Ormonde v Chief Executive Officer, Healthquest [2004] NSWADT 191

CITATION: Ormonde v Chief Executive Officer, Healthquest [2004] NSWADT 191 DIVISION: General Division APPLICANT PARTIES: Peter Ormonde RESPONDENT Chief Executive Officer, Healthquest FILE NUMBER: 043152 HEARING DATES: 17/08/2004 SUBMISSIONS CLOSED: 08/17/2004 DATE OF DECISION: 08/31/2004

BEFORE: Hennessy N - Magistrate (Deputy President) APPLICATION: amendment of documents - Freedom of Information Act - amendment of documents MATTER FOR DECISION: Principal matter Administrative Decisions Tribunal Act 1997 LEGISLATION CITED : Freedom of Information Act 1989 Public Sector Employment and Management (General) Regulation 1996 CASES CITED: Crewdson v Central Sydney Area Health Service [2002] NSWCA 345 Secretary, NSW Treasury v C (GD) [2004] NSWADTAP 6 APPLICANT REPRESENTATION: In person RESPONDENT A Johnson, solicitor ORDERS: The agency's decision to amend paragraph 3 of the report of Dr Casolin dated 30 April 2003 but otherwise to refuse to amend the report is affirmed except that the content of the amendment in relation to paragraph 3 is varied to read: The reference to a medical certificate from Mr Ormonde's GP, Dr Peter Purches, in the third paragraph of the report is a reference to a certificate dated 26 September 2002 written by Dr Purches. The word "supposedly" should be deleted from this paragraph.

REASONS FOR DECISION Introduction 1 Mr Ormonde applied to the Tribunal to review the decision of the Chief Executive of HealthQuest to refuse to amend a medical report relating to him except in one respect. Dr A Casolin, NSW Government Medical Officer, signed the medical report after Dr Donsworth interviewed Mr Ormonde and dictated a draft report on 28 April 2003. The report was released to Mr Ormonde under the Freedom of Information Act 1989 (FOI Act.) Mr Ormonde says that the report is incorrect and misleading and should be amended. The agency maintains that only one part of the report is incorrect and they amended the report by adding a notation to correct that error. Mr Ormonde is not satisfied with HealthQuest's decision. Relevant statutory provisions 2 Under s 39 of the FOI Act, a person may apply to the agency for an amendment of the agency's records. There was no dispute that each of the requirements in s 39 had been met and that Mr Ormonde was entitled to apply for amendment to the report. Pursuant to s 44 of the FOI Act, HealthQuest decided to refuse to amend its records except in one respect because it was satisfied that its records were not "not incomplete, incorrect, out of date or misleading in a material respect." HealthQuest amended paragraph 3 of the report by adding the following notation: The document described by Dr Casolin as a medical certificate was in fact an unsigned draft letter prepared by the applicant and subsequently withdrawn. Issues and onus 3 Based on s 39 and 44 of the FOI Act and s 63 of the Administrative Decisions Tribunal Act 1997 (ADT Act) the issue for the Tribunal is whether HealthQuest's decision to refuse to amend its records except in one respect was the correct and preferable decision. The onus is ultimately on the agency under s 61 of the FOI Act to justify its decision not to amend the document as requested by Mr Ormonde. Factual background 4 The background to Mr Ormonde attending HealthQuest was that his employer, the National Parks and Wildlife Service (NPWS), referred him for assessment on 12 December 2002 ("the first referral"). Dr Mahadev assessed him on 10 January 2003 and wrote a report dated 15 January 2003. Mr Ormonde gave Dr Mahadev a certificate from his general practitioner, Dr Purches, dated 26 September 2002 ("the September certificate") which stated that: Mr Ormonde is suffering from a chronic medical condition requiring ongoing periodic treatment over the next three months. In my opinion, Mr Ormonde will be unable to undertake his routine duties during this course of treatment. He will require rest and a reduced workload during this period. 5 Dr Mahadev telephoned Dr Purches who apparently told him that the 26 September 2002 certificate was no longer current and that Mr Ormonde was fit for his job. In his report, Dr Mahadev diagnosed Mr Ormonde with depression but concluded that he was fit for normal duties. Dr Mahadev said that Mr Ormonde may benefit from working reduced hours for one to two months. 6 In a letter dated 10 April 2003 the Director General of the National Parks and Wildlife Service directed Mr Ormonde to cease duty immediately because he was not fit for work. The Director General was of the view that Mr Ormonde was not fit for work because, under See Cl 17(1)(a) of the Public Sector Employment and Management (General) Regulation 1996, his health "may render (him) a danger to other members of staff or to the public." (1) For the purposes of this clause, a member of staff is not fit for work if the health of the member of staff: (a) may render the member of staff a danger to other members of staff or to the public, or (b) is likely to be seriously affected by the staff member's remaining on duty or, if the member of staff is absent from duty, by the staff member's resuming duty. (2) The appropriate Department Head may direct a member of staff to submit to such medical examination or other health assessment as the Department Head may, on the advice of HealthQuest, consider necessary, if the Department Head has reason to believe that the member of staff is not fit for work. (3) If the appropriate Department Head has issued any such direction to a member of staff, the member of staff: (a) must, if on duty, cease duty immediately, and (b) must not resume duty until the completion of the medical examination or other health assessment concerned unless the concurrence of HealthQuest is first obtained or a certificate is furnished by a medical practitioner that the member of staff is fit for work. (4) If the appropriate Department Head receives a health assessment from HealthQuest that a member of staff: (a) is fit for work, the Department Head is to direct in writing that the member of staff, if absent from duty, must resume duty, or (b) is not fit for work, the Department Head is to direct in writing that the member of staff must cease duty immediately or, