Christopher James Roberts has applied to the Tribunal under S163 of the Health Practitioner Regulation National Law (NSW) seeking a reinstatement order pursuant to s163 B (1)(c) of the Act. The grounds for the application stated that Mr Roberts was a fit and proper person to practice as a medical practitioner in accordance with the provisions of the Act.
In April 2007 the former Medical Tribunal made orders that Dr Robert's name be removed from the register of medical practitioners and that he was not to apply for registration for a period of five years from the date of the Tribunal's orders. It was further ordered that until he was again registered as a medical practitioner he was not to offer any health services in the nature of counselling.
The proceedings before the Tribunal in 2007 arose as a result of a complaint by the Health Care Complaints Commission alleging that Dr Roberts as a medical practitioner was guilty of unsatisfactory professional conduct and/or professional misconduct in that he had:
1. Demonstrated that the knowledge, skill or judgement possessed, or care exercised in the practice of medicine was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or
2. Contravened the Medical Practice Regulation 1998; and/or
3. Had engaged in improper or unethical conduct relating to the practice of medicine.
There were 161 particulars of the complaint relating to 30 patients. Broadly the particulars related to prescribing and record-keeping practices followed by Dr Roberts.
Generally speaking it was alleged that Dr Roberts was prescribing prohibited substances and drugs of addiction when he ought to have known that patients could become dependent. He had failed to exercise adequate medical judgement in prescribing restricted drugs and drugs of addiction and had not considered whether such prescription was appropriate in the circumstances. He had prescribed drugs in quantities and for purposes not in accordance with recognised therapeutic standards.
In relation to record keeping it was alleged that Dr Roberts had failed to record information relevant to the patient's diagnosis or medical treatment, or record particulars of any clinical opinion he had reached, to record treatment plans and full particulars of medication prescribed. There was a failure to record sufficient and appropriate details about cases to allow other registered medical practitioners to continue the management of the patient.
In the decision it was noted that Dr Roberts for some time had an interest in counselling, natural therapies and dependencies. He had undertaken some counselling training in the United States in a model of co-dependency and addictions. His treatment theory had led his Redfern practice to prescribe hundreds of tablets of benzodiazepines for drug addicted patients who attended the practice. Mr Roberts had involvement in other practices from 1979, with a number of other doctors. He began the Holistic Medical Centre and he also worked in general practice in Campsie. The 2007 decision of the Tribunal concerned only his conduct in the Redfern practice.
Dr Roberts did not cooperate with the investigation conducted by the Pharmaceutical Services Branch of the New South Wales Department of Health that had investigated his colleagues in the Redfern practice in relation to the level of prescribing benzodiazepines. He was then warned by the PSB in relation to the frequency with which he was prescribing benzodiazepines.
Dr Roberts stated that through his work in a co-dependency model of treating addictions he commenced prescribing on request subject to the patient's agreement to attend Narcotics Anonymous (NA). That approach had been taken because Dr Roberts felt increasingly frustrated with the available alternatives for the treatment of drug addiction and in particular at the referral of patients to drug and alcohol experts and detoxification programs that he believed did not address the problem of addictions. His treatment strategy allowed patients to continue using large quantities of drugs while he counselled them and encouraged them to attend NA in a way where they could substitute ' medication for people'.
The Tribunal pointed out that the Commonwealth Health Insurance Commission conducted what was called the ' Dr Shopper Program' that monitored a number of doctors attended by drug seeking patients in order to reduce the amount of drugs received and the number of doctors prescribing for patients. The program was developed to stop patients obtaining benzodiazepines and opiates from many different doctors and then selling them or swapping them for other drugs. As part of the program patients were asked to enter into voluntary agreements where they agreed that the details of drugs prescribed to them could be made available to the HIC. Despite knowing that drug seeking patients could be manipulative and liars Dr Roberts maintained that he could detect those who were not serious about treatment and he would send them away. He was of the opinion that most of his patients had psychiatric problems but he did not refer any patient to a psychiatrist preferring his co-dependency model. Dr Roberts accepted the training in the co-dependency model on which his method of treatment was based was 'outside the mainstream'. His American certificate he agreed was not recognised by the medical profession, the Psychologists' Registration Board or any other relevant organisation in Australia. He also conceded there was nothing in the co-dependency model that recommended or advocated prescribing on demand but this was an extrapolation by him and he thought it might work.
Under his model Dr Roberts took a minimal history of patients, conducted no medical examination and ordered no tests of these patients to ascertain the effect on them of taking benzodiazepines. The vast majority of patients were on Methadone and during the hearing Dr Roberts conceded that he should have contacted the Methadone prescribing doctor in relation to these patients. He accepted that he was not applying the standards expected of ordinary medical practitioners but did not regard himself as the ' primary care practitioner'. He was only seeing these patients for a very specific reason and that was to get their drug taking under control. He did not regard himself as acting as a general practitioner to these patients. Until the complaint was made regarding benzodiazepines he had regarded the drug as safe and that people did not overdose on them. Following the complaint he realised that what he was doing was ' potentially harmful to patients'. He recognised his prescription of benzodiazepines at the time could contribute to the risk of patient death and that he was prescribing in a quantity outside recognised therapeutic standards. He admitted prescribing benzodiazepines for purposes for which they were not meant to be prescribed. This was done to reward patients who promised to go to NA.
The Tribunal was ultimately satisfied that between 1997 and 1999 Dr Roberts pursued his theory knowing the risks and dangers of prescribing large amounts of benzodiazepines. While counselling was a critical part of his theory he never referred patients for psychiatric assessment. It was observed that Dr Roberts isolated himself from those who could assist him and his patients in circumstances where he knew the literature and the risks to his patients yet he carried on applying his own theory. The Tribunal found Dr Roberts, in essence, was engaged in an 'experiment'. He had made demonstrably false statements to the Tribunal and gave evidence that was evasive and undermined his credibility. He had given contradictory evidence, had not been ' frank' and there were inconsistencies in his evidence. In the circumstances the Tribunal could not accept Dr Roberts as an honest witness.
While Dr Roberts ultimately acknowledged that he was wrong in his approach to the prescription of benzodiazepines, the Tribunal thought 'that came very late in the day', and was ' hardly expansive' when it did come. His admissions always came with a caveat that he had good intentions. It was noted that no sympathy had been expressed or apology offered to his patients. Further a coroner's report had concluded that the use of benzodiazepines together with other drugs was implicated in the death of two of his patients. It was stated that Dr Roberts had very little insight into the gravity of his conduct. He had embarked on an experiment with no empirical evidence to support his theory. He had used addicts as ' guinea pigs' and for two years acted as a ' supermarket supplying drugs', offering addicts drugs they asked for. Dr Roberts never informed his patients of the risk of using large amounts of benzodiazepines yet at all relevant times he knew his prescribing was an anathema to everything he had learnt about the proper practice of medicine. A peer reviewer and an expert on drug and alcohol treatment were scathing in their views about Dr Roberts' conduct.
