Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Liprini [2020] NSWCATOD 94 Hearing dates: 18 March 2020 Date of orders: 25 August 2020 Decision date: 25 August 2020 Jurisdiction: Occupational Division Before: Le Poer Trench ADCJ, Principal Member Dr R Batey, Senior Member Dr K Keenan, Senior Member R Kusuma, General Member Decision: (1) The registration of Allan Stephen Liprini, as a medical practitioner, is cancelled. (2) Allan Stephen Liprini is not able to apply for a review of this cancellation until after 15 February 2021. (3) If either party seeks a costs order, submissions in support of same is to be filed and served within 21 days from the date hereof. (4) Any response to a submission seeking a costs order is to be filed and served within a further 14 days of receipt of such a submission. Catchwords: PROFESSIONS AND TRADES – health care professionals – medical practitioners – disciplinary proceedings. Legislation Cited: Health Practitioner Regulation National Law (NSW) No 86a Civil and Administrative Tribunal Act 2013 (NSW) Cases Cited: Chen v Health Care Complaints Commission [2017] NSWCA 186 Grant v HCCC [2003] NSWCA 73 Health Care Complaints Commission v Do [2014] NSWCA 307 Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 Qasim v Health Care Complaints Commission [2015] NSWCA 282 Category: Principal judgment Parties: Health Care Complaints Commission (Applicant) Allan Stephen Liprini (Respondent) Representation: Counsel: D New (Applicant) Dr Liprini (self-represented) Solicitors: Health Care Complaints Commission (Applicant) File Number(s): 2019/00171207 Publication restriction: Nil REASONS FOR DECISION BACKGROUND 1. The Health Care Complaints Commission (HCCC) is the applicant and it moves on an Amended Complaint filed 28 February 2020. 2. The document filed by the HCCC on 28 February 2020 contains three separate complaints. 3. Complaint One alleges Dr Liprini has an impairment within the meaning of section 5 the Health Practitioner Regulation National Law (NSW) (the National Law), being a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the practitioner's capacity to practise the profession of medicine. 4. As a background to all the complaints made by the HCCC, the following is set out in the complaint document: 1. "In 1979, the practitioner's Schedule 8 Authority to prescribe, be in possession of and supply drugs, was withdrawn due to abuse of pethidine. 2. In 1983, the practitioner ceased to be registered and on 29th March 1985, he sought re-registration during which process he advised that he had been under the care of a psychiatrist in recent years for alcohol and drug dependence. 3. On 9 May 1985, the NSW Medical Board (the Board) declined the application for re-registration. 4. On 5 February 1986, the Board restored the practitioner's registration with the former restrictions on his Schedule 8 authority and he was required to be assessed by a psychiatrist every three months. 5. In September 1988, the Department of Health restored the practitioners Schedule 8 Authority subject to some conditions. 6. In 1991, the practitioners Schedule 8 Authority was again withdrawn after an investigation found out that he had breached a condition placed on his registration. 7. Between 1993 and 1999, the practitioner was assessed regularly by a psychiatrist appointed by the Board. 8. In May and July 2015, the practitioner contacted the Medical Council of New South Wales ("the Council") and it requested reinstatement of his Schedule 8 authority. 9. In August 2015, the Council held proceedings pursuant to section 150 of the National Law and conditions were imposed on the practitioner's registration including that he attend an assessment by a Council Appointed Psychiatrist ("CAP") and was referred to an Impaired Registrants Panel. 10. The CAP Assessment was conducted in November 2015. At the Impaired Registrants Panel convened on 10 December 2015, recommendations were made to impose practice and health conditions on the practitioner's registration. The practitioner refused to agree with the conditions being imposed and the Council held section 150 proceedings on 18 December 2015 and suspended his registration. 11. On 1 May 2017, the practitioner made an application pursuant to section 150A of the National Law for review of the Council's decision to suspend his registration, which on 14 June 2017 was refused." 1. The HCCC relied on three items of Particulars for Complaint One. Those three are as follows: 1. The practitioner suffers from features of Paranoid Personality Disorder. 2. The practitioner suffers from Schizophrenia Spectrum Disorder. 3. The practitioner suffers from possible Post Traumatic Stress Disorder. 1. Complaint Two is stated to be that Dr. Liprini "is not competent to practise in the profession of medicine under section 139 of the National Law as the practitioner does not have sufficient physical and/or mental capacity to practise the profession". 2. The Particulars of Complaint Two are as follows: "The practitioner suffers from an impairment as particularised in Complaint One, Particulars 1, 2 and 3." 1. Complaint Three is stated to be that Dr. Liprini is guilty of unsatisfactory professional conduct under section 139B(1)(a) and/or (l) of the National Law in that the practitioner has engaged in: 1. Conduct that demonstrates the knowledge, skill or judgement possessed, or care exercised, by the practitioner in the practice of medicine is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or 2. Engaged in improper or unethical conduct relating to the practice or purported practice of medicine. 1. The Particular relied upon for Complaint Three, is as follows: "Between 2012 and August 2015, the practitioner self-prescribed the following medications contrary to the NSW Medical Council Policy, Medical Practitioners treating relatives and Self and Part 3.14 of the Medical Board of Australia's Code of Conduct." 1. There are then listed 16 drugs/medications. The list includes the following: 1. Metaclopromide Hydrochloride 10mg 2. Cephalexin 500mg 3. Esomeprazole 20mg and 40mg 4. Esomeprazole Magnesium Trihydrate 20mg and 40mg. 5. Telmisartan 80mg 6. Metformin 1 g 7. Chloramphenicol 8. Atorvastatin 80mg 9. Glucose Indicator strips 10. Gliclazide 30mg 11. Dutasteride and Tamsulosin 500mcg and 400mcg 12. Meloxicam 7.5mg 13. Tramadol 100mg and 200mg 14. Prednisone 5mg 15. Dapagliflozen 10mg 16. Empagliflozin 25mg. 1. The respondent, Dr. Liprini, filed a "Reply to Application for Disciplinary findings" (the "Reply") on 13 February 2020. He filed a further document on 13 March 2020 which repeated the Reply document and then added a further document titled "Amended Response Added 13 March 2020". 2. In the Reply document, Dr. Liprini set out the following: "The respondent objects to the jurisdiction of the Tribunal to hear and determine Complaint One Particular 1. The respondent objects to the jurisdiction of the Tribunal to hear and determine Complaint Two Particular 1." 1. Under the heading "Grounds for objection to jurisdiction as above are", the respondent stated as follows: "absence of corroborating evidence of delusional disorder necessary for the diagnosis because. Reference to the origin of suggested necessary evidence was referred to on three occasions contained in "Reasons for Decision letter" sent by NSW Medical Council following initial section 150 meeting held on 31 August 2015 was derived from a list of failed legal proceedings contested by respondent who alleges the decisions had been fraudulently obtained by and older brother and multiple legal professionals wherein for the entirety of the list of proceedings there is no mention of the respondent's practice of medicine." Moreover, the contested list of wholly legal proceedings that have been interrupted are you to be dealt with as criminal Proceedings involving indictable crimes." 1. In relation to Complaint Three, the respondent denies that the description of the conduct claimed by the applicant justifies any disciplinary finding. The grounds relied upon by the respondent are set out as follows: 1. A detailed explanation of personal circumstances responsible for the necessity to self-prescribe therapeutic medications and; 2. The description of the benign context in which the respondent originally albeit unsuccessfully attempted to seek advice from the NSW Medical Council in 2015 in regard to the respondents Prisco for shared patients in new employment at local Medical Centre. 3. The respondent requests consideration for orders to negotiate settlement I'll dispute as outlined in both applications for review of my medical suspension that were ignored. ADDENDUM 1. Request for the tribunal to allow an extension of time for filing this response because a blank "Reply…" did not accompany the application. The accompanying medical certificate provides some explanation of my current difficult medical circumstances." 1. Dr. Liprini did not at the hearing press for or raise the necessity for any adjournment or for any extra time to file any document. 2. In any event, Dr. Liprini did file another document which added to the first Reply he had filed on 13 February 2020. In that document he added a further document which follows on from what was appended to his first Reply document. 3. In the first Reply document there is a document attached to the Reply which is headed "Summary of Evidence in Support of Grounds to Dispute Application File No. 2019/171207". He thereafter sets out his summary of evidence. 4. Attached to the Amended Reply document filed 13 March 2020, is attached a document titled "Summary of Evidence in Support of Response to Amended Application file No 2019/171207 That disputes Amended Complaints One and Two." Thereafter he sets out his summary of argument. 5. We will return to consider the "Summary of Evidence" documents and the balance of the evidence relied upon by Dr. Liprini after we have set out the evidence relied upon by the HCCC. 6. In relation to the complaints numbered one and two, impairment and competency, the HCCC relies on the report provided by Dr Anthony Samuels. 7. There is no challenge to the qualification of Dr Samuels as an expert in this matter. Expert evidence of Dr Samuels 1. The report of Dr Samuels was based upon an interview with Dr Liprini, on 18 February 2020. The brief to Dr Samuels to provide the report is contained in a letter from the HCCC to him dated 7 February 2020. All of the documents provided to Dr Samuels have now been included in the evidence contained in exhibit A1. 2. In the interview which took place between Dr Samuels and the respondent on 18 February 2020, the respondent provided Dr Samuels with some documents which have not been attached to Dr Samuels' report. No objection is taken to that omission. Dr Samuels listed the documents provided by the respondent as "including some letters he had written to his daughters about the family history of alcohol abuse and I declined to take those but I did accept from him: 1. A brief chronology from October 2004 to the present, in which he outlines the conflict with his brother and legal issues. 2. A brief overview of his curriculum vitae from his graduation in 1973 to working in Basin View General Practice in 2014." 3. Dr Samuels noted in his report that the respondent had given him verbal and written permission for a psychiatric report to be provided to the Health Care Complaints Commission. 