The TG Act was amended by the Health and Community Services Legislation Amendment Act (No 2) 1993 (Act No 76 of 1993). It repealed s. 4 as set out above and substituted a section in different terms none of which is materially different from the present s. 4 for the purposes of this case. The new s. 4 has not yet come into operation (it commences on a date to be fixed by proclamation, but that day has not yet been proclaimed (s. 2(2) of Act No 76 of 1993)).
Part 3 of the TG Act provides for the maintenance of a register to be known as the Australian Register of Therapeutic Goods, the purpose of which is to compile information in relation to, and provide for evaluation of, therapeutic goods for use in humans (s. 17(1)). Section 18(1) provides that the regulations may, subject to such conditions (if any) as are specified in the regulations, exempt inter alia, specified therapeutic goods or a specified class of therapeutic goods from the operation of Part 3 (s. 18(1)(b) and (c)).
It is an offence for a person who is the sponsor of therapeutic goods to knowingly or recklessly import the goods into Australia for use in humans or to supply the goods in Australia for use in humans unless, inter alia, the goods are exempt goods (s. 20(1)(a), (d) and (f)). A penalty of $24,000 is provided for contravention. Other offences are created by Part 3, to which I need not refer.
"Sponsor" is defined by s. 3 of the TG Act in relation to therapeutic goods as meaning, inter alia, a person who imports, or arranges the importation of, the goods into Australia, subject to certain exceptions which are not relevant for present purposes.
Regulation 12(IA) of the Therapeutic Goods Regulations (the TG Regulations) provides that, for the purposes of s. 18(1) of the TG Act, the therapeutic goods or classes of therapeutic goods specified in an item in column 2 of Schedule 5A are exempt from the operation of Part 3 of the TG Act, subject to compliance with the relevant condition specified in column 3 of that Schedule.
Schedule 5A is divided into three columns headed "Item No", "Therapeutic Goods" and "Conditions" respectively. The
relevant item is item 3 relating to "therapeutic goods used solely for experimental purposes in humans"; and the conditions which appear under the heading "Conditions" are as follows:
"(a)before starting to use the goods, the sponsor must notify the Secretary:
(i) in a form approved by the Secretary; and
(ii)in accordance with the requirements (if any) determined by the Secretary for the form of notification;
that the sponsor intends to sponsor a clinical trial using specified goods; and
(b) the notification must be accompanied by the relevant notification fee referred to in item 14 or 14A of Schedule 9; and
(c) the approval of the goods for this purpose must be given by the sponsor (if the sponsor is conducting the trial), or by the body or organisation conducting the trial for the sponsor, having regard to the advice of the ethics committee that has, or will assume, responsibility for monitoring the conduct of the trial; and
(d) the terms of the approval by the sponsor, body or organisation referred to in paragraph (c) must be no less restrictive than the terms advised by the ethics committee; and
(e) the Secretary must not, at any time:
(i) have become aware that to conduct or continue the trial would be contrary to the public interest; and
(ii)have directed that the trial not be conducted, or be stopped; and
(f) the sponsor (if the sponsor is conducting the trial), or the body or organisation conducting the trial for the sponsor, must not receive, or have received, advice from the ethics committee that is inconsistent with the continuation of the trial."
It is condition (e) with which this case is directly concerned.
Facts
The Therapeutic Goods Administration (the TGA), a section of the Department of Human Services and Health (the Department), received three Clinical Trial Notifications (CTNs) in relation to mifepristone. The relevant CTNs were described in detail by his Honour and I need not do more than summarize them.
The first CTN was given by letter dated 5 August 1993 from Professor Fraser within the Sydney Centre for Reproductive Health Research, which is a joint initiative of the University of Sydney and the Family Planning Association of New South Wales. Professor Fraser gave notice that he would be responsible for the importation of mifepristone tablets in three different concentrations (200mg, 50mg and 5mg) and that they would be administered in single dosages of 600mg, 50mg or 10mg as noted on the CTN form which accompanied the letter. Professor Fraser stated that he would be importing the tablets directly from the World Health Organization's Special Program of Research in Human Reproduction in Geneva and that the study was a multi-centre study being organized by the World Health Organization. The form stated that the sponsor was Professor Fraser and that the
"title and aim of the trial/study" was "a prospective randomized multicentre study to compare three doses of mifepristone (600mg; 50mg and 10mg) in emergency postcoital contraception". The form stated that the Sydney Centre for Reproductive Health Research was the hospital or institution in which the trial was to be undertaken and that October 1993 was the expected starting time for the trial or study and that the expected time for completion of the trial was the end of 1994.
A certificate appeared on the form signed by the Chairperson of the Ethics Committee of the Family Planning Association of New South Wales stating that the Committee had approved the clinical trials.
The second CTN was sent to the TGA by Professor Healy, Chairman of the Monash Medical Centre, Department of Obstetrics and Gynaecology, Monash University under cover of a letter dated 4 March 1994. The letter was expressed to be an application for "permission to import mifepristone from the Therapeutic Goods Administration Branch for two CTN studies". Professor Healy stated that he was the sponsor for the studies "with the Family Planning Association of Victoria and the World Health Organization". The letter stated that the Human Ethics Committee of the Family Planning Association of Victoria was the relevant Ethics Committee responsible for reviewing the trial.
Family Planning Inc (Vic) (Family Planning) is the second respondent to this proceeding. It is the successor to the Family Planning Association of Victoria. Family Planning was found by his Honour to have an interest which would be affected by the result of the litigation. No party has disputed that finding.
The third CTN was sent to the TGA, also by Professor Healy. On this occasion the drug product to be trialled contained as active ingredients, mifepristone and misoprostol. Like the second CTN, the third was dated 4 March 1994. Unlike the first and second CTNs, the title and aim of the trial/study was said to be "a multi-centre study of 2 combination regimens of mifepristone plus misoprostol for termination of early pregnancy". As in the case of the second CTN, the name of the hospital or institution in which the trial was to be undertaken was said to be the Family Planning Association of Victoria and the World Health Organization. The time scheduled for the trial or study was stated to be from 1 March 1994 to 1 March 1995; and the same Ethics Committee was identified with this trial as was identified with the second CTN.
By letters dated 7 and 10 March 1994 addressed to Professor Healy and Professor Fraser respectively, the TGA granted approval to the importation of mifepristone supplied by the World Health Organization for use in the studies.
On 20 April 1994 the appellant wrote a letter to the Secretary asking him to take action to prevent the importation or, alternatively, to cancel consent for the use of the drug mifepristone on the basis that there is a real danger that some or all of the tests would involve illegal abortions, which was said to infringe s. 83 of the Crimes Act 1900 (NSW). The TGA replied on 8 June 1994 stating that the Secretary's approval was not required and that the trials would not be stopped unless the Secretary directed that they be stopped in the event that he became aware that the continuation of the trials would be contrary to the public interest. It was said that to date there appeared to be no evidence upon which the Secretary could properly determine that the continuation of the trial in question would be contrary to the public interest.
By letter dated 16 August 1994 the appellant wrote to the Secretary (this is a critical letter) asserting that, in the opinion of the appellant and of senior and junior counsel retained by it, the conduct of the clinical trials was "contrary to the law of NSW and Victoria and, thus, contrary to the public interest". A summary of a joint opinion of senior and junior counsel was enclosed which stated that in their view the trials were contrary to the public interest within regulation 5A item 3(e) of the Regulations made pursuant to s. 18 of the TG Act on the ground that the trials appear to involve persons in the possible commission of
offences under s. 83 of the Crimes Act 1900 (NSW) and s. 65 of the Crimes Act 1958 (Vic). The Secretary was requested by the letter to exercise his authority under Schedule 5A of the Regulations to direct that the use of mifepristone for the clinical trials should cease.
The Secretary replied by letter which appears to be undated but was received on 31 August 1994. It included the following statements;
"The approvals to import mifepristone for use in these trials were given by an officer of my Department subject to the condition that the use of the mifepristone be in compliance with Commonwealth, State and Territory legislation. I have been presented with no evidence that this condition has not been met.
Certain abortions are legal in both NSW and Victoria. Your Association has concluded that the abortions being carried out are illegal simply because you do not have evidence on which to make an informed judgement as to whether they are or are not legal. I do not think that such a conclusion is justified. The approvals were granted on the basis that the relevant laws be complied with and until I am presented with evidence to the contrary, I must act on the belief that in fact there is compliance with these laws. You have raised nothing which would warrant my acting to stop the trials.
While the broad issue that you have raised of compliance with the law concerns all three trials, I should point out that the specific issue of whether illegal abortions are being performed is relevant to only one trial (CTN 94/138) as the other two relate to the use of mifepristone as an emergency post-coital contraceptive not an abortifacient."
Is there a positive obligation or duty imposed on the Secretary under paragraph (e) of Item 3 of Schedule 5A to the Regulations to investigate possible breaches of State law (question 3)?
Although logically this question does not arise first, it is convenient to deal with it because it has a real bearing on the other two questions. For example, if, contrary to his Honour's finding, there is a positive duty on the Secretary to investigate possible breaches of State law, this would lend assistance to the argument of the appellant that there was a "decision" by the Secretary (question 1) and that it is a "person aggrieved" within the meaning of the ADJR Act (question 2). So it is to this question that I shall now turn.