The Tribunal was satisfied that his conduct amounted to the ' abandonment of all skill, judgement and care expected of a medical practitioner'. It was misconduct of the ' gravest kind'. The Tribunal concluded that if Dr Roberts continued to practice in this way, by offering counselling, he would pose a substantial threat to the health of the public. He could therefore not offer any health service after deregistration.
In evidence before this Tribunal Mr Roberts stated he was now 64 years old.
In reference to the conduct which led to his deregistration he stated that in 1997 when the heroin crises had deepened and death from overdose had escalated he had formed the view that he could assist drug addicted patients to stop using drugs if they agreed to attend NA and did in fact attend. In return for agreeing to do so he would prescribe benzodiazepines for them. He said he was aware at that time that feeding a drug habit was not likely to stop the habit but he ' irrationally believed' that patients attending NA may have the result of ending their habit. He had a lengthy period of time to reflect on his conduct and now realised that his hope was a ' forlorn' one borne out of what he perceived to be otherwise a hopeless situation for those patients. At the time he did not believe there was any other way those patients could be dealt with that offered any likelihood of them ending their addiction to drugs of dependence. He said at the time he knew that he was inappropriately prescribing benzodiazepines, there was a real likelihood of dependence and increasing tolerance with the risk of death for his patients. He thought the risk was worth taking if there was some chance that NA attendances might result in the loss of drug habituation. He now realised his view was ' entirely wrong'. In hindsight he found it difficult to understand how he was able to entertain that view and now accepted that whatever might be the limitations of conventional approaches to the treatment of drug addiction they were preferable to his previously held view that something akin to a miracle cure might be effective.
Since deregistration he had undertaken the following courses:
Issues in General Practice Prescribing (Faculty of Medicine, Nursing, and Health Sciences at Monash University)
Graduate Diploma in Mental Health Sciences - Community Mental Health (Monash University)
Currently enrolled in Master of Mental Health Science (Monash University)
In relation to the General Practice Prescribing course he stated that it had brought home to him the importance of not prescribing long acting benzodiazepines to anyone deemed to be at risk of developing chemical dependence and avoiding the prescription of short-term benzodiazepines in such cases. It reinforced the absolute importance of following prescribing guidelines that were very carefully developed as a result of much experience and showed him the importance of close communication between medical practitioners and between allied health practitioners, including, most importantly, pharmacists.
In relation to the Masters of Mental Health Science course it had shown him the extent of research behind the various validated mainstream approaches to the management of mental health illness and had shown the historical developments leading to present-day situations in managing the mental health of people from both public health and personal perspectives approaches. It had shown him the importance of regular professional communication between the various deliverers and providers of mental health care and by extrapolation, by health care providers generally.
Since deregistration he had undertaken regular consultation with his psychiatrist, Dr Barry Blicharski, between March 2008 and September 2012 when he retired from practice. From August 2013 to the present time he had undertaken weekly consultations with another psychiatrist, Dr Anna Banning. His general practitioner was Dr Greg Heron who was treating him by medication for some conditions including depression and anxiety.
In relation to his psychiatric treatment Dr Roberts stated:
…. I now understand that as a result of a confluence of hospitalised and home-based childhood experiences I had developed a mistrust of the medical profession, combined with a compulsive drive to attempt to assist and rescue people with severe problems. That resulted in my acting in professional isolation and without consulting drug and alcohol experts within the profession. Such expertise from appropriate colleagues would have been able to guide and direct my drive to assist the patients in a constructive way rather than the destructive way I see I did.
Mr Roberts said he had read and reread the comments of the Tribunal when he was deregistered and had a great deal of time to reflect on those matters. While he genuinely believed that he may have been able to assist those patients where others had failed he was entirely embarrassed by his naivety and conduct. He realised his conduct was inappropriate.
In relation to professional development Mr Roberts said that since deregistration he had attempted to keep up to date with developments in the medical profession especially those relating to medical practice and mental issues, being a specialty in which he wished to practise should he be restored to the register. He had maintained online subscriptions to Medical Observer, the Australian Doctor, the Australian Family Physician and Australian Prescriber. He had completed the quality improvement and continuing professional development requirements of the RACGP for the 2011-2013 triennium.
Because of his particular interest in mental health Mr Roberts was currently undertaking a Master of Mental Health Science degree through Monash University. The course involved advanced training and knowledge up skilling in the disciplines dealing with mental health issues in the community and closed environments. The course had 12 units and he had completed 5 to the present time. He was also sitting with Dr George Abouyanni, a general practitioner in Campsie and observing his practice.
A number of lifestyle changes had been made by Mr Roberts since his deregistration in 2007. He had taken a significant time to address his shortcomings and believed he had made real progress regarding his own thought process. He said he had developed a better sense of self and a better sense of his obligations as a medical practitioner. He had consulted with Dr Blicharski on a fortnightly basis until March 2009 and believed these sessions helped him recognise his shortcomings and assisted him in achieving a greater personal insight into his behaviour during the 1990s and during the Tribunal hearing in 2007. He was now consulting Dr Anna Banning on a weekly basis.
Since February 2013 Mr Roberts had been attending AA meetings for doctors on a weekly basis. Previously he had attended AA because of alcohol problems he had developed in the 1980s but were dealt with at that time. More recently he had attended AA to gain support and insight into his behaviour. Those meetings had assisted him with opening up with his colleagues especially about negative projections he had towards medical authority. He could now see how he had practised in relative isolation from his colleagues and authority figures and how he had lost his way.
In relation to his personal circumstances, since deregistration Mr Roberts' wife had been the main income earner for the family. He had assumed the role of stay at home father and primary care-giver for his two daughters aged 8 and 11. He had become closely involved in his daughters school activities and their P&C, the Anti-Bullying committee and other areas of the school community including assisting in a weekly remedial program for pupils with reading difficulty. Since 2007 he had spent 3 to 4 mornings teaching music to preschool aged children at various preschools and other venues. He found this involvement extremely rewarding and felt that he was giving something back to the community. He had been very fortunate to have the support of family and friends who had continued to provide guidance and support since his removal from the register in 2007. He believed that having such a strong and personal network had assisted him greatly.
As to the future Mr Roberts said that he was hopeful that he would be restored to the register and would be again able to work as a general practitioner. It was his intention to commence working in a group general practice specialising in the area of mental health. His interest in mental health medicine led him to commence a Master's degree in Mental Health Science and he believed his training and genuine interest in that area would be of benefit to a potential patient.
During the 1990s he had an increasing number of patients who died following heroin overdoses. With the benefit of hindsight and much soul-searching he could see now that he misguidedly felt that he was fighting the good fight by controlling drug dependent patients' prescriptions and requiring them to attend NA. He said that he was ashamed to admit that the significance of his conduct only hit him during the course of his counselling with Dr Blicharski rather than during the course of the Tribunal proceedings in 2007. While such understanding and awareness only came about after the Tribunal proceedings, when it did come he was devastated by his actions and had since sought, in numerous ways, to become a better person in both a personal and professional sense. In the past he had refrained from seeking guidance and assistance from those colleagues from whom he could have sought guidance. He now understood that he simply could not keep doing that in the future and appreciated the benefits of seeking guidance from others in a collegiate fashion.
He did not believe that he would make such mistakes again whether in his prescribing, his attitude towards medical practice or his refusal to seek guidance or counsel from others. In the event he was able to practise medicine again he was aware that conditions could be imposed upon his registration. He was eager to return to general practice and would accept any condition the Tribunal considered suitable.
Mr Roberts was extensively cross-examined in relation to the findings of the Tribunal leading to his deregistration and also in relation to aspects of the statement he had filed in the Tribunal in the present matter.
He agreed that questions arose in these proceedings as to whether he had changed and whether he would be a risk to patients if he was allowed to return to practice. When the Redfern practice reached the level of 700 patients, all being drug addicts, he now understood that people were attending for easy drugs. Patients were attending because they were getting benzodiazepines on demand. He was of the view that 700 drug addicted patients was no longer a GP service practice and he was just giving drugs to his patients. He had come to realise that at the time and well understood that position now. He was not looking at the general health of the addicted patients and they were not interested in their general health either. He agreed that this was a neglectful approach. He agreed that as a GP he needed to look at the social stresses and also agreed that there may be a need for others to be consulted. He agreed that he had lost perspective in dealing with his drug addicted patients and was driven by his own issues.
In relation to the contract his patients entered into to attend NA in order to obtain benzodiazepines, Mr Roberts agreed that it was difficult to know if patients were telling the truth when they said they would do so and later if they had attended NA. He understood that a number would be lying to him but he had lost his perspective and finally accepted that if a few went to NA then that would be better than none. He now believed that these were crazy ideas and he was being told what he wanted to hear. He said it was difficult to advise these patients and often they would not listen to advice but would ignore or laugh at him. The main thing they were coming for was the drugs. He said he was obsessed with his model and today regarded it as a distorted approach. There was an arrogance in this approach that may have sprung from his upbringing.
Two of his regular patients had died and were the subject of separate coronial enquiries. He agreed that those deaths should have been the time to question the approach he had adopted but he only gained that insight later after the proceedings in the Tribunal ending in 2007 and after counselling. He did not take any corrective action earlier because then he could not see anything wrong in what he was doing and believed that he was correct in his approach. He accepted that the benzodiazepines he was prescribing could have got out onto the street.
In relation to his post-dating of prescriptions and the extraordinary level of prescriptions for particular patients Mr Roberts said he now felt that his prescribing practice was abhorrent.
As to his scant clinical notes Mr Roberts said he did not take this approach in his other practices but only at Redfern. He did not think his normal practice was relevant for Redfern because he only had to get his addict client to NA.
In relation to the Tribunal's concern at his isolation from professional colleagues up to the time of his deregistration Mr Roberts said that he had considered that problem and would no longer practise unless there were other doctors around and that he would want to discuss issues with other doctors on a regular basis. He had continued to attend AA, not because of problems with alcohol, but to be able to talk about issues- these meetings had given him an insight into his past approach and the things that drove him. If re-registered he said he would agree to conditions being imposed including reporting to the Medical Council.
When questioned about the type of practice he might now wish to join if re-registered, Mr Roberts stated that he had no particular proposal in mind but understood that some group practices were very busy and there would be very little chance of consultation with other colleagues. Until he knew the result of his application for registration he had not sought out practices for future engagement but thought there might be a possibility of continuing to work with Dr Abouyanni in the Campsie practice but there had been no formal discussion about this possibility. He had commenced sitting with Dr Abouyanni as an observer in order to reach out to the medical profession and to brush up on his medical knowledge and approach because of the length of time since he was last in practice. He also spoke of the benefits he had derived from courses he had taken more recently. He did not think that he would be overborne by difficult patients but accepted that if matters became too complex he would refer a patient or speak with professional colleagues about the patient. He did not believe that he was overborne by a difficult person while in practice at Redfern. Although he had practised bad medicine in relation to drug-related patients he nevertheless had a strong sense of self at the time.
Mr Roberts was asked to comment on the report prepared by consultant psychiatrist Dr Murray Wright, engaged by the Medical Council of New South Wales. He did not disagree with anything contained within that report and agreed that it was essential that he continue consulting a psychiatrist because of the benefits he obtained from continued counselling and the insight he had gained that would not have occurred without such therapy. He was not opposed to conditions that would suspend his prescribing rights in relation to Schedule 4D and Schedule 8 drugs nor confining him to general practice in a group practice. He agreed with the necessity for other GPs to be on site while he was in attendance and that he would require supervision of a senior colleague. As it had been some time since he last practised he agreed that it was appropriate that limitations be placed upon his patient load and hours of work. If the Medical Council required regular reports Mr Roberts said that he would be willing to participate in suitable arrangements and would do so fully and frankly.
In support of his application for re-registration Mr Roberts tendered reports from three treating doctors.
Dr Barry Blicharski was a psychiatrist who consulted with Mr Roberts between 2008 and 2012 on some 47 occasions. He had conducted an assessment of previous treatment and had assessed current problems in Mr Roberts' life and clarified his needs and goals. Mr Roberts earlier had some hopes of returning to medical practice but was ambivalent about applying. He had concerns about his marriage and was trying to benefit from additional medical studies while continuing to teach music to children. It was decided that it would be best for him to regularly consult for therapy and to monitor the progress of that therapy. The nature of counselling was Individual Psychotherapy. This approach involved a focus on the present rather than past problems or future worries. Mr Roberts became more relaxed and gradually functioned better and gradually provided memories of suffering from Perthes Disease from the age of three when he experienced severe pain and a period of hospital treatment. Mr Roberts reported that there were medical mistakes as well as minimal contact with parents and these events had paved the way for not trusting doctors.
Dr Blicharski thought that Mr Roberts had developed over time considerable insight into his past behaviour to the extent that when considering his past behaviour he was very unhappy and disgusted about the way he had behaved. He had been working for some years at changing those behaviours and attitudes and was now doing very well when last seen. Although he had some ambivalence he was functioning quite well. He thought that Mr Roberts may do well given the work they had put in and the changes he had made. He thought Mr Roberts could re-enter the medical system but that he would need support at the time especially in the initial stages by continuing consultation with a counsellor. It would not be of help if Mr Roberts was left alone in his endeavours.