4. Dr Samuels set out his opinion in his report. We noted the following from that section of his report. * "On mental status examination, Dr Liprini was dressed in a suit and tie, his hair was quite long and dyed. He was pleasant and cooperative. There was no evidence of thought disorder. He did not express any frank delusional ideas. He did vigorously defend his knowledge and expertise in the area of quantum physics, despite having had no formal education in the area." * "Dr Liprini indicated that part of the problems that he had at the hearing in 2015 related to the fact that he had naphthalene poisoning (this is his own diagnosis and has not been substantiated). He continues to feel that he is affected by this toxicity. He remains quite litigious, focused on seeking legal solutions to his problems although indicating he has no faith in the legal system. He presents with a slight grandiosity, indicating that the medical Council have 'jurisdictional issues' that he would be 'asking NCAT to authorise out of court settlement'. He does not feel there is any need for conditions on his registration and he is adamant that he is not deluded." * "In terms of having psychological symptoms, Dr Liprini does have some features suggestive of Post Traumatic Stress Disorder" (PTSD). * "At this point, I do not find clear evidence of a frank psychotic process. There are, however, strong suggestions from the material I have reviewed, particularly the reports of Dr Pulley, and Dr Smith, that at times Dr Liprini has been frankly psychotic and certainly when he is under stress and particularly involved in litigation, it seems likely that psychotic symptoms become more apparent and this may have been a factor in his been declared a vexatious litigant, although I have limited information in this regard. I certainly think it is likely that Dr Liprini has some features of schizophrenia spectrum type disorder but at this point I am not in a position to give a definitive opinion as to whether or not he has some form of paranoid schizophrenia or indeed does have a delusional disorder." * "I do think Dr Liprini has features of paranoid personality disorder in that he certainly has a pervasive distrust and suspiciousness of others; he does seem to suspect without sufficient basis that others are exploiting, harming or deceiving him; he seems to read hidden demeaning or threatening meanings into benign remarks or events; he seems to be preoccupied with unjustified doubts about the loyalty of friends and associates; he does seem to bear grudges. It is uncertain whether he has had recurrent suspicions, without justification, regarding the fidelity of a spouse or sexual partner but he certainly has history of quite difficult relationships that he was unable to sustain." 1. Dr Samuels was asked to answer the following question raised by the HCCC. "Your opinion as to whether Dr Liprini currently suffers from impairment within the meaning of section 5 of the National Law and, if so, the nature of any such impairment?" In response to that question, Dr Samuels provided the following opinion: "It is my view that Dr Liprini suffers from an impairment within the meaning of section 5 of the National Law in that he may be suffering from a Schizophrenia Spectrum Disorder which is not overly apparent at the present time but there are historical pointers towards. He is manifesting some current features of Paranoid Personality Disorder and possibly Post Traumatic Stress Disorder. At this point, Dr Liprini's problems of opioid and alcohol abuse do appear to be in remission. It is my view that these impairments have the potential to impact upon his professional practice, interactions with others and particularly regulatory bodies". 1. Dr Samuels was asked to provide his opinion as to whether Dr Liprini is currently competent to practise the profession of medicine under section 139 of the National Law. He responded with the following, in part: "I do have some concerns about Dr Liprini's current competence to practise medicine even with conditions. He remains preoccupied with litigation, he continues to have an adversarial stance towards the Medical Council and the HCCC. He appears to have very little insight into the possibility that he is suffering from some form of mental illness, and he really is unwilling to engage in treatment with psychiatrist or to take medication"…. "He makes comments on the background of the belief that the justice system is corrupt; that there are conspiracies within it and he is suffering from 'legal abuse syndrome'". …" there are also significant recency of practice issues: Dr Liprini has not practised since around late 2014 although he said he is up-to-date with CPD". 1. Dr Samuels was asked: "if applicable, your opinion as to any conditions you consider should be applied to Dr Liprini's registration as a medical practitioner?" Dr Samuels provided the following answer: "In the first instance he needs to engage with a psychiatrist and psychologist, follow their treatment advice and direction and if they feel after an appropriate period of treatment and engagement he has reached the point that he is fit to return to some form of medical practice, he should be reviewed again by a CAP. At that stage, if he is willing to continue with treatment and accepting the need for some conditions on his registration, consideration could then be given to him returning to some form of medical practice. However, recency of practice issues will also need some consideration at that time." 1. Dr Samuels gave oral evidence. He confirmed that he had provided a report dated 18 February 2020 and that the contents of same were true and correct. He confirmed his opinion that Dr Liprini has paranoid personality disorder. He said it was very likely Dr Liprini has a vulnerability to psychotic illness. There is a probability that he has Post Traumatic Stress Disorder because of abuse by a brother. He is delusional about abuse by courts. 2. Dr Samuels was asked how the disorder diagnosed as Paranoid Personality Disorder may be manifested in Dr Liprini. He said he could be mistrustful of others, see conspiracies, present as grandiose and voice his persecutory beliefs. 3. The HCCC submission in relation to Complaint One, the impairment claim, relies principally upon the evidence of Dr Samuels. It submits that the evidence from Dr Samuels will satisfy the Tribunal that the way in which Dr Liprini's mental health is likely to manifest itself, should he be practising medicine, is likely, as a matter of logic, to detrimentally affect his ability to practise: including his ability to openly trust his patients, communicate with them and thereby treat them. 4. The HCCC referred the Tribunal to section 139 of the National Law which defines when a person is competent to practise as a health professional. The section provides as follows: "139. Competence to practice health profession [NSW] A person is competent to practice a health profession only if the person- (a) Has sufficient physical capacity, mental capacity, knowledge and skill to practice the profession; and (b) Has sufficient communication skills for the practice of the profession, including an adequate command of the English language." 1. The HCCC submits that: "A Paranoid Personality Disorder, possible PTSD and schizophrenia spectrum type disorder (In times of stress or litigation) are impairments that the Tribunal can find affect the respondent's mental capacity to practice and his communication skills. These diagnoses have the potential: (a) To affect the respondent's judgement with his patients; (b) To distract him during times that clinical expertise is required; (c) To potentially distrust a patient (without foundation) and find conspiracy in an ordinary event; and (d) To affect his ability to communicate with his patients. The corollary being that the respondent cannot properly treat and care for his patients". 1. The HCCC submits that the respondent's registration history is relevant to a finding as to whether the respondent is competent to practise medicine. 2. We note from the history set out by the Medical Council of NSW, in its written reasons dated 9 October 2015, (Tab 9 of exhibit A1) (The section 150 Decision) and the Chronology prepared for 14 June 2017 in relation to Dr Liprini (Tab 8 exhibit A1), the following relevant history: * Dr Liprini is 71 years of age. * He obtained a Bachelor of Medicine/ Bachelor of Surgery (Sydney). * On 7 May 1973 Dr Liprini was first registered in NSW. * In January 1979 Dr Liprini's Authority to prescribe, be in possession of and supply drugs of addiction (S8 drugs) is withdrawn. * On 1 October 1983, Dr Liprini's name was removed from the Register. * 9 May 1985, the Medical Board of NSW declined the application by Dr Liprini for re-registration and advised Dr Liprini it would be happy to re-consider the application once he had shown signs of a sustained cure. * On 5 February 1986, the NSW Medical Board restored Dr Liprini to the Register, noting that his S8 authority remained withdrawn and that he should be re-assessed by a psychiatrist at three monthly intervals. * In June 1988, Dr Liprini made an application for the restoration of his prescribing authority. That authority was restored in September 1988 subject to conditions. * On 18 April 1991, the Department of Health withdrew Dr Liprini's S8 authority. * On 3 November 1993, Dr Liprini attended a NSW Medical Board Assessment interview and entered into undertakings. * In November 1994, Dr Liprini entered into further undertakings with the NSW Medical Board. * In January 1995, Dr Liprini's S8 authority is restored in a limited manner. * In September 1996, Dr Liprini again attends a Board Review Interview and agrees to continue his previous undertakings. * In October 1999, Dr Liprini attended a Board Review Interview. The reviewers recommend that Dr Liprini exit from the Health Program. * On 16 November 1999, Dr Liprini is restored to unconditional registration. The Board recommended to him that he not apply for restoration of his S8 authority. * On 31 August 2015, the Health Committee resolved to convene a section 150 proceedings which Dr Liprini attended before on 31 August 2015. Health conditions were imposed. * Pursuant to conditions imposed in the section 150 decision, Dr Liprini attended Council-appointed psychiatrist, Dr Glen Smith. * On 10 December 2015, Dr Liprini was required to attend before an Impaired Registrants Panel. * On 18 December 2015, section 150 proceedings were conducted, the outcome of which was that Dr Liprini's registration was suspended. * In May 2017, Dr Liprini lodged an application with the Medical Council of NSW for a review of the suspension under section 150A. * On 14 June 2017, section 150A proceedings were conducted. 1. The evidence contained in the Evidentiary Certificate dated 11 March 2020 from the Australian Health Practitioner Regulation Agency ("AHPRA"), sets out the registration history for Dr Liprini. It includes the following: Registered from 1 July 2010 until 18 December 2015 (General) (Including a period of suspension); Suspended from 18 December 2015 to current (General and Specialist). The document also recites that Dr. Liprini has been subject to conditions between 1 September 2015 and 18 December 2015. The conditions were: 1. To attend for assessment and review by the Council-Appointed psychiatrist as directed by the Council, at the Council's expense. 2. 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 his health status (including a significant temporary change). 1. The decision of the Medical Council of NSW was published on 5 July 2017. The decision affirmed the section 150 decision which had been the subject of an application to review by Dr Liprini. The reason for the hearing was explained in the first paragraph of the judgement as follows: "On 18 December 2016, delegates of the Council decided to suspend Dr Liprini's registration following proceedings held pursuant to section 150 of the National Law. The matter arose because Dr Liprini refused to consent to conditions being imposed following an Impaired Registrants Panel held on 10 December 2015. In making the decision to suspend Dr Liprini's registration, the delegates placed great weight on Dr Smith's psychiatric assessment and his finding that Dr Liprini suffers from an impairment under the National Law." 1. The HCCC referred in submission to the oral evidence of Dr Samuels. It relied upon the response by Dr Samuels to the question: How could the diagnosis of Paranoid Personality Disorder manifest itself in Dr. Liprini's observable behaviour? Dr Samuels said the following are facets of the disorder in Dr. Liprini: * He is mistrustful of others; * He believes they are trying to do him harm or deceive him; * He reads things into things; * He has doubts about loyalty of people; * He bears grudges; * He has had quite difficult relationships with people over time; * He could not engage with his treating psychiatrist Dr Pulley; * He believed Dr Pulley was an agent of the Medical Council; * He is isolated from people living in a remote location; * He is pervasively suspicious; * He is somewhat grandiose; * He continues to have some slightly unusual belief that he is suffering from naphthalene poisoning. That is self-diagnosed and not substantiated by medical evidence; * He doesn't believe he has a mental illness; * He doesn't believe he has any practice issues; * He believes he is ready to go back to work; * He is quite dismissive of official bodies; * He has an underlying persecution belief; * He believes that there was a conspiracy between his brother and the courts. 1. Dr Samuels was asked if there would be any triggers which might cause the re-emergence of the schizophrenic spectrum disorder, which Dr Samuels had opined, was probably an underlying condition for Dr. Liprini. 2. Dr Samuels opined that any form of stress or conflict with bodies such as the Medical Council or relationship issues or financial stress could cause an escalation in his condition to a point where he became quite psychotic with the delusional ideas. Dr Samuels said, given the history of substance abuse, then the use of alcohol and/or non-prescribed drugs, could destabilise his mental state. 3. Dr Samuels was asked about the possibility of organic impact upon Dr. Liprini's mental state. He said he considered that Dr. Liprini was cognitively quite sharp. He considered it unlikely that his condition was connected to any organic degeneration. 4. Dr Samuels was asked whether the paranoid personality disorder would have the ability to pervade the manner in which Dr. Liprini would practise as a medical practitioner. He said: "Absolutely. The problem is if you think your patients or colleagues may be trying to harm you, or are a plant of the Medical Council, it can impact upon your ability to form a therapeutic relationship with your patients". He also opined Dr. Liprini has some, frankly unusual ideas. If he is involved in any form of confrontation, Dr Samuels opined he would lose the ability to engage with patients and colleagues. This could translate into treatment of patients which is not evidence based. 5. Dr Samuels explained that people with Paranoid Personality Disorder are very difficult to treat because not only do they not believe there is anything wrong with them but also they don't trust anybody. 6. Dr Samuels was told that the HCCC was alleging that Dr. Liprini has self-prescribed medication. Dr Samuels was asked whether, assuming that was established, he saw any connection between the diagnosis of Paranoid Personality Disorder and the self-prescribing conduct of Dr. Liprini. Dr Samuels said that he did see a link, namely, that Dr. Liprini considers he is right and everyone else is wrong. Further he thought that Dr. Liprini would at times not believe that the conditions imposed on him by the Medical Council or others actually apply to him. He noted that Dr. Liprini had refused to sign conditions on the last hearing because the Medical Council would not read his affidavit. He said Dr. Liprini is quite grandiose and that he has a sense that he is in control and that people should comply with his wishes and demands. In a meeting with Dr. Liprini, Dr Samuels said that he had been told by Dr. Liprini that he was proposing to have some form of mediation with the Tribunal. 7. Dr Samuels said the problem with a person such as Dr. Liprini is that although the Tribunal might impose conditions on him, there will be times when Dr Liprini thinks that he doesn't need to comply with the conditions. 8. Dr Samuels opined that there may be innocent reasons why Dr. Liprini self-prescribed however it may also be part of the condition that led him to behave in that manner. 9. In relation to PTSD, Dr Samuels was asked what the triggers might be for that condition to re-emerge and how would it be manifested in the observable behaviour of Dr. Liprini. Dr Samuels opined that if he assumed the information provided by Dr. Liprini about the abusive nature of his brother were correct then any incident that reminded Dr. Liprini of his brother or the conflict with his brother or conflict of any nature are all things which could trigger memories of the past abuse. That could lead to a recurrence of the PTSD and all the incidents of illness that can accompany such a condition. 10. Dr Samuels also warned that there was a well-known link between PTSD and substance abuse. People with that disorder self-medicate and that may in part be an explanation for his alcohol use or even opioid abuse in the past. 11. In relation to Dr. Liprini's stated position that he would appeal to a higher court if he was unsuccessful in the Tribunal hearing, Dr Samuels said such a position was in keeping with Paranoid Personality Disorder, i.e. that he would continue up the ladder of courts in an endeavour to have the decision he did not like overturned. The other aspect is the grandiosity where a person with Paranoid Personality Disorder simply does not accept that what has been determined applies to them. 12. Dr Samuels was asked: "If he was required to engage with a psychiatrist, what amount of time should he be required to engage with the psychiatrist before there could be consideration of whether he should be permitted to practise again?" Dr Samuels opined that there are a lot of impediments to him engaging with a psychiatrist. He thought it would take a long time for Dr. Liprini to accept he did need help and then it would take a long time for him to form a trusting relationship with somebody, and although he might be able to say all the right things to the psychiatrist in order to have the psychiatrist sign off on the fact he was OK to work, it would take 12 to 15 months of engaging with him before you had any sense of how well or unwell he was let alone whether he would be fit to practise, and then there would need to be an independent review at that point of time as to what type of safety nets should be in place if he was to return to work. 13. Part of the evidence relied upon by the HCCC, was a report by Dr Glen Smith, psychiatrist. The report is dated 5 June 2017 and is one of the documents which was provided to Dr Samuels. Dr Samuels referred to the report, in passing, and relied upon it to provide historical evidence of the mental health of Dr. Liprini. Dr Glen Smith was not called to provide oral evidence in the hearing. Dr Smith saw Dr. Liprini for the purpose of preparing the report on 5 June 2017. It is relevant to note the following as historical background to the assessment of health contained in the evidence of Dr Samuels, referred to in this decision. 14. In the report, Dr Samuels sets out information provided to him by the respondent under the following headings: "psychological history, developmental history, education/employment history, medical history, psychiatric history, family history, current treatment, drug and alcohol history, forensic history and current situation". In order to understand what Dr Samuels has referred to when he speaks of the reports of Dr Smith, we will set out some of that evidence which we understand Dr Samuels drew upon for support, when providing his opinion. 15. Under the heading "Current Symptoms", Dr Smith stated: "Dr. Liprini stated that his mood remains and depressed (with no clear diurnal variation, "it is never good") and his sleep is "terrible" with initial insomnia off and not being able to sleep before 0200. He stated that he experiences multiple awakenings and early morning awakening. He stated that he sometimes takes naps during the day. Dr. Liprini reported poor appetite and "bad reflux". He stated that he had felt socially isolated since 2004, "with all the corruption, after my brother rang up the police and told them I had murdered my parents." 1. Under the heading "Summary and Opinion", Dr Smith reported as follows: "In my opinion, Dr. Liprini has been suffering from a significant psychotic illness before many years and since my last review in November 2015 his condition has not changed significantly. He remains preoccupied with persecutory and grandiose ideation. A brief period of psychiatric treatment did not appear to alter his condition appreciably. He did not take antipsychotic medication during that period. Despite the suspension of his medical practice over the past 18 months he had not sought to alter his predicament by adhering to conditions on his registration." … "In my opinion, Dr. Liprini suffers from impairment according to the meaning outlined in section 5 of the Health Practitioners Regulation National Law (NSW). Given that he does not display any intention to adhere to any conditions on his registration or to engage in psychiatric treatment, in my opinion, Dr. Liprini cannot be considered fit to practise medicine." Evidence of the Respondent 1. We now turn to consider the evidence of Dr. Liprini in relation to Complaints numbered One and Two. 2. Dr. Liprini filed three documents which collectively make up his Reply to Application for Disciplinary Findings. The first was filed 13 February 2020. The next titled "Amended Response Added 13/03/2020" filed 13 March 2020. The third titled "Addendum to Evidence in Support of Respondent to Amended Application 2019/171207", which was filed 16 March 2020. 3. Doing the best we can to discern the case Dr. Liprini is wishing to present, we understand his Reply to the Complaints One and Two to be captured as follows. 4. The respondent objects to the jurisdiction of the Tribunal to hear and determine Complaint One, Particular 1 and Complaint Two Particular 1. We note that the Particular 1 for Complaint One is "The practitioner suffers from features of Paranoid Personality Disorder." 5. Dr. Liprini in his Reply document then set out a heading "Grounds for objection as above are". Under that heading Dr. Liprini set out three sub-headings which, in our view do not raise jurisdictional arguments, rather they assert inadequacy of evidence to establish the complaint. The three sub-headings are as follows: 1. "Absence of corroborating evidence of delusional disorder necessary for the diagnosis because." 2. "reference to the origin of suggested necessary evidence was referred to on three occasions contained in "Reasons for Decision Letter" sent by NSW Medical Council following an initial section 150 meeting held on 31st August 2015 was derived from a list of failed legal proceedings contested by the respondent who alleges the decisions had been fraudulently obtained by an older brother and multiple legal professionals wherein for the entirety of the list of proceedings there is no mention of the respondent's practise of medicine. 3. Moreover, the contested list of wholly legal proceedings that have been interrupted are yet to be dealt with as criminal proceedings involving indictable crimes." 1. Dr Liprini thereafter sets out another heading "THE REMAINDER OF THE COMPLAINT including Complaint Three". He states "The respondent denies that the description of the conduct claimed by the applicant justifies any disciplinary finding. Grounds for denial of justification for any disciplinary finding are based on". 2. The Grounds are stated as follows: 1. A detailed explanation of personal circumstances responsible for the necessity to self-prescribe therapeutic medications and; 2. The description of the benign context in which the respondent originally albeit unsuccessfully attempted to seek advice from the NSWMC in 2015 in regard to the respondent's prescribing capacity for shared patients in new employment at a Local Medical Centre. 3. Respondent requests consideration for orders to negotiate settlement of dispute as outlined in both applications for review of my medical suspension that were ignored." 1. The respondent then set out a heading "ADDENDUM" under which the following was set out: "request for the Tribunal to allow an extension of time for filing this response because a blank Reply did not accompany the Application. The accompanying medical certificate, provide some explanation of my current difficult medical circumstances." The Respondent's summary of evidence document 1. The respondent then attached a document which is described as follows: "SUMMARY OF EVIDENCE IN SUPPORT OF GROUNDS TO DISPUTE APPLICATION File No. 2019/171207." 2. Under the heading "jurisdictional error", the respondent set out the following: "Construction of a diagnosis wrongly based on an assumption that fraud allegations are outside the box of common convention. That assumption was segued from a wholly legal domain and different jurisdiction about matters that are yet to be properly tested in intended future proceedings." 1. At first glance the above ground appears nonsensical, however Dr Liprini provided further written support for that statement. He set out the heading "Grounds for objection to jurisdiction as above are:" then a further heading "(i) absence of corroborating evidence of delusional disorder necessary for the diagnosis because the diagnosis requires confirmation that the delusional belief is invalid." 2. The submission appears to be a reference to the earlier proceeding under s 150 before the Medical Council. In this hearing it is also possibly a reference to the evidence of Dr Samuels and the earlier evidence of Dr Smith. 3. In relation to the assertion by Dr Liprini that the diagnosis of Dr Samuels that he suffers from Paranoid Personality Disorder, or any other psychiatric or mental health illness, the following matters need to be noted: * Dr Liprini chose not to cross-examination Dr Samuels. Thus, no contrary or variant diagnosis was put by Dr Liprini to the expert evidence of Dr Samuels. * Dr Liprini called no contrary evidence to that put by Dr Samuels. 1. Returning then to grounds of objection to jurisdiction, further matters need to be noted as matters of law: * The action before the Tribunal was instituted by the HCCC as a new complaint. This is not a hearing of an appeal against any order or finding made by the Medical Council. * The focus of the Tribunal therefore, is on the evidence which has been presented in this hearing and in particular the expert evidence which has been prepared "afresh" for this hearing. What was said by the respondent, in earlier proceedings held by the Medical Council, together with correspondence and representations made by him to the Medical Council, is evidence which can carry weight, however, in the context of this hearing, that evidence, to the extent it was particularised in his report, was provided to Dr Samuels to assist in the task cast upon his professional opinion. 1. In his report, Dr Samuels noted the statement by Dr Liprini, that he "denied depersonalisation, he denied derealisation and he denied psychotic symptoms." Dr Samuels therefore knew that Dr Liprini was opposing any diagnosis of a psychiatric disorder of any kind or degree. 2. At paragraphs 79 to 81 of his report Dr Samuels said: "I asked Dr Liprini if he had considered having a lawyer to represent him and he said he did not, and he said, "nor could I trust one". I asked Dr Liprini why he thought the outcome of this hearing would be different. He said, "It's never been tested. I can go to the Supreme Court, not that that's very legitimate. The police need to settle things but it's just been wasting my time." I asked Dr Liprini if there were any other issues. He wanted to give me two letters that he had written to his daughters about alcohol in the family, which he said were quite enlightening. I indicated that I did not need them and that I had enough material. Dr Liprini said, "you only want what you want, that doesn't make you independent." I said to him again that I thought it was unlikely that he would be allowed to practise without some sort of conditions, given the background history and the length of time he has not practised. Dr Liprini said, "it depends on who and how the truth comes out, NCAT is meant to be fair but none of the other courts have been fair or honest." 1. To the submission by Dr Liprini that there is an absence of evidence to support a diagnosis of a delusional disorder, we note Dr Samuels relied upon not only his own diagnosis of Dr Liprini, as he presented to Dr Samuels, but also the diagnosis of two psychiatrists who had seen Dr Liprini in different contexts at an earlier time. Dr Glen Smith had been engaged by the Medical Council to report on the health of Dr Liprini in the circumstances of his impairment to practise medicine was under consideration. Dr Pulley was engaged by Dr Liprini as his own psychiatrist. Dr Glen Smith saw Dr Liprini in about 2014. He diagnosed Dr Liprini with a Paranoid Disorder. Dr Glen Smith saw Dr Liprini again in 2017 and at that time considered Dr Liprini had frank psychosis and that he was unfit to practise (see report Dr Samuels exhibit A2 page 11). 2. Dr Samuels reported that in about 2017, Dr Liprini also saw Dr Pulley. He also considered Dr Liprini was suffering from a psychotic illness, having seen him over a period of time. Dr Pulley opined Dr Liprini to have either a delusional disorder or paranoid schizophrenia. Dr Samuels noted that at one point Dr Liprini, under the care of Dr Pulley "did agree to take fluvoxamine but suffered side effects and stopped it". 3. In his meeting with Dr Liprini, Dr Samuels was told by Dr Liprini that he considered that Dr Glen Smith had "fabricated his report and diagnosis". He told Dr Samuels that he considered the comments of Dr Pulley "were vacuous, no substance to it. I was interested to see if the Medical Council and Health Care Complaints would pull back, they haven't." Dr Liprini told Dr Samuels that he trusted NCAT more than other judicial bodies. He also said he felt he could not trust a lawyer (to represent him). If unsuccessful before the Tribunal he would go to the Supreme Court. 4. As set out earlier, Dr Samuels formed his own diagnosis of Dr Liprini, describing it as "features of Paranoid Personality Disorder". He further opined that Dr Liprini suffered from an impairment within the meaning of section 5 of the National Law. He opined further that Dr Liprini may be suffering from Schizophrenic Spectrum Disorder and possibly PTSD. 5. We have noted the oral evidence of Dr Samuels earlier in these reasons and in particular how the diagnosis reached by Dr Samuels, might manifest itself in the interaction between Dr Liprini as a medical practitioner and a patient under his care. 6. We conclude that there is no basis, revealed by the respondent, in his challenge to the jurisdiction of this Tribunal to hear and determine the application brought by the HCCC. Consequently we find the Tribunal does have the requisite jurisdiction to hear and determine the Complaints now before it. 7. The second matter referred to in the "Summary of Evidence" document is "Inadmissible Evidence". It is difficult to understand the case Dr Liprini is pursuing under this heading. He appears to be asserting that no evidence which predates 2017 can be admissible in this hearing. He refers to section 150 (presumably of the National Law) and to section 41O (of the same legislation). In relation to each of those sections, his submission is directed to matters set out in the decision of the Medical Council published 9 October 2015. It is noted that the HCCC pursues no order under section 150 of the National Law. Again, there appears to be a fundamental misunderstanding of the nature of this hearing, in this Tribunal. We have set out the nature of the order sought by the HCCC in its application and the reference to the National Law upon which it relies. 8. As best as can be discerned from the expansion of the reasons for this ground in the document provided by Dr Liprini, at the commencement of exhibit R1, his complaint is that the specialist medical evidence relied upon by the Medical Council for its decision, imposing a suspension of Dr Liprini's registration, is that the Medical Council took into account evidence which related to, or was about, the litigation in the Supreme Court of NSW between Dr Liprini and his brother. Dr Liprini submitted that evidence was irrelevant or inadmissible in the determination which the Medical Council was required to make. Once again, what occurred in the hearing before the Medical Council, as above referred to, and the outcome, is not a matter for this Tribunal. We are to determine the application brought by the HCCC and opposed by Dr Liprini. 9. The third item set out by Dr. Liprini, in his "Summary of Evidence" document, is "Invalidation of Legal Arguments". Under this heading the following was set out: "1 & 2 above and effectively invalidate the main legal arguments provided in the application, specifically originating from the psychiatric opinions fabricated by the various psychiatric witnesses attached to or associated with the Medical Council of NSW. This also includes Dr Rafe Pulley because of his faulty report, admitted friendly association with Dr Giuffrida and his correspondence from early on with the legal offices of the MCNSW." 1. Again, the argument set out above by Dr. Liprini addresses complaints about the hearing before the Medical Council rather than the issues to be determined in this hearing. To this extent, it is asserted Dr Samuels or Dr Smith allowed their professional standing to be subverted to the influence of a person or persons unnamed, yet within the structure known as the Medical Council of NSW. There is absolutely no evidence to support such an assertion and we completely reject any such inference. 2. The next heading in the "Summary of Evidence" provided by Dr. Liprini is as follows: "Benign nature of initial inquiry as to whether there was any restriction to write S8 prescriptions." Once again this is a reference to the earlier hearing by the Medical Council and it is really a comment on how the section 150 hearing was prompted. It was an application by Dr. Liprini to have his Schedule 8 prescription writing authority restored, which he considered led to the proceedings conducted by the Medical Council. 3. The next heading in the "Summary of Evidence" is "Accuracy of psychiatric diagnosis". Dr. Liprini set out the following: "The alleged diagnosis and provisional diagnosis (Dr Smith) of delusional disorder, psychosis and other fabricated (sic) in the sick artists reports stipulated in 3 above, are all INCORRECT due to the failure to properly meet the criteria required as specified in the DSM-V." Whilst we understand that Dr Liprini denies the diagnoses made by both Dr Samuels and Dr Smith, such diagnoses are well explained and based upon each expert's knowledge and experience which is not the subject of challenge. The reference to "sick artists" leaves us perplexed. 4. Dr Liprini also set out a heading "My comments about the interview with Dr Samuels and his report." Under that heading he is critical of the earlier report of Dr Smith, however, he considered there was "a basis on first hand evidence" by Dr Samuels when he opined Dr Liprini suffered "possible PTSD". 5. Dr Liprini then addressed a possible diagnosis of Paranoid Personality Disorder, as suggested by Dr Smith in his report of November 2015. 6. Dr Liprini said in relation to the report of Dr Samuels of 18 February 2020, (exhibit A2) it was "noteworthy that he considers Paranoid Personality Disorder as unlikely". We pause here to note two things in relation to a diagnosis that Dr Liprini suffers from Paranoid Personality Disorder. Firstly, the Complaint One particulars allege "The practitioner suffers from features of Paranoid Personality Disorder" (our emphasis added). It is not the case of the HCCC that Dr Liprini suffers from Paranoid Personality Disorder. Secondly, Dr Samuels' report, exhibit A2, states precisely that his view is that Dr Liprini "is manifesting some current features of Paranoid Personality Disorder and possibly PTSD." 7. In his criticism of the report of Dr Samuels, Dr Liprini accuses him of forming his diagnosis based upon the evidence of the other psychiatrists he refers to in his report and not from his observations of Dr Liprini, which Dr Samuels recorded during interview for the preparation of the report. Again we note, such an assertion was not put to Dr Samuels when he was available for cross-examination during the hearing. 8. In relation to a possible diagnosis of a Schizophrenia Spectrum Disorder, Dr Liprini points to the content of paragraph 90 of the report of Dr Samuels, where he clearly states that upon presentation in the interview, Dr Samuels did not find clear evidence of a frank psychotic process. 9. In relation to the opinion expressed by Dr Samuels, that Dr Liprini had some manifestations of PTSD, Dr Liprini agrees he has been suffering from PTSD. Dr Liprini aligns the diagnosis of PTSD with what he called "Legal Abuse Syndrome". He said: "I officially first claimed that PTSD/Legal Abuse Syndrome was highly likely to be precisely the main diagnosis that had emerged from the associated anxiety/ depression/ adjustment disorder problems at the 14th June 2018 section 150A Review meeting, as part of changed circumstances. That was wholly dismissed without comment!" 10. Dr Liprini is critical of the evidence of Dr Rafe Pulley, which was relied upon by Dr Samuels. Dr Liprini questioned the medical notes provided by Dr Pulley, in that he claimed there were references to consultations which Dr Liprini refuted as correct. Dr Liprini did confirm that he had six consultations with Dr Pulley, at Worrigee Medical Centre. He did not accept there were nine appointments with Dr Pulley, conducted at his Macquarie Street rooms. He conceded there may have been two such consultations and he said that meant "there are four bogus appointments." 11. Under the heading "Accusations of grandiosity" Dr Liprini set out aspects of his academic life from primary school through to the completion of his degree at university. If accurately reported, which we accept it is, Dr Liprini has a very high achieving academic record. There is nothing else stated in opposition to an assertion that he displayed or may display grandiose behaviour. The underlying suggestion may be that Dr Samuels has confused high intellect demonstrated by Dr Liprini with grandiose behaviour. We do not accept any such suggestion. 12. Dr. Liprini set out another heading "Legal Abuse Syndrome-PTSD Diagnosed". Under this heading Dr. Liprini refers the Tribunal to annexure 12 which is attached to his Reply document. Annexure 12 is a copy of article written by Donna Anderson. The article is an opinion piece about the impact of sociopathic behaviour on another person. Dr. Liprini identifies with this opinion piece which in particular, points out the impact of PTSD. Dr. Liprini has highlighted particular parts of the article. In particular he has highlighted the following sentence: "The litigation against the sociopath makes your client re-experience the underlying trauma and triggers the symptoms of PTSD." 13. In reference again to the decision of the Medical Council, dated 9 October 2015, Dr. Liprini said: "the allegation that I had refused to agree to conditions being imposed on my medical registration has been extensively misreported." Dr. Liprini made that statement under a heading "Reasons for Suspension". 14. Under the heading "Complaint Three Particulars", Dr. Liprini said: "there is no evidence that my professional objectivity has been compromised. I have been consulting my own independent general practitioner for many years but it became difficult when I was forced to live on the NSW South Coast. The loss of access to my established network of medical colleagues, due to geographical dislocation meant I was living in an isolated setting which was for me an ongoing emergency situation". 1. The next document which is set out in exhibit R1 is a ten page submission with annexures numbered 1 to 16. This document expands upon the headings which had been set out earlier and contains further submissions in support of those headings. Once again to the extent the further submission addresses some complaints about the outcome of the hearing before the Medical Council, it is not addressing the matters we have to consider. We will however address the content of the ten page document to the extent that it addresses matters for determination by us. 2. Dr Liprini submits that there is no corroborating evidence of delusional disorder and therefore the diagnosis is invalid. The problem for Dr Liprini, with that submission, is that he did not put the proposition to Dr Samuels nor did he call evidence from an expert, engaged by himself, to establish the proposition he wishes to advance. We pause here to note, in case it is not understood, we do not accept that Dr Liprini can put himself forward as an expert in psychiatric medicine, for the purpose of this hearing. To the extent that he is attempting to do so, we do not accept same as he has not established, to our satisfaction, that he possesses the requisite expertise, having regard to the evidence he has provided. 3. To the extent it might be submitted the material presented under tab 4 of exhibit R1 is the equivalent of expert evidence, we would reject that submission on the basis that the material is sourced from "Wikipedia". Dr Liprini did not ask Dr Samuels to review that "Wikipedia" material and have him confirm that the content of the document was medically accurate and reliable. 4. Dr Liprini annexed to the ten page submission, two affidavits filed by him in a proceeding in the Supreme Court. He included the affidavits as part of the material in exhibit R1 (albeit in a separate folder). He is named as a party in the affidavits. The first affidavit was filed on 15 August 2014 and is 184 pages long. The second is dated 20 August 2014 and is 193 pages long. Dr Liprini said the affidavits were filed in support of his application to the Supreme Court to set aside the order which declared him a "Vexatious Litigant". He said his application to file his appeal against the making of that order was refused by a "Duty Registrar". His submission in this case, makes clear he rested great significance on these affidavits when he appeared before the Medical Council. Affidavit of the Respondent of 15 August 2014 1. The affidavit filed in the Supreme Court of NSW on 15 August 2014 provides the following evidence which we consider is potentially relevant to the determination we have to make. * As best we can discern, Dr Liprini describes a series of occurrences which seemed to overwhelm him at a time he was seeking to appeal an order of the Supreme Court of NSW. He was, at the time, a declared vexatious litigant. He was seeking to set aside a writ of possession issued from the court. That writ was to enable the taking of possession of the property owned and occupied by Dr Liprini at that time. He conceded that his application was out of time. * He considered the action, in court, by Justice Ball was dismissive of him. He asserted the decision given by Justice Ball failed to have considered the material Dr Liprini had presented. * The judgment of Ball J (8 March 2012) is annexed at page 47 of the affidavit and the judgment clearly shows Ball J did read Dr Liprini's affidavit, even though it was unsworn. Ball J determined "Dr Liprini is unable to offer any real ground for a stay of execution of the writ of possession." * The executed writ of possession saw Dr Liprini dispossessed of his home. * Dr Liprini applied to the Federal Magistrates Court (as it was then called) for an annulment of his bankruptcy. That application was listed for 29 March 2012. * Dr Liprini accuses his Bankruptcy trustee of "fraudulently advising" the Federal Magistrates Court he was insolvent at a time when Dr Liprini asserted he was not. * Dr Liprini's Bankruptcy Trustee sought an interlocutory application for Dr Liprini to be declared a vexatious litigant. * On 20 March 2012, Dr Liprini's former wife was admitted to hospital with a serious life threatening illness. He needed to be available to care for his children. He applied for an adjournment of his proceeding in the Federal Magistrates Court, on compassionate grounds. He also applied for an urgent stay to accompany the adjournment. That application was made on 23rd March 2012. * Much to his surprise, Dr Liprini found himself required to attend before the Supreme Court on Saturday, 24 March 2012 for a hearing of the application he be declared a vexatious litigant. The Supreme Court Justice who heard the application was said by Dr Liprini to be "very hostile towards me and accused me of abuse of process." * The judgment of Justice White, (24 March 2012) in the Supreme Court, states that Dr Liprini was the applicant in that court for a stay of the writ of possession issued on 8 March 2012. * The judgment of White J contains the following passage: "Dr Liprini says that he was made bankrupt as the result of criminal behaviour on the part of his brother, the solicitors who acted for him in earlier litigation, and the trustee in bankruptcy." The judgement also set out detail of earlier applications made by Dr Liprini seeking the same order and where such applications had been dismissed. * Dr Liprini said he was unable to leave his home following that decision and that caused him to not be available at hospital for his children. His former wife died on the 27 March 2012. * The application made by Dr Liprini in the Federal Magistrates Court was listed for 29 March 2019. It seems Dr Liprini was unable to attend that day as he was defending his house against an attempt to execute the writ of possession. His proceeding in that court was to be determined following receipt of evidence and submissions from the parties. One of the respondents to that application was the brother of Dr Liprini. * Dr Liprini stated: "The immediate outcome due to those orders was to force me into homelessness, destitute without food, funds, clothes or any of my possessions, making it impossible to comply with the court orders. How could that possibly reconcile with my late parents' wishes. I became very confused and disoriented on top of the accumulated emotional trauma and was unable to contact my family isolating me from them, becoming seriously ill without my normal medications and was unable to function or look after myself properly." * An order was made in the Federal Magistrates Court naming Dr Liprini as a vexatious litigant and he says that prevented him from being able to appeal his bankruptcy in the Federal Court. * In October 2012, Dr Liprini was granted a Disability Support Pension. It was not paid in full until June 2014. * Dr Liprini claims all his legal documents, computers and everything necessary to be able to prepare legal documents for court were stolen. This appears to be a reference to the execution of the Writ of Possession. * Dr Liprini asserted he had been denied an opportunity to provide a proper defence in the hearing before Justice Adamson on 1 December 2011. He asserted that Justice Adamson had refused his application (we assume for an adjournment), without any specific acknowledgement that his compromised ability and circumstances prevented him from exercising his right to be given a fair and honest opportunity to provide a defence. Dr Liprini stated: "specifically, that the deliberate loading (sic) by the other parties that interfered with, by sabotaging, my failing physical and mental ability to address the fabricated impasse of proper preparation. Tactics horribly used by psychopaths who partake in bullfights, game-fishing and all pointless forms of fighting including war. Unethical, does not equate to fair and honest justice." * Dr Liprini sets out the history of the litigation arising from his parents' wills. He annexed a copy of his parents wills to his affidavit which demonstrate that he was left the whole of his parents' estate and that his brother was excluded. It appears that his brother contested the wills, with some level of success, in that his brother, apparently received some $770,000. That payment, Dr Liprini asserts was wrongly obtained even though it was the subject of a consent order. As best we understand, Dr Liprini claims the authority he provided to his lawyers, was exercised without his consent and gave rise to his agreeing to a payment of $770,000 being paid to his brother from his parents estates. * Dr Liprini accused his brother of embezzlement of the family's Company funds. * He also said "Additionally, there are the phone calls to the local hospitals and police falsely accusing me of having been abusing my parents for years until eventually murdering both of them, along with the shocking and equally slanderous letters he sent to the hospital staff, the NSW office of the Coroner and the Medical Board of NSW." Dr Liprini annexed the three letters he was relying upon. * Dr Liprini accused the legal team, engaged by his brother in the contest over his parents' estate, of "getting away with re-writing history". He said it demonstrated a "criminal way of thinking". He stated "The truth emerges that there exists a potential network of corrupt legal professionals at the ready to link up with like-minded colleagues who were entrusted to process wealthy Estates." * Dr Liprini accused the solicitor he engaged to administer his father's estate of "a fraud conspiracy". This related to a failure on the part of that solicitor to advertise a notice that he intended to