual relationship with a client.
Dr Freckelton said that the therapeutic relationship had not finished before the affair started because while no further therapeutic treatment took place, the respondent had failed to properly or at all bring the therapeutic relationship to an end. In fact, what the respondent did was to put the therapeutic relationship on hold while ON was assessed for acquired brain injury from a neurological psychologist through ARBIAS.
Dr Freckelton is correct that the therapeutic relationship between ON and the respondent had not been brought to an end, and it should have been. Nonetheless, the sexual relationship between the respondent and ON should be seen in the light that no further therapeutic treatment took place once the personal relationship had commenced.
Dr Freckelton also relied on the respondent's statement and evidence in relation to the completion of the therapeutic relationship. At paragraph 25 of her witness statement, the respondent stated:
I did not see ON or have any contact with him for about 2 months after the completion of treatment. I then made a very misguided and impulsive decision.
At page 169 of the transcript, Dr Freckelton asked the following question :
I suggest to you that in paragraph 25 of that, you stated that you had no contact with ON for about 2 months after the completion of treatment.
The respondent answered "Yes". Then Dr Freckelton asked :
However, in spite of the apparent contradiction of the respondent between her witness statement and her oral evidence, we gained the impression that she was attempting to tell the truth. Any deviation of the truth, we believed came from both her highly emotional state and her own confusion of the events. We do not believe that she intended to deliberately deceive us on this point.
While the respondent may have been misguided in both her act of sex with the respondent and the many telephone calls that took place after ON was released from prison, that is not to say that the respondent did not give us a correct version of events.
Dr List stated that he believed the respondent's conduct was an attempt by her to placate ON in order to prevent the difficulties that the respondent perceived (and correctly so) that her relationship with ON was causing her, the people around her and ON himself.
In the way that the respondent gave her evidence, we see no reason to not accept her version of the facts in this particular instance.
The test is whether a professional has done something in pursuit of his or her profession which would reasonably be regarded as 'disgraceful or dishonourable by professional colleagues of good repute and competency'. ...
The words 'infamous' and 'disgraceful' have been held to denote conduct deserving of the strongest reprobation and indeed so heinous as to merit, when proved, the extreme professional penalty of striking off. (see Felix v General Dental Council [1960] AC 719 at 720. Certain kinds of conduct are manifestly incompatible with the role of a registered practitioner.
I shall now state some propositions relevant to a case in which the charge of 'infamous conduct' concerns a medical practitioner who in the conduct of his medical practice is alleged to have prescribed drugs improperly, unreasonably, or in a manner which would be contrary to good medical practice.
Counsel for the Board contends that the appellant was guilty of acts amounting to 'reckless indifference' and 'gross negligence', those acts being particularized in the charge in paras (b), (c), (d), (e), (f) and (g). In R v Medical Board of Victoria; Ex parte Epstein, [1945] VicLawRp 8; [1945] V.L.R. 60, Lowe, J gave examples of gross incompetence or negligence which might constitute infamous conduct. I would add the following examples which are relevant to the charge in the present case.
(a) Persistently, wrongly, prescribing toxic drugs for a patient or patients.
(b) Wilfully prescribing toxic drugs contrary to law.
(c) Persistently departing from general and approved practice in examining and prescribing for patients. Something more serious than merely being out of step with generally accepted medical opinion in the community on the subject would be necessary.
(d) Persistently undertaking the treatment of patients suffering from a particular illness when his own experience and expertise was inadequate to undertake the treatment competently by the standards accepted generally in the medical profession.
I believe that if a case of reckless indifference or gross negligence were proved against a medical practitioner in a professional respect right-thinking competent colleagues of the person charged would inevitably regard such conduct as reprehensible, disgraceful, shameful, or dishonourable. Therefore, the essential elements of a charge of 'infamous conduct' under s 171(1)(b) would be established.
We also note that there is not always formal closure of a therapeutic relationship between the client and the therapist. While there should in fact be formal closure, there are often circumstances that prevent such formal closure happening. Clearly, the circumstances of this proceeding are one of those types of matters.
Clearly such conduct would not be serious if it was trivial, or of momentary effect only at the time of the commission or omission by which the conduct was so defined. It must be a departure, in a substantial manner, from the standards which might be reasonably expected of a registered nurse. The departure from such standards must be blameworthy and deserving of more than passing censure.