Dr Anna Banning was a psychiatrist who had been seeing Mr Roberts since 2013 and after he had ceased attending Dr Blicharski. Mr Roberts had initially sought counselling due to anxiety about his application for re-registration. He had suffered from depression and anxiety of long-standing and this would worsen in contemplation of such an application. Mr Roberts was said to be acutely aware and triggered by memories of his previous shame and the ruthless cross-examination that had occurred in the 2007 proceedings.
Mr Roberts' early childhood was described as being traumatic and involving lengthy periods of hospitalisation and separations. Perthes' Disease had been diagnosed at two and a half followed by hospitalisation and immobilisation for 10 months with his parents visiting only once a week. From 3 to 7 years of age he had callipers and crutches and felt humiliated by children at school. Between 9 and 10 years of age he spent over three months with minimal visits in hospital while his leg was straightened. Initially the wrong leg was immobilised and in the second period hospital staff mistook the leg that was affected when he was relearning to walk. His mother had tricked him into going to hospital and then abruptly left the hospital with no explanation as to what was to happen. Dr Banning said it was little wonder that he developed a deep distrust of doctors and also of his mother. He had a long-standing fear of abandonment and intense separation anxiety. He still felt fear of being alone but this had ameliorated with therapy.
In the initial phase of therapy they worked on early childhood issues of abandonment, his suppressed rage that had been denied and converted into depression and issues within his marriage. Now the marriage had dramatically improved. Further, in his mid-30s Mr Roberts developed a drinking problem and went to AA. He was then able to drink socially but returned to AA meetings for doctors but not for a drinking problem but to seek collegial support. That step helped him to trust in doctors as well as his participation with general practitioners observing his practice.
Dr Banning described Mr Roberts' misguided treatment of addicts as being explained by his identification with victims, being the addicts, and his deep and compulsive need to rescue them. He saw the situation in Redfern as the persecutors flooding Redfern with cheap heroin. He was unable to seek or accept advice from his medical colleagues due to his mistrust of the medical profession. There was a dynamic cycle of victim, persecutor and rescuer with interchanging roles. None of these roles was functional and Mr Roberts adopted the role of rescuer to an extreme degree, explaining his lack of insight with addicts. His long periods of isolation, abandonment and traumatic surgical procedures as a child left him feeling he was a victim of the medical system with no compensatory reassurance from his mother and what he perceived as her deception.
Dr Banning noted that in the judgement of the previous Tribunal reference was made to the fact that reformation of character and behaviour could doubtless occur but such an occurrence was not the usual but the exceptional thing. She said that without treatment that statement was largely true although maturation can and did occur. In her opinion Mr Roberts had made substantial character and behavioural changes. He now had insight into his misguided treatment of addicts as a result of therapy. He had attended relevant medical courses: he said he had lost his way. At a deeper emotional level he had the experience of the benefits of not being a victim and rescuer with his wife and this had given him a deeper understanding of the harm that can occur through blindly acting as a rescuer. From her knowledge of Mr Roberts Dr Banning said she had no doubt that he would be a very caring, conscientious and knowledgeable general practitioner, noting that he had kept his medical knowledge up to date.
Dr Greg Heron was a local GP who was first consulted by Mr Roberts in late March 2007. Thereafter Dr Heron had multiple consultations with Mr Roberts and was currently treating him in relation to a number of issues including depression and anxiety.
Having seen Mr Roberts over a period of several years and having read his statement filed in the Tribunal in this matter Dr Heron stated that Mr Roberts had developed a high degree of insight into his conduct as a general practitioner up to and including 2007. He was satisfied Mr Roberts understood that his previous prescribing habits were unacceptable and that if he was restored to the medical register it was most likely that restrictions would be placed on his ability to prescribe drugs of dependence. Dr Heron was aware that Mr Roberts had undertaken extensive remedial education in the fields of General Practice Prescribing and Mental Health Sciences. He believed that Mr Roberts had practised medicine with only the best of motives, misguided as they may have been. Having regard to these factors and the probable restrictions that might be placed on his prescribing Dr Heron believed that Mr Roberts was fit to return to practising medicine as a general practitioner.
Dr George Abouyanni had known Mr Roberts since 2014, being referred to attend his Campsie practice as an observer by the Royal Australian College of General Practitioners. From that time Mr Roberts had been attending his consultations once or twice weekly having obtained the permission of patients. Dr Abouyanni was very impressed by Mr Roberts' communication skills that he described as full of ' empathy and understanding'. Although Mr Roberts had not been practising medicine for 7 years, he had kept up to date with his medical knowledge as evidenced by subsequent discussions they had about patients seen together. Mr Roberts continuously updated his medical knowledge by constantly refreshing through electronic resources during and after consultations. Feedback received from Dr Abouyanni's patients was very positive.
Dr Abouyanni stated that he was certain that Mr Roberts would continue to be an asset to the medical community if he was granted re-registration by the Tribunal and he had not the slightest hesitation in so recommending.
Six personal character references were also tendered by Mr Roberts supportive of his application. These references were provided by persons who had significant contact with Mr Roberts and his family, some for more than 25 years and a number more recently arising from school and family contact in the last 5 to 12 years. They spoke of Mr Roberts as being a strong family man and a person who was caring and supportive and who had concern for the welfare of others. He was said to be a sincere and genuine person who had contributed not only to his local community but in particular the school community where his children attended. In relation to the matters that brought him to the previous Tribunal in 2007 it was variously said that he accepted the judgement of that Tribunal and was addressing his shortcomings and was unlikely to act in the same manner in the future. He had frankly expressed his regret about the practices that led to his deregistration, freely acknowledging his previous conduct and was now demonstrating a greater understanding of his professional obligations. He was described as having a more balanced outlook, having positively reflected on the matters that led to his deregistration and had expressed remorse for his previous breaches.
Doctors who provided reports for Mr Roberts and those who provided character references were not required for cross examination.
The respondent Medical Council had engaged a psychiatrist, Dr Murray Wright, as a council appointed psychiatrist to provide a report for these proceedings in relation to Mr Roberts. Amongst other matters Dr Wright was provided with the decision of the Tribunal made in 2007, the statement by Mr Roberts made in the present proceedings, the reports prepared by Dr Blicharski, Dr Banning, Dr Heron and Dr Abouyanni and six character references. In relation to the medical reports Dr Wright was asked to identify any difference of opinion to those expressed in the reports tendered for Mr Roberts.