administer the estate and calling upon any creditors. Dr Liprini said: "If the notice had been properly placed in the SMH, then without contributing his own fraudulent actions, (his brother) would have been unable to access the deceased estates." Later in his document Dr Liprini explained he was able to find the notice was actually published however, a second notice advising that the estate was to be distributed to beneficiaries was not published. He said it was the failure to publish the second notice which facilitated his brother being able to make his successful claim. He said: "the agenda of the fraud conspiracy became refreshed with every decision against me." He further stated: "validation of (his solicitors') intention to do fraud as the foundation stone is by way of the first two court proceedings." * Dr Liprini also spoke of another solicitor, described as the "family solicitor", who was also representing either Dr Liprini or the estates of his parents. Dr Liprini said of that solicitor: "the lie that was (the solicitor's) malevolent intentions was later to contaminate the Statement of Claim that he made for an additional $60,000 plus unpaid legal fees." That solicitor was also said by Dr Liprini to have taken "and initial active role in the fraud conspiracy". * In May 2009, Dr Liprini said he contracted "Swine Flu". He said that he was too ill to attend a hearing in June or July of that year. He requested his lawyers seek an adjournment. He said they emphatically refused to make the application. Dr Liprini said he recorded two conversations with his lawyers "because they intended to misrepresent what had happened with the consent orders." It is unclear whether the lawyers knew they were being recorded. Dr Liprini claimed that he had been misrepresented by his own lawyers in a subsequent hearing. He said he was denied the opportunity to give his own oral evidence. * Dr Liprini had a sequestration order made against him on 3 September 2010. Again Dr Liprini asserts that it was inappropriately made as he was not insolvent at the time. * At paragraph 131 of the affidavit Dr Liprini stated: "It then became clear to me what had really taken place as (my solicitor) had confused me but had deliberately failed to place the Notice of Intention to Distribute to Beneficiaries in the SMH without explaining to me what the consequences would be, which was an action that could only mean that he intended for me to become liable for a late claim from my brother that would provide undisputed access to the deceased estate for my brother which would need to be defended in court, eventually allowing him to expect significantly greater legal fee payment." * Dr Liprini said that his solicitor and barrister had introduced "incorrect facts into the Court record". The intimation was that this was a knowingly deliberate action. He later described "two pieces of false evidence" which he linked to the incorrect facts introduced by his lawyers. * On the hearing of an appeal he said the Justice presiding had given him "Little opportunity to plead in a reasonable fashion. His honour instead stated that there was no error of law or grounds for appeal". Dr Liprini said the barrister opposing the appeal had "rattled off that I had not complied with procedural orders and the appeal was summarily dismissed." * A further appeal was heard on 28 June 2010. Dr Liprini said he had been denied a reasonable opportunity to obtain a transcript of the earlier hearing so that he could provide same to the Court of Appeal. * At paragraph 174 Dr Liprini highlights a "Key Point". He said: "This should be noted as indicative of the only accurate legal advice I received from (my solicitor), who has a vain person, and in his office on one occasion during the 15 months in my employ, he boasted how the legal profession had been honing chicanery methodology for hundreds of years making it impossible for the general public to compete. He explained that it is common practice to detour NSWSC jurisdiction by branching into an expandable maze of bankruptcy applications and the Federal jurisdictions generally." Affidavit of the Respondent of 20 August 2014 1. The second affidavit Dr Liprini included in Tab 2 of exhibit R1, is dated 20 August 2014 and was filed in the Supreme Court of NSW. The affidavit is stated to support an application by Dr Liprini to set aside the decision of Justice Adamson which named Dr Liprini as a vexatious litigant. We note the following matters in that affidavit which are potentially relevant to the decision we are required to make. * At paragraph 6 of the affidavit Dr Liprini states: "once again, as I have stated in the other affidavit, there is already sufficient defence provided to this point to clearly demonstrate a true fraud conspiracy against me making it unnecessary to go any further unless there is some value in further demonstrating the intrepid extent of the corruption employed to cover up such a serious betrayal of trust." * In paragraph 12 of the affidavit, Dr Liprini accuses counsel for an opposing party to himself of "lying about the prospects for my evidence". * In a letter Dr Liprini wrote to the Commissioner Andrew Scipione (NSW Police), he asserted that the lawyer for the Trustee of his Bankrupt estate, had informed him of a position the Trustee was proposing to take in relation to the failure of Dr Liprini's lawyer, acting in relation to his father's estate, to publish a required notice. Following that statement Dr Liprini wrote in his letter to the Commissioner the following: "I haven't been able to check this and there isn't anyone that I can think of who would be able to give me a straight but honest answer. Needless to say the judges would not hesitate to nebulously agree with them and dismiss that aspect of my claims without going into any detail, like they have done on many occasions in the past, in a bluster and claiming they have already gone over all that if I try to get them to explain in detail." * In his letter to the Commissioner, Dr Liprini described his grounds for the Application for Annulment of his Bankruptcy. He said: "three (grounds) of fraud and one of vexatious intent due to my brothers pathological jealousy". * In the same letter to the Commissioner Dr Liprini stated: "the other two frauds were to do with the sham 'mediation' that the barrister and solicitor (names excluded) orchestrated as a sting to the tune of Stanley Milgram's Shock Machine Experiment, where they used an authority from me, without permission, to give $770,000 to my brother, who they pretended was in another room but was really in Port Douglas despite he and his solicitor signing affidavits saying he was present that day." * Dr Liprini told the Commissioner that his own solicitor had been part of a collaboration to "access the estates wealth through me being personally liable." He also told the Commissioner: "the Civil Court is too corrupt for them to let that happen." 1. The affidavit sets out Dr Liprini's version of the history of his interaction with civil court proceedings over a number of years. All the proceedings appeared to stem from his parents' estates, including his own bankruptcy. He did however, make very serious allegations, including at paragraph 28 where he stated: "Due to the ongoing contamination with the fraud conspiracy, the issues in relation to what is more appropriately called the criminally responsible seizure of my home of 23 years and all my possessions is a very large 'can of worms', but I will just leave it at that". 2. At paragraph 30 and 31, Dr Liprini described an action brought by his trustee in relation to obtaining title to his property. He described an affidavit sworn by the trustee as "blatant perjury". He complained that different Justices in the Supreme Court had failed to refer the perjury complaint to the NSW Attorney General. 3. Dr Liprini said: "The Manager of the Costs Assessment Department of the NSW Supreme Court rang me and in an openly hostile voice, told me that he had filed my application for leave out of time, in a place where no one is ever going to read it." 1. Dr Liprini repeated his fraud accusations made against his original solicitor engaged to represent Dr Liprini in relation to his father's estate. He said he had commenced proceedings against that solicitor for professional negligence however he said: "Predictably I was denied the opportunity for a hearing." 2. In order to avoid the "vexatious litigant" branding, Dr Liprini decided to commence proceedings in a court in the ACT. It is unclear who the defendants were, although it was possibly an action for damages against his brother and another. This action was discontinued after a decision of a Federal Magistrate to the effect that the NSW Supreme Court order naming Dr Liprini a vexatious litigant did not prevent the Federal Magistrates Court from hearing an application filed by Dr Liprini in that court as it was a Federal jurisdiction. 3. We have considered the evidence contained in the two affidavits, as set out above, predominantly because Dr Liprini has emphasised how important those affidavits are to his case and also because of his complaint that the Medical Council declined to read the affidavits as had other judicial officers in different jurisdictions in which Dr Liprini has pressed the affidavits be read. 4. The material in the affidavits, which we have identified above, serves to illustrate the circumstances in which Dr Liprini has found himself in since before the death of his father. 5. Whilst acknowledging that it is not impossible for the conspiracies and criminal activities, described by Dr Liprini in his affidavit, to have occurred, it is in our view highly improbable. The alleged frauds cover multiple legal, administrative and judicial actions or inactions. Whereas, if it was the case that Dr Liprini was alleging only one incident of deception, conspiracy, negligence or fraud, perpetrated upon him by his brother and his own lawyer, authorities and or a court, might show scepticism in relation to such a serious allegation, it is reasonable to expect that the allegation would at least be investigated or considered as possible, in any determination of relevant litigation. However, where the allegations extend further than one instance, an investigator or a tribunal considering such allegations, is likely to see the allegations as not based upon established fact, but as illustrative of disillusionment, unmet expectation, or irrational or skewed thinking. 6. The material, which was provided to Dr Samuels in this matter, has enabled him to view accounts, given by Dr Liprini, of unfortunate and adverse experiences with the litigious processes he has engaged in, including with single Justices of the Supreme Court of NSW, the NSW Court of Appeal, the Federal Magistrates Court (now named the Federal Circuit Court of Australia) and the Medical Council of NSW. Those accounts have enabled Dr Samuels to draw support for his opinions about the state of the mental health of Dr Liprini. 7. In his final document filed in the Tribunal on 16 March 2020, Dr Liprini provided an "Addendum to evidence in support of response to amended application file number 2019/171207." 8. Again, the abovementioned "Addendum" addresses matters set out in the decision of the Medical Council published 9 October 2015. His statement in relation to the diagnosis of Dr Smith has been recognised by Dr Samuels, who understood Dr. Liprini disagreed with that diagnosis. The disagreement with, or opposition to such a diagnosis, is relevant to the matter which is to be determined by this Tribunal and we have noted same. 9. Annexed to the "Addendum" document is a chronology, prepared by Dr Liprini. Prior to setting out the Chronology, Dr Liprini wrote, at the end of the Addendum, "For at least the duration of the period from the beginning of the year 2000 to now I have always been shown to be completely open, honest and competent. See included 'chronology' attached". 