The first point to be made is that the language of condition (e) of Item 3 in Schedule 5A to the Regulations is not that of obligation or duty. This must work against the contention that the Secretary is subject to a positive obligation to investigate possible breaches of State law or anything else that may relate to the public interest. But the legislative scheme of which condition (e) is a part is one which prohibits sponsors of therapeutic goods from knowingly or recklessly importing such goods into Australia for use in humans or supplying the goods in Australia for use in humans unless relevantly the goods are exempt goods or the subject of an approval or authority under s. 19 (s. 20(1)). Hence, under
the regulations, to qualify for a relevant exemption from this prohibition, each of the elements of Item 3 set out in Schedule 5A to the Regulations must be satisfied before the exemption can operate. So the starting point for an analysis of condition (e) is that the importation of mifepristone is prohibited unless one of the relevant exemptive conditions (including condition (e)) applies.
It does not follow, however, that when the sponsor gives notice of his intention to sponsor a clinical trial using relevant specified goods, that the Secretary has an obligation cast upon him to determine whether the conduct or continuation of the trial would or would not be contrary to the public interest.
It was argued on behalf of the appellant that one would expect to see somewhere in condition (e) some obligation cast on the sponsor to justify a departure from the norm of prohibition of the goods which it is sought to import or supply in Australia for use in humans. However, the answer to this lies in my view in conditions (c), (d) and (f) of Item 3 which involves the relevant Ethics Committee.
The first of these conditions is that the sponsor or other body or organization conducting the trial is required to have regard to the advice of the Ethics Committee that has or will assume responsibility for monitoring the conduct of the
trial (condition (c)). Secondly, the terms of the approval by the sponsor or other body or organization must be no less restrictive than the terms advised by the Ethics Committee (condition (d)). Thirdly, the sponsor conducting the trial or the body or organization conducting the trial for the sponsor, must not receive or have received advice from the Ethics Committee that is inconsistent with the continuation of the trial (condition (f)). Thus, one important element of public interest considerations is the responsibility of the Ethics Committee.
It must be remembered that condition (e) is separate from conditions (c), (d) and (f), each of which involves the Ethics Committee in one form or another. The matters which may be appropriate for the Ethics Committee to consider under those conditions may also fall within the ambit of the public interest to which the Secretary may have regard under condition (e). There may in other words be an overlap; but the presence of condition (c), (d) and (f) involving the role of the Ethics Committee, in particular a monitoring role, with respect to the conduct of the trial, argues against the notion that condition (e) imposes some form of positive obligation upon the Secretary to investigate matters that may be contrary to the public interest.
The second point which suggests that there is no positive obligation on the Secretary, as suggested by the appellant, is
that, even though in some cases a contravention of State law may or would be committed by the conduct or continuation of a trial or experiment of the relevant therapeutic goods for experimental purposes in human beings, it does not necessarily follow that it would also be contrary to the public interest within the meaning of the regulations. As the primary Judge observed, and I agree with him, an investigation into whether importation or use of relevant therapeutic goods might lead the Secretary to think that contravention of State or Territorial law was being committed, would not necessarily compel a conclusion that continuance of the clinical trials was contrary to the public interest within the meaning of condition (e). The public interest is a concept of wide meaning and not readily delimited by precise boundaries. Opinions have differed, do differ and doubtless always will differ as to what is or is not in the public interest. It is not difficult to find examples in history where laws on the statute book have become outmoded and crimes that were theoretically grave crimes punishable by heavy penalties were in fact rarely, if ever, the subject of prosecution because the thinking of society had undergone a change which had not yet found its way into legislative reform. Merely to say that State (or Territory) law may be infringed if the drug mifepristone is used in the conduct of experiments with respect to human beings would be a criminal offence under State law does not necessarily conclude the question of public interest.
Importation of drugs, their distribution and use are activities which in our federal system of government involve regulation by large numbers of criminal statutes and legislative and executive bodies designed to enforce those statutes, in addition to the common law. It would be a highly impracticable and inconvenient task for the Secretary to be responsible for the investigation and consideration of possible breaches of criminal law generally. Also the Federal Government and the Governments of the States and Territories have extensive and elaborate means of enforcing the administration of the criminal justice system and therefore protecting the public interest through police forces, the various public investigative and prosecuting authorities and the courts themselves. I see no reason to construe condition 3 of Item 3 as imposing upon the Secretary some obligation or duty to engage a parallel inquiry into the criminal law or its enforcement.
Also, as the trial judge observed, in my opinion correctly, possible breaches of State law are matters for the State prosecuting authority. As his Honour put it:
"It cannot be assumed that any contravention of any law of any State is necessarily contrary to the Australia public interest, or, concomitantly, that it is necessarily in the Australian public interest that every contravention of every law of every State be prosecuted".