In his report Dr Wright noted that he had worked as a consultant psychiatrist since 1990 and for 20 years provided reports to the Medical Tribunal and the Medical Council of New South Wales as a Council Appointed Practitioner.
Dr Wright took an extensive history from Mr Roberts including the period covering his Redfern practice and his treatment of drug addicts. Mr Roberts stated that part of him was driven to help the addicts but it had taken over his life. Other medical colleagues were not as understanding in dealing with addicts. In this period he described himself as having lost his way yet being well intentioned. He was over identifying with addicts and going too far to try to help them. The idea of prescribing benzodiazepines in exchange for undertakings to attend NA was his own idea - he did not trust the medical community and thought other doctors did not understand addicts. He knew that benzodiazepines were being diverted and considered this to be the lesser of two evils. Between 1999 and 2007 he struggled to understand what he had done wrong and felt let down by his legal advisers. He did not consider doing any relevant courses because he did not think he had done anything wrong. He admitted to having a 'superiority thing' going on in his life and added that he had to lose his prestige, his career, his income and his job to make him more aware and appreciate what he had done. He was not expecting the outcome that occurred at the Tribunal. He had always been a bit different and felt superior but losing his career flattened him. He was depressed for a couple of years and started seeing Dr Blicharski. He had initially attended a psychiatrist for support and that led to an engagement in psychotherapy and a process of developing a deeper understanding of some of his own issues and how his long-term fears of abandonment and subsequent shame and mistrust had shaped his personality and his professional misconduct. He came to see how he had become a rescuer and identified with addicts and mistrusted all other members of the medical profession.
Mr Roberts explained to Dr Wright the steps he was now taking to maintain and develop his medical skills and expressed a desire to return to general practice hoping eventually to return to a practice that involved counselling for people experiencing mental ill health. He understood that he would work in a group practice under supervision with conditions that would suspend his right to prescribe Schedule 4D and Schedule 8 drugs.
Dr Wright asked Mr Roberts about any changes in attitude or perspective to which Mr Roberts replied that he did not have any more the sense that other doctors were wrong and that he was right. He was horrified that he may have contributed to deaths and suspected that benzodiazepines caused harm to some patients. He described himself as a sincere fool, the worst sort of person. He now had a great sense of humility and was very aware of his previous ' neurotic arrogance' which he found now to be ' abhorrent'. When asked why he had waited until now for reregistration Mr Roberts said he did not feel ready to apply for reregistration two years ago and that he felt the need for further therapy.
In addressing specific questions raised by the respondent Dr Wright stated:
Mr Roberts had a clear insight into the inappropriateness of his conduct particularly relating to his prescribing and in his relationship with the wider medical profession. He had a deepening insight, through psychotherapy, of his own personality, vulnerability and its origins which led to his inappropriate professional conduct. Dr Wright expected that continuing to address these issues would lead to consolidation of his insight.
Mr Roberts had remorse in relation to the conduct that brought him before the Tribunal in 2007 and this remorse extended to the impact of his conduct on his patients.
In the past Mr Roberts had psychological problems that affected his judgement or ability to act in the best interest of his patients. He had been addressing these psychological vulnerabilities through psychotherapy with Dr Blicharski and more recently with Dr Banning, to the extent that those vulnerabilities were far less likely to affect his judgement or ability to act in the best interest of his patients in the future.
Through psychotherapy Mr Roberts, possibly for the first time, had addressed his own psychological conflict and vulnerabilities which almost certainly contributed to his professional misconduct. It had taken some time and the trauma of deregistration for him to take this step but it appeared that it had in turn led him to better understand both his own psychological vulnerabilities and the complete inappropriateness of his previous professional misconduct. It was therefore essential that this psychotherapy continued. Mr Roberts suffers an impairment and required ongoing psychotherapy to address that impairment and to help ensure that he did not return to a state of mind which contributed to his misconduct. Dr Wright recommended that Schedule 4D and Schedule 8 prescription rights remain suspended, that Mr Roberts return to work as a general practitioner and be required to work in a group practice where there would always be at least one other general practitioner on site and that he be required to submit to supervision with a senior colleague. These work and health related conditions could contribute to a successful return to practice.
Dr Wright was in broad agreement with opinions expressed in the reports of Drs Blicharski, Banning and Heron but emphasized the importance of a requirement that he continue in psychotherapy and requirements that he only work in a group practice where other doctors were on site at all times and that his work be subjected to supervision by way of case review and that his Schedule 4D and Schedule 8 prescribing rights remain suspended. Further it would be appropriate to set some limits on his patient load and hours worked per week in order that he had adequate time for reflection on his practice and to adjust properly to a return to work after a very significant time out of the medical workforce.
There were no other matters Dr Wright considered relevant to an assessment of whether Mr Roberts was a fit and proper person to be registered as a medical practitioner other than those already raised in his report.
The evidence summarised in the preceding paragraphs is to be considered in the context of the provisions of the National Law.
Counsel for the applicant readily accepted that in order to succeed the applicant must establish, on the balance of probabilities, that he is now a fit and proper person to be registered as a medical practitioner. Satisfaction of this requirement included persuading the Tribunal that the defects in his character and behaviour, that led to his previous conduct, have been addressed and were no longer a factor likely to resurface in future in his role as a medical practitioner.
In the submission of counsel for the Medical Council it was put that it was for the applicant to demonstrate on ' solid and substantial grounds' that he is a person of good character and qualified to be held at out to the profession and the public as someone who is worthy of their confidence as a medical practitioner.
No issue arose between the parties as to the statutory provisions that governn this application nor did any issue arise as to the applicable principles to be applied in cases such as this.
For present purposes it is sufficient to set out that part of the decision of this Tribunal in Bahramy v Medical Council of NSW [2014] NSWCATOD116, dealing with the relevant principles and the National Law concerning an application for reregistration as a medical practitioner:
53. It was accepted by the applicant that he bears the onus of proving he is a person of good character, and is presently qualified to be registered as a registered medical practitioner. It was not in dispute that the standard of proof to be applied by the Tribunal in determining the applicants application is the civil standard of proof, that is, on the balance of probabilities. Because the nature of the jurisdiction, as set out in s 3 (2) (a) and s 3A of the National Law, is protective of the public, the Tribunal must be satisfied to a high level of probability that the applicant is ' fit and proper to be held out to the rest of the profession, to patients and to the whole of the community as a person worthy of their confidence', (see in Re: Jason Martin (2010) NSWMT13; Bringinshaw v Briginshaw (1938) 60 CLR 336). In summary, the onus the applicant bears in a review applicable is a high onus.
54. This application is brought under Division 7 of Part 8 of the National Law. Section 163A (1) provides a person may apply to the appropriate review body (in this case the Tribunal) for the review of a ' relevant order'. Section 163A (4) (b) defines a ' relevant order' to be ' an order that a person's registration as a registered health practitioner be cancelled'.