10. The Chronology commences in 2004 and concludes in August 2015. It sets out Dr Liprini's version of fact. It portrays an oppressive and unending series of events, including unsuccessful litigation with his brother and others, all of which illustrate loss and possible victimisation on the part of Dr Liprini. Conclusion in relation to Complaint One 1. We commence this portion of our deliberation with the following statement: Where a respondent fails to call any evidence to oppose protective orders sought by the HCCC, the Tribunal is still required to be satisfied the HCCC has made out the case for any protective order to be made. Consequently, it is necessary, in this case, to establish Dr Liprini suffers an impairment which requires a protective order to be made. 2. We have assessed the unchallenged evidence of Dr Samuels. We find Dr Samuels to be a credible witness and his evidence, both written and oral, to be credible and acceptable. There was nothing in his evidence which suggested any reservation should be held about the content of his evidence. It follows that we accept his evidence. 3. In the submission provided by the HCCC, it points out that the impairment which it seeks to establish which affects Dr Liprini's ability to practise medicine, is not physical. Clearly the HCCC relies upon a finding that it is the mental health of Dr Liprini which gives rise to the impairment. 4. The order sought by the HCCC relies on section 5 of the National Law. That section defines "impairment" as: "in relation to a person, means the person has a physical or mental impairment, disability condition or disorder (including substance abuse or dependence) that detrimentally affect or is likely to detrimentally affect:- (a) for a registered health practitioner or an applicant for registration in a health profession, the persons capacity to practise the profession…." 1. The HCCC submits that the Tribunal is not required to specify precisely what mental illness or disorder a respondent suffers from in making a finding of impairment. It relies on the decisions in Grant v HCCC [2003] NSWCA 73 and in Qasim v Health Care Complaints Committee [2015] NSWCA 282. In the latter case the Court of Appeal held that: "The finding as to a mental condition or disorder 64. There was no requirement under the applicable National Law that a diagnosis that a person has a mental condition or disorder in the sense of an "impairment" be formed in accordance with the DSM or that, having concluded that the practitioner has a paranoid disorder, it was necessary to identify where along the paranoid spectrum, from personality disorder to paranoid schizophrenia, the practitioner fell: see Grant v HCCC [2003] NSWCA 73 at [11], [12]. Dr Samuels' evidence was that the appellant has a paranoid condition "which falls somewhere between a paranoid personality disorder and a paranoid schizophrenia". That was sufficient to support the Tribunal's finding that Dr Qasim has a "serious psychiatric disorder" which constitutes an "impairment" under the applicable National Law: [138], [140], [163], [164]." 1. The HCCC relied upon the evidence of Dr Samuels which we have set out in these reasons. In particular it highlights the conclusion of Dr Samuels where he opines that the diagnoses in relation to Dr Liprini have the potential to "impact upon the respondent's professional practice, interactions with others, and particularly regulatory bodies". It also points to the evidence given by Dr Samuels as to the way in which his diagnosis of Dr Liprini will impact on the way in which he could perform his functions as a medical practitioner. 2. We are satisfied that the HCCC has established Complaint One to the requisite standard. We are satisfied the evidence, accepted by us in this proceeding, establishes Dr Liprini has an impairment within the meaning of section 5 of the National Law. We are satisfied the impairment is a mental impairment. We are satisfied that the impairment identified by Dr Samuels is likely to detrimentally affect Dr Liprini's capacity to practise the profession of medicine. Conclusion in relation to Complaint Two 1. This complaint relies upon the same Particulars and evidence as is relied upon for Complaint One. The HCCC, however, seeks a finding pursuant to section 139 of the National Law. That section is as follows: 139 Competence to practise health profession [NSW] A person is competent to practise a health profession only if the person— (a) has sufficient physical capacity, mental capacity, knowledge and skill to practise the profession; and (b) has sufficient communication skills for the practice of the profession, including an adequate command of the English language. 1. Clearly it is section 139(a) which the HCCC relies upon. The HCCC submits that the diagnoses of Dr Samuels, as set out in these reasons, are impairments which the tribunal can find affect the respondent's mental capacity to practise and his communication skills. It submits the diagnoses have the potential to: 1. Affect Dr Liprini's judgment with his patients; 2. Distract him during times that clinical expertise is required; 3. To potentially distrust patients (without foundation) and find conspiracy in an ordinary event; and 4. To affect his ability to communicate with his patients. 1. The HCCC submits that the reasonable conclusion is that the respondent cannot properly treat and care for his patients. 2. We find, on the evidence before us, that Dr Liprini is not, at this time, competent to practise the profession of medical practitioner in an unrestricted manner. We will consider whether he would be competent to practise medicine in a manner which is restricted by conditions placed upon his registration, when we come to consider what protective orders, if any, should be made in this case. Conclusion in relation to Complaint Three 1. Complaint Three, alleges that between 2012 and August 2015 Dr Liprini self-prescribed medications, contrary to the NSW Medical Board of Australia's code of conduct. Dr Liprini does not dispute that he self-prescribed the medications listed in Complaint Three, however, he submits his circumstances were such, at the time of the self-prescription, that the Tribunal will determine no disciplinary action is required. 2. Even where a respondent fails to call any evidence to oppose protective orders sought by the HCCC, the Tribunal is still required to be satisfied the HCCC has made out the case for a protective order to be made. 3. The Particulars supporting Complaint Three, allege action on the part of Dr Liprini which is contrary to the NSW Medical Council Policy. The self-description policy provides: 1. That wherever possible, medical practitioners should not treat themselves and members of their family; 2. That all medical practitioners should have their own, independent General Practitioner. 3. That medical practitioners should not initiate treatment (including prescribing) for themselves or members of their family; and 4. That in emergency situations or isolated settings, where there is no help available, medical practitioners may treat themselves or members of their family until another medical practitioner becomes available. 1. Given that Dr Liprini admits that he did self-prescribe the medication's listed as part of Complaint Three, we do not need to investigate that part of the complaint. We do, however, need to consider the reason provided by Dr Liprini as he asserts that reason will guide the Tribunal in formulating appropriate protective orders. Dr Liprini submits the Tribunal will accept his evidence and will conclude that no protective order is required emanating from his self-prescription. 2. The evidence of Dr Liprini's reason/excuse for self-prescribing the subject medications, is found in different parts of the evidence before us. Dr Liprini has not specifically directed us to the evidence he relies upon in the documents he has filed. 3. Dr Liprini gave evidence before the Medical Council of NSW on 18 December 2015. In that hearing he was asked about self-prescription. It is difficult to follow the transcript of evidence, which appears at Tab 20 of exhibit A1, because Dr Liprini does not answer the questions asked of him to completion. 4. The HCCC in its' submission referred to a portion of the reasons for decision given by the Medical Council of NSW on 26 January 2016. There the following is stated about the self- prescribing of Dr Liprini: "he is aware of the Council's policy of not self-prescribing but considers it unnecessary for him. He informed the delegates that he is on various medications that he has determined are the best combination for him." The HCCC submits the evidence given by Dr Liprini before the Medical Council of NSW hearing conducted in December 2015, illustrates an aspect of the evidence of Dr Samuels, where he opined Dr Liprini's mental condition was such that he would ignore the determinations or requirements of regulatory bodies boosted by his grandiose conclusion that "he knows best". 1. Doing the best we can, we understand that the reason Dr Liprini was self-prescribing, as he has, was because of inconvenience in having to attend before another general practitioner to have his medications prescribed. This was particularly so in circumstances where Dr Liprini considered there was no problem with his practise of medicine at that time. 2. He also told the hearing in December 2015, that many general practitioners who he could have seen in the area he lived in, would no longer see him because his brother had accused him of murdering his parents. 3. We conclude it was a combination of convenience and also rejection by other general practitioners which Dr Liprini relies upon as an acceptable excuse for his having to self-prescribe. 4. Dr Samuels was asked about this aspect of Dr Liprini's practice. He considered the explanation given by Dr Liprini for self-prescribing was an example of grandiose behaviour in control and that others should comply with his demands as "he knows best". The identified grandiose behaviour in Dr Liprini was one of the features which supported Dr Samuels' opinions about the mental health of Dr Liprini. 5. We also understand that Dr Liprini relies on the evidence he has given about the circumstances that befell him following the death of his parents. The evidence establishes, to our satisfaction, that the events unfolding following the demise of firstly his father and then his mother, placed Dr Liprini under considerable stress. That stress, we accept, at times must have been overwhelming for him and at those times compliance with the code of conduct would have been far from his mind. Further, at those times, he may well have been suffering PTSD, and that may have impacted upon his decision to self-prescribe medications which he required at that time. 6. We note that it is not suggested in the case of the HCCC, that any of the medications self-prescribed by Dr Liprini, were not appropriate for a health condition he suffered at the time of the prescribing. Orders to be made 1. In its submission the HCCC drew the Tribunal's attention to the decision of Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 and the decision of the Court of Appeal in Health Care Complaints Commission v Do [2014] NSWCA 307 where Meagher JA stated: 35. The objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct operates both as a deterrent to the individual concerned, as well as to the general body of practitioners. It also maintains public confidence by signalling that those whose conduct does not meet the required standards will not be permitted to practise. 1. In Law Society of New South Wales v Foreman (1994) 34 NSWLR 408 Mahoney JA described (at 441) the scope of the objective of protecting the public interest in the context of disciplinary proceedings against a solicitor as follows: "The protection of the public has been described as, for example, the primary purpose or primary object of such proceedings: ... In the relevant sense, the protection of the public is in my opinion not confined to the protection of the public against further default by the solicitor in question. It extends also to the protection of the public against similar defaults by other solicitors and has, in this sense, the purpose of publicly marking the seriousness of what the instant solicitor has done. But, in my opinion, it would be wrong to confine the objects of disciplinary proceedings and the purposes to be achieved by the orders made in them strictly to matters of this kind. Those purposes and objectives have traditionally been seen as having a wider operation. In the end, the question to be determined is whether the solicitor is a fit and proper person to be a solicitor of the Court and the orders to be made are to be directed to ensuring that, to the extent she is not, her practice is restricted." 