(a) unprofessional conduct of a health practitioner, where the conduct involves a substantial or consistent failure to reach or maintain a reasonable standard of competence and diligence; and
(b) conduct that 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; and
(c) conduct of a health practitioner, whether occurring in connection with the practice of the health practitioner's health profession or occurring otherwise than in connection with the practice of a health profession, that would, if established, justify a finding that the practitioner is not of good character or is otherwise not a fit and proper person to engage in the practice of that health profession;
Applying the authorities, Dean J held in the Victorian Supreme Court decision Re a Solicitor[1] that 'misconduct' 'in a professional capacity' under s 15 of the Legal Profession Practice Act 1958 (Vic) bore the same meaning as described by the House of Lords in Myers v Elman in respect of 'professional misconduct'. To a similar effect, Gillard J in Mullany v Psychologists Registration Board[2] held that while 'professional misconduct' is not defined in the Psychologists Registration Act 1987 (Vic) it 'has a well established meaning in this State in respect of the activities of professional persons. The word 'misconduct' has been considered with reference to solicitors. Here we are concerned with 'professional misconduct'. The definition of 'misconduct' which has been accepted in this State is that stated by Dean J in Re a Solicitor.
On the same issue, Eames J has commented of juridical interpretation of the expression 'professional misconduct' that the words, 'comprised conduct which was more than mere professional incompetence, or mere deficiencies in professional practice, but would encompass conduct which included 'a deliberate departure from accepted standards or such serious negligence as, although not deliberate, to portray indifference and an abuse of the privileges which accompany registration as a medical practitioner'. Per Kirby P in Pillai v Messiter (No 2) [1989] 16 NSWLR 197 at 200.[3]
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.
The Board may refuse to grant registration to an applicant on any one or more of the following grounds -
(a) the character of the applicant is such that it would not be in the public interest to allow the applicant to practise as a registered psychologist.
In Dr Mark Pearson-Gills v Chiropractors Registration Board [2006] VCAT 436, the Tribunal (SM Davis) there set out what the design of the Chiropractors Act was to achieve. That Act is in similar terms to the Chinese Medicine Registration Act and what is stated there equally applies to this situation. At paragraph 147 ff it was stated :
Thus it is apparent that the Act was designed to protect the public and looks at the interest of the community. In Robbins v Business Licensing Authority (2000) VCAT 457 (29 January 2000), Kellam J considered the public interest in the context of the Motor Car Traders Act. For this purpose, I do not consider there is any real difference between public interest in relation to the Motor Car Traders Act or in relation to the Chiropractors Act. At p 4 of that decision, his Honour considered the public interest and what it meant. He stated :
It is apparent that the term 'public interest' embraces matters, among others, of standards of human conduct acknowledged to be necessary for the good order and well-being of the public, and in the circumstances of this case, those members of the public who buy and sell motor cars. Accordingly, the function of the Business Licensing Authority (and this Tribunal on an application to review a decision of the Authority) is entirely protective, not punitive. The Authority (and this Tribunal) may only grant permission for a person who has a conviction for a serious offence within the last ten years to be employed in a customer service capacity, if satisfied that to do so will not be contrary to the public interest.
As Murphy J said in Inglese v Estate Agents Board & Anor (unreported Supreme Court of Victoria, 15 August 1988):
'If an estate agent is to be disqualified, the purpose which the Tribunal should have in mind is not the punishment of the individual (though it may appear to be a punishment to him) but the importance of protecting the public and the necessity to maintain standards in the conduct of an estate agent's business'.
Those words apply equally to motor car traders, and their employees, under the system established by the Act. Accordingly, notwithstanding the fact that the applicant has been punished by the criminal justice system, the issue of the protection of the public remains to be considered.
I would add to what his Honour said that the "words apply equally" to the chiropractic profession.
The Tribunal should consider what is necessary for general deterrence purposes. This may include such considerations as the need to send a message to practitioners generally that conduct of this nature is unacceptable and will be met with appropriate consequences. It is also relevant to consider the interests of the public in observing that the profession upholds its rules of ethics and that they can trust that registered chiropractors maintain strong ethical standards.
I agree with the submission made by Ms McLeod. This is in line with what I decided in Whiting v AMC Investments Pty Ltd (2005) VCAT 1830 (22 August 2005).
The principles quoted above apply equally to wrongful conduct pursuant to the Act.
[1] [1960] VicRp 96; [1960] VR 617 at 622
[2] Unreported, Supreme Court of Victoria, 22 December 1997 at p 9
[3] McGrath v Medical Practitioners Board, unreported, Supreme Court of Victoria, 1 November 1996
[4] [1999] VSC 113 at [23]- [24]
[5] [1990] 1 Qd R 498 at 507
Psychologists Registration Board of Victoria
Mair