55. The Tribunal's powers on review relevant to this application are found in s163C. That section relevantly provides as follows:
(1) the appropriate review body must conduct an inquiry into an application for review and may then do any of the following-
(a) dismiss the application;
…
(c) make a reinstatement order,
…
56. The Tribunal's obligations in conducting the enquiry for a review of the earlier order are found in s 163B. That section provides:
(1) A review under this Division is a review to determine the appropriateness, at the time of the review, of the order concerned.
(2) The review is not to review the decision to make the order, or any findings made in connection with the making of that decision.
(3) In addition to any other matter the review may take into account, the review must take into account any complaint made or notified to a Council or a National Board, or a former Board under the repealed Act, about the person, whether the complaint was made or notified before or after the making of the order that is the subject of the review and whether or not the complaint was referred under Subdivision 2 of Division 3 or any other action was taken on the complaint.
57. Section 3 of the National Law sets out the objectives and guiding principles of the law, as those objectives and principles apply to the national registration scheme. The relevant parts of s 3, for the purposes of this hearing, are as follows:
(2) The objectives of the National registration and accreditation scheme are -
(a) to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practice in a competent and ethical manner are registered;
and
(3) The guiding principles of the national registration and accreditation scheme are as follows -
(a) this scheme is to operate in a transparent, accountable, efficient, effective and fair way;
…
(c) restrictions on the practice of a health professional are to be imposed under the scheme only if it is necessary to ensure health services are provided safely and are of an appropriate quality.
58. As in all applications in which the Tribunal in NSW is involved under the National Law, the guiding principle and object in s3A applies. That section provides as follows:
In the exercise of functions under a NSW provision, the protection of the health and safety of the public must be the paramount consideration
59. Although determined prior to the introduction of the National Law, principles dealing with re-registration applications under repealed legislation remain relevant and apposite to this application. Those principles are not in doubt and have been discussed in many decisions of courts, including the High Court of Australia, intermediate appellate courts, as well as tribunals, (see Re Lenehan; [1948] HCA 45; 77 CLR 403; per Latham CJ, Dixon and Williams JJ at [33] Ex Parte Tziniolis; Re the Medical Practitioners Act (1966) 67 SR 488; Peter Cecil Harcourt Dawson v Law Society of NSW[1989] NSWCA 58; Re Mansoor Haider Zaidi [2006] NSWMT 6 at [42]; Zaidi v HCCC [1998] NSWSC 335 per Mason P at 15; Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637).)
60. In Re Jason Martin the Medical Tribunal explained the purpose of the jurisdiction is "not punishment or further punishment" of the former practitioner, rather the jurisdiction being exercised is for the protection of the public.
61. Although decided in the context of lawyers who have been removed from the roll of practitioners, the principles enunciated in such cases are generally apposite to these proceedings. The High Court has made it plain that the power to re-instate should "be exercised with great caution and only upon solid and substantial grounds". However a court (or a tribunal) should exercise its discretion having regard to the facts of each case (see Lenehan).
62. While found in a dissenting judgment, the remarks of Kirby P (as his Honour then was) in Dawson have been adopted and applied in other decisions in the Medical Tribunal and other health practitioner disciplinary tribunals. His Honour explained:
There is no public interest in denying forever the chance of redemption and rehabilitation to former practitioners. On the contrary, the public is better served if, in appropriate cases, those who have offended, once they have affirmatively proved reform, are afforded a second chance.
63. In Re Jason Martin the Medical Tribunal pointed out it is not "a question of what an applicant has suffered in the past. It is a question of his [her] worthiness and his [her] reliability for the future". That Tribunal noted the difficulty associated with predicting how a practitioner will behave in the future and remarked that "the decision in the particular case is to a greater or lesser extent dependent upon the Tribunal's assessment of the applicant". The Tribunal explained "in making that assessment [the tribunal] may draw inferences from what has happened in the past and in particular, what led to his [her] being removed from the Register".
64. When considering issues of "good character" the principles set out in HCCC v Karalasingham [2007] NSWCA in the reasons of Basten JA are instructive. His Honour, at [45] explained the words" 'not of good character" do not bear a special or technical meaning." His Honour went on to discuss situations, by reference to authority, where personal conduct, as distinct from professional misconduct, may be relevant to the question of a practitioner's good character. His Honour cited, with apparent approval, the factors set out in the decision of McBride v Walton (unreported NSWCA 15 July 1994) as follows:
To determine whether a finding of proven misconduct should be followed by a consequential finding that the practitioner is not of good character in the context of fitness to practise medicine, one must consider:
(a) whether the misconduct can be satisfactorily explained as an error of judgment rather than a defect of character;
(b) the intrinsic seriousness of the misconduct qua fitness to practise medicine,
(c) whether the misconduct should be viewed as an isolated episode and hence atypical or uncharacteristic of the practitioner's normal qualities of character;
(d) the motivation which may have given rise to the proven episode of misconduct;
(e) the underlying qualities of character shown by previous and other misconduct; and
(f) whether the practitioner's conduct post the proven episode of misconduct demonstrates that public and professional confidence may be reposed in him to uphold and observe the high standards of moral rectitude required of a medical practitioner.
Also of relevance to the present application are the observations of the Tribunal in Bahramy concerning the underlying qualities of character shown by previous conduct and misconduct. In that regard at [84] the Tribunal stated:
While we are not, in accordance with National Law, re-examining the applicant's conduct at the time of the previous hearing we have regard to the findings of those Tribunals to assess whether or not the deficiency in the applicant's character, particularly those identified by the 2008 Medical Tribunal have been remedied. In so doing we are conscious of the comments of the Court of Appeal in the Litchfield (Health Care Complaints Commission (1997) 41 NSWLR 630) where their Honours said:
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 Tziniolas: Medical Practitioners Act (1996) 67 SR (NSW) 448 at 661: 84 WN (NSW) (Pt2) 275 at 286:
…
Reformations of character and behaviour can doubtless occur but their occurrence is not the usual but the exceptional thing. One cannot assume that 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 attitude it must require clear proof to show that some years later he has established himself as a different man.
The Tribunal, therefore, comes to a consideration of the evidence in this matter bearing in mind the above principles and observations.
As previously noted Mr Roberts was extensively cross-examined. The only other witness to give oral evidence was Dr Wright and in particular he was questioned as to details of conditions that might be appropriately imposed upon the applicant if his application for reinstatement to the register was successful.