1. The HCCC is seeking an order for the cancellation of Dr Liprini's registration as a medical practitioner. In support of that outcome, it referred the Tribunal to the decision of the NSW Court of Appeal in Chen v Health Care Complaints Commission [2017] NSWCA 186 where Basten JA stated at paragraphs [21] and [22] the following: "21. Finally, in determining whether to suspend the practitioner's registration or cancel it, it is entirely appropriate for the Tribunal to take into account the consequences of the order being considered. Unless a period of suspension is made conditional, renewal of the practitioner's registration will occur automatically on completion of the period of suspension. By contrast, an order of cancellation will require the practitioner to justify re-registration. Uncertainty as to the future may lead the Tribunal to cancel a registration rather than suspend it. 22. The fixing of a period within which re-registration may not be sought may be seen to have a twofold operation. On the one hand, it indicates the minimum period within which the Tribunal considers the person should not be able to practise his or her profession; on the other hand, it holds open the possibility that an application for re-registration thereafter will at least be considered. It is entirely proper for the Tribunal to consider all aspects of the possible orders available to it in determining what order to make. The suggestion that there must be a two-stage process in undertaking that function was misguided". 1. The HCCC submits that the protection of the public requires that the registration of Dr Liprini be cancelled. It submits that the option of allowing Dr Liprini to continue to practise with conditions, carries with it the unwarranted risk that he will ignore the conditions because of his mental ill health. It refers to the evidence of Dr Samuels who opined that part of the illness he opines Dr Liprini suffers from, is that he considers the dictates of bodies like the Medical Council of NSW, or this Tribunal, do not really apply to him. There is a real concern, submits the HCCC, that Dr Liprini would not comply with any or all conditions which might be imposed on his registration in his current state of mental health. 2. The HCCC is seeking orders which would see Dr Liprini having to satisfy the Medical Council of NSW and/or any other regulatory body which might renew registration of Dr Liprini as a medical practitioner, that his health is such that he would not be seen as impaired if permitted to practise medicine. 3. In addition to the above the HCCC submits that the registration should be cancelled because: 1. his continued registration would damage the confidence in and reputation of the medical profession; and 2. there is no evidence of insight into his unsatisfactory professional conduct or his impairment. A lack of insight suggests a very real and significant likelihood of repeat behaviour, and/or failure to treat his mental health. 1. The HCCC submits that cancellation, coupled with the conditions that require addressing mental health concerns, are protective measures directly related to the complaint. 2. The HCCC seeks the following orders: 1. Cancellation of the respondent's registration; 2. A condition pursuant to section 149 A(3)(a) that the respondent cannot be re-registered unless he has attended ongoing treatment with a treating psychiatrist and psychologist for a minimum period of 12 months, or whatever further period the treating practitioner deems appropriate; 3. A condition pursuant to section 149A(3)(b) that, upon successful re-registration the respondent has ongoing treatment with a treating psychiatrist and treating psychologist for a minimum period of 12 months or whatever further period the treating practitioner deems appropriate; 4. A condition pursuant to section 149 A(3)(b) that the respondent attend a CAP within one month of becoming re-registered; and 5. Cost in the order of a fixed sum. 1. We pause to note our concern about the power or appropriateness of this Tribunal making orders which would seek to bind the Tribunal which might hear an application by Dr Liprini to be re-registered, after a period of cancellation. We make no definitive statement about that power as it is unnecessary in this case to do so. 2. The registration for Dr Liprini is currently suspended. That circumstance came about, it seems in part, because Dr Liprini would not countenance the imposition of conditions upon his registration. In the decision of the Medical Council dated 29 January 2016 the following is stated on page 7: "The delegates asked Dr Liprini whether, based on the Council's concerns, he believed that conditions may be necessary. Dr Liprini responded that there was no need for conditions as he was practising without issue. He noted that if conditions were imposed, he would stop practising." (We note what has been set out earlier in these reasons, on Dr Liprini's part, about the above quoted portion of the reasons of the Medical Council delegates. Dr Liprini seems to be saying that quote was not a correct reflection of what he would do if conditions were imposed.) 1. We note there is no evidence, which has been brought to our attention by the HCCC, of any complaint made by a patient of Dr Liprini, nor is there any evidence from the medical practitioners, who worked in the same medical practise as Dr Liprini, during the time he was practising. The evidence from former medical practitioners, who might give evidence supportive of Dr Liprini, would normally be provided by Dr Liprini. In ordinary civil litigation, an inference would operate in such a circumstance, namely, that the reason Dr Liprini failed to call such witnesses was because he was unable to obtain supportive or favourable evidence from a practising medical practitioner, which evidence would be supportive of his continuing to practise without conditions. We do not consider in this case, such an inference would be appropriate given the expert evidence of Dr Samuels. We conclude it is probable that Dr Liprini would consider the obtaining of such evidence unnecessary as he does not have any mental ill health other than PTSD which condition, would not affect his practice as a medical practitioner in any adverse manner. 2. One problem, which we are faced with, is whether Dr Liprini would accept any condition imposed upon his registration. We note the position he took when confronted with the prospect of imposed conditions when he was before the Medical Council in December 2015. 3. We will consider the merit in proposing a set of conditions to be imposed upon Dr Liprini's registration, should he choose to agree to same within a defined period and absent such agreement then cancellation of his registration. Such conditions would need to include the Medical Council being satisfied as to "recency" qualifications, given that Dr Liprini has not practised since at least 2015. 4. We note that the Medical Council had proposed it would impose conditions upon Dr Liprini's registration at the conclusion of the hearing conducted in December 2015, however, that option became unavailable due to Dr Liprini advising he would not accept the imposition of conditions. We are mindful that if we concluded the imposition of conditions would be appropriate to comply with the provisions of the National Law and the authorities which apply to the jurisdiction exercised by the Tribunal, Dr Liprini might take a different stand now to that taken five years ago. 5. It seems to us that, absent the impact upon his practice as a medical practitioner by, the mental health afflictions from which he probably suffers, Dr Liprini may well be a competent and able medical practitioner. Consequently, if he is able to accept the imposition of conditions upon his registration, he could fulfil a valuable function by the practice of medicine in NSW. We again refer to the earlier statement by Dr Liprini, which raises the potential that he would now consent to conditions being imposed if it permitted him to practise medicine. We are cognisant of the position Dr Liprini would probably take, if he considered the imposition of conditions onerous, in the circumstances in which he wishes to practise medicine. 6. We now turn to consider what conditions would be appropriate if we were to conclude that was an appropriate outcome. 7. We find that there would need to be a period during which he would not be permitted to practise medicine at all. During that period he would have to engage a psychiatrist of his choice to assess and treat him. If he considered it necessary, or if his psychiatrist recommended it, he would need to engage a psychologist, of his choice, to work in conjunction with, the psychiatrist engaged by Dr Liprini. 8. At the conclusion of the non-practice period Dr Liprini would need to be prepared to present himself for examination, by a Medical Council of NSW appointed psychiatrist, who would provide advice to the Medical Council as to the fitness of Dr Liprini to resume practise, subject to the further conditions which we would require. 9. We consider it is outside our role to impose conditions which are very onerous, and which require a high level of ongoing management by other bodies. Where it becomes clear that such a situation is present, then we consider the appropriate path for us is to make an order for cancellation of registration and impose an exclusion time. Such period should be no longer, than we consider necessary. 10. In this case the evidence shows Dr Liprini has been exposed to a great deal of stress, tension and conflict, with his brother, with the Trustee of his bankruptcy and with others, over a number of years. We are concerned that stress, tension and conflict is still occurring and that in order for Dr Liprini to address his health issues, identified in this hearing, it may be necessary for him to have concluded all the litigation and other actions he may be contemplating initiating. To that end we are hopeful that if he can concentrate his effort now on restoring his health and his registration as a medical practitioner, he might again return to a purposeful and fulfilling life as a medical practitioner. 11. Having considered the alternatives available to us, we conclude the offer of conditions, without any cancellation period, is not appropriate in this case as we consider it unlikely that Dr Liprini would, at this time, willingly accept conditions. Further, we could not be confident he would be able to comply with the conditions, in his current state of health. We consider that we should encourage Dr Liprini to address his mental health, with a psychiatrist and psychologist of his choice and when those practitioners advise that he is fit to return to practice, he should then make a reinstatement application. 12. We propose to make an order for cancellation of Dr Liprini's registration and impose a short period, during which he could not apply for reinstatement. We consider a period of six months will be appropriate as experience suggests there will be a delay between the filing date of any reinstatement application to the Tribunal, and the date the matter would be able to be heard by the Tribunal. 13. The HCCC sought an order for its costs to be paid, however, there was no submission provided which addressed a costs order. Likewise Dr Liprini did not make any submission in relation to the question of costs. We will order that if either party is pressing for a costs order then submissions be filed and served within 21 days of the date of the orders and any submission in response be filed within a further 14 day period. 14. The orders we will make are as follows: 1. The registration of Allan Stephen Liprini, as a medical practitioner, is cancelled. 2. Allan Stephen Liprini is not able to apply for a review of this cancellation until after 15 February 2021. 3. If either party seeks a costs order, submissions in support of same is to be filed and served within 21 days from the date hereof. Any response to a submission seeking a costs order is to be filed and served within a further 14 days of receipt of such a submission. ********** 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 DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 25 August 2020