In submissions for the respondent it was noted that the 2007 order removing the applicant from the register of medical practitioners followed proceedings in which he had admitted the particulars of the complaints made against him relating to his prescribing and record keeping practices. The applicant also admitted that he was guilty of professional misconduct. In relation to the present proceedings it was accepted that Mr Roberts had not rushed to seek reregistration but had taken his time to take stock of his health and had addressed the need to keep abreast of current medical practice in a variety of ways including taking courses of study, continuing subscriptions to medical journals and more recently observing Dr Abouyanni in the conduct of his general practice. Counsel for the respondent accepted that Mr Roberts impressed as a thoughtful witness and that contrasted with his actions and conduct dealt with by the Tribunal in 2007. He exhibited insight regarding the causes of his previous conduct while accepting responsibility for that conduct and appeared to be remorseful .While these matters were of real significance in an application of this nature it was emphasised that there could be no consent orders under the statutory regime and that the Tribunal must satisfy itself that the applicant was now a fit and proper person to be held out to the public as a registered medical practitioner capable of performing the onerous duties and functions of that position. It was the respondent's submission that if the Tribunal concluded that Mr Roberts could be reinstated there would need to be extensive conditions imposed upon him. From the outset of the proceedings Mr Roberts had emphasised his acceptance of any conditions thought appropriate by the Tribunal and that was confirmed during the course of the proceedings. At the conclusion of the hearing the parties were able to produce a document that reflected terms of conditions that would be appropriate to impose upon Mr Roberts if he was reinstated to the register. The document setting out these matters was divided into 15 practice conditions and nine health conditions. Counsel for Mr Roberts raised no objections to the 15 practice conditions but objected to 2 health conditions relating to abstinence from the consumption of alcohol and a proposal for testing twice weekly to detect if alcohol had been consumed by Mr Roberts.
Having regard to the nature of the conduct found by the previous Tribunal in the 2007 decision, this Tribunal has closely examined the evidence not only called by Mr Roberts but also on behalf of the respondent Medical Council. This case is another example of the difficulties faced by the Tribunal in being satisfied that in the seven years since being removed from the medical register Mr Roberts has fully accepted the danger he posed to patients by his theory and practices involved in implementing that theory and that he is remorseful for the harm caused and capable of being caused to patients of the practice. There needs to be clear evidence of his remorse and positive steps taken to change his attitude to the medical profession and the standards adopted and applied by the profession. Understanding the nature of the onus borne by the applicant in these proceedings, after careful consideration, the Tribunal is satisfied that the applicant is a changed person and that he is now a fit and proper person to be readmitted to the register of medical practitioners.
When the evidence of the medical practitioners is analysed it is all favourable to the applicant and supportive of his reinstatement.
Dr Blicharski spoke of his childhood health problems being a source of Mr Roberts not trusting doctors leading him to practice in isolation and under his own unsupportable theory. Dr Banning spoke of his childhood illnesses and concluded that it was little wonder that he developed deep distrust in doctors. This was the reason he was unable to seek or accept advice from his medical colleagues while practising at Redfern and had developed his own theory in isolation with a desire of rescuing addicts.
It is of real significance that the medical evidence demonstrates that Mr Roberts now understands the reasons why in the past he had acted in isolation and was unable to seek advice from other medical practitioners and further that he now had insight into his misguided treatment of addicts as a result of therapy. He was described as being unhappy and disgusted in the way he conducted himself in the Redfern practice and how he had ' lost' his way.
Dr Blicharski noted that Mr Roberts had worked for some years to correct and change his previous behaviour and attitude and was now doing very well. He believed that Mr Roberts could re-enter the medical profession although needing support initially and continuing consultation with counsellors.
Dr Banning observed that Mr Roberts had made substantial character and behaviour role changes and was in no doubt that he would be ' a very caring, conscientious and knowledgeable GP.'
Dr Heron stated that Mr Roberts had developed a high degree of insight into his conduct as a general practitioner that led to the 2007 decision of the Tribunal. He was satisfied that Mr Roberts understood that his previous prescribing habits were unacceptable and if restored to the register restrictions would be placed upon his prescribing capacity. He was aware that Mr Roberts had undertaken extensive remedial education in the fields of General Practice Prescribing and Mental Health Sciences. Overall he believed he was fit to return to practising medicine as a general practitioner.
Dr Abouyanni concluded that he was certain that Mr Roberts would be an asset to the medical community if registration was granted by the Tribunal and had not the slightest hesitation in so recommending.
None of the views expressed by the doctors referred to above were called into question by Dr Wright who was specifically asked to identify aspects of those reports with which he did not agree. The significance of Dr Wright's report is that it stands outside of those who have formed a relationship with Mr Roberts and represents a professionally detached and independent opinion.
Dr Wright was satisfied that Mr Roberts had clear insight into his inappropriate conduct and his own personal vulnerability and continued to address those issues. He was remorseful and was aware of the impact his conduct had on patients. Previously he had psychiatric problems that affected his judgement to act in the best interest of his patients but was addressing these vulnerabilities through psychotherapy and was not now as vulnerable. As earlier summarised Dr Wright was in broad agreement with the opinions expressed in the reports of Drs Blicharski, Banning and Heron and had no other matters of relevance to raise regarding whether Mr Roberts was a fit and proper person to be registered as a medical practitioner. Dr Wright emphasised the need for continuing psychotherapy and suggested other possible conditions and those matters became the focus of some discussion between the parties and the Tribunal during the course of the proceedings.
Dr Wright also observed that through psychotherapy (firstly with Dr Blicharski and more recently with Dr Banning) possibly for the first time Mr Roberts had addressed his own psychological conflicts and vulnerabilities ' which most certainly contributed to his professional misconduct'. He then expressed the opinion that Mr Roberts did suffer an impairment and required ongoing psychotherapy to address that impairment and to help ensure that he did not return to a state of mind that contributed to his professional misconduct.
Dr Wright was asked to expand on that comment during the course of his evidence. It is apparent to the Tribunal that the impairment referred to by Dr Wright is the impact of the developmental vulnerability on his personality functions and hence his decision making in medical practice in the past. When Mr Roberts returns to medical practice it will be necessary to monitor and assess whether this vulnerability has resolved so as to no longer affect or impair his medical judgements and decisions.
This consensus arising from the medical reports satisfies the Tribunal that while Mr Roberts is now a fit and proper person to be readmitted to the register as a medical practitioner there are a number of conditions that should be imposed in order to adequately protect the community.
After discussion with the parties and on further consideration by the Tribunal the 15 practice conditions proposed by the parties (as amended in discussions with the Tribunal) are accepted as providing a suitable framework under which Mr Roberts may resume practice.
Counsel for the Medical Council sought nine health conditions to be satisfied by Mr Roberts in order to return to practice.
After discussion the Tribunal accepts the appropriateness of the first seven health conditions. The two remaining conditions sought an obligation that Mr Roberts abstain from the consumption of alcohol and attend for twice weekly testing for the presence of alcohol with the results to be forwarded to a Council appointed practitioner, treating practitioners and the Medical Council. The Tribunal is unable to accept the necessity for such stringent and invasive conditions. There was nothing in the evidence or the opinion of the medical practitioners whose reports have been tendered in the proceedings to suggest at any relevant time Mr Roberts had or has now a problem with alcohol and in particular there is nothing to suggest that alcohol played a role in his conduct occurring in the Redfern practice during the period considered by the Tribunal in the 2007 decision. If the consumption of alcohol arises as a potential problem affecting his practice of medicine in the future, it appears to the Tribunal that the strict scheme of the conditions requiring frequent review, monitoring, discussion with colleagues and reporting to the Council will disclose such potential difficulty and permits appropriate action to be taken if necessary. In these circumstances the Tribunal does not propose to endorse any health conditions regarding abstinence from the consumption of alcohol or testing for its presence.
In written submissions received after the hearing, the respondent Medical Council sought an order for Mr Roberts to pay its costs of the proceedings. In support of that order the Medical Council pointed out that it had been joined as a party to the application filed by Mr Roberts in order for there to be a contradictor capable of testing the evidence for re-registration. In this role the Council had incurred costs in obtaining an independent psychiatric report from Dr Wright.
The Medical Council drew attention to previous decisions on costs, noting that different views had been taken over a period of time. It was accepted that the costs' provisions governing the application were expressed in broad discretionary terms. It was not suggested that a contradictor was always entitled to costs in re-registration applications. Mr Roberts did not file any submission on the issue of costs.
The jurisdiction to award costs in applications similar to this were considered recently in some detail by the Tribunal in Donnelly v Health Care Complaints Commission [2014] NSWCATOD 155. The Tribunal identified three possible approaches to the question of costs including the compensatory principle whereby the successful party would be awarded costs. The Tribunal, however, observed that this approach may not always be appropriate in re-registration cases. Ultimately the Tribunal decided that neither party had conducted themselves in the proceedings such as to warrant a reduction in any costs ordered in their favour - to award costs to one of the participants would be either to favour the compensatory principle over acknowledging the fact that costs are involved in acting as a contradictor or vice versa. No basis had been established for adopting either option and so no order was made regarding costs resulting in each party paying their own costs.
In the present case the report of Dr Wright did not call into question any of the medical opinions tended on behalf of Mr Roberts. Counsel for the Medical Council acknowledged that Mr Roberts had taken time before applying for registration and had taken steps to keep himself up-to-date with medical practice. He had shown remorse. It was only the absence of a provision permitting the respondent to consent to the application for re-registration that prevented that course being adopted. In a formal sense the application was not opposed. Having regard to the discussion in Donnelly and the particular circumstances of this case the Tribunal is satisfied that no costs order should be made with both parties therefore bearing their own costs.
[3]
ORDERS
Mr Roberts application under s163 A of the Health Practitioner Regulation National Law for re-instatement to the Registrar of Medical Practitioners is granted, subject to following conditions:
PRACTICE CONDITIONS
1. To obtain Medical Council of NSW approval prior to commencing or changing the nature or place of his practice.
2. To practise only in a group practice approved by the Medical Council of NSW where there are at least three practitioners (excluding the subject practitioner):
1. Where the patients and patient records are shared between the medical practitioners
2. Where there is always one other registered medical practitioner on site at the time the practitioners working there.
1. To practise no more than 25 hours per week.
2. Not to participate in any home visits, offsite consultations or on- call rosters.
3. To treat no more than 15 patients in any one day.
4. Not to possess, supply, administer or prescribe any ' drug of addiction' (Schedule 8 drug) as defined by Poisons and Therapeutic Goods Act 1966 (NSW).
5. Not to possess, supply, administer or prescribe any substance listed in Schedule 4 Appendix D of the Poisons and Therapeutic Goods Regulation 2008 (NSW).
6. To forward evidence to the Medical Council of NSW within 14 days of commencing in an approved practice that he has provided a copy of these practice conditions to:
1. the medical director, and/or
2. the director of clinical services, and/or
3. the principle of practice, and/or
4. the supervisor, and/or
5. the responsible senior officer,
in any place that he works( including any local agencies and hospitals).
1. To authorise and consent to any exchange of information between the Medical Council of NSW, Medicare Australia and Pharmaceutical Services for the purpose of monitoring compliance with these conditions.
2. To authorise the Medical Council of NSW to notify current and future persons or organisations at places where he works as a medical practitioner in Australia, of any issues arising in relation to compliance with these conditions.
3. To practice under category B supervision in accordance with the Medical Council of NSW's Compliance Policy - Supervision ( as varied from time to time) and as subsequently determined by the appropriate review body.
4. Not to practice until the supervisor has been approved by the Medical Council of NSW.
5. Each fortnightly meeting with the approved supervisor is to last at least one hour during which the practitioner is to review and discuss his practice with his approved supervisor with particular focus on: clinical performance; medical record reviews; appropriate prescribing practices; patient follow-up; and clinical outcomes.
6. To authorise the medical Council of NSW to provide proposed and approved supervisors with a copy of any relevant decisions.
7. The Medical Council is the appropriate review body for the purposes of Part 8, Division 8 of the Health Practitioner Regulation National Law (NSW).
Note:
Sections 125 to 127 of the Health Practitioner Regulation National Law are to apply whilst the practitioner's principal place of practice is anywhere in Australia other than in New South Wales, so that a review of these conditions can be conducted by the Medical Board of Australia.
[4]
HEALTH CONDITIONS:
1. That the extent of all his professional medical duties is to be guided by his/her health status and the advice of his treating & Council Appointed Practitioners.
2. To attend a Review Interview at the Council in three months or as otherwise directed by the Council.
3. To attend for review by the Council Appointed Psychiatrist on a three monthly basis or as otherwise directed by the Council, at the Council's expense.
4. To authorise the Council to forward copies of this Decision and any subsequent Council Review interview or other reports and any other information relevant to his health and treatment, to the Council Appointed Practitioners and to his treating practitioners.
5. To attend for treatment by a general practitioner of his choice, at a frequency to be determined by the practitioner and the treating practitioner. To authorise the treating practitioner to inform the Council of failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change).
6. To attend for treatment by a psychiatrist of his choice, at a frequency to be determined by the treating psychiatrist. To authorise the treating psychiatrist to inform the Council of failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change).
7. To continue taking any medication prescribed by his treating practitioner/s.
2. No order as to costs.
I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales.
Registrar
[5]
Amendments
22 April 2015 - Coversheet - Title error
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Decision last updated: 22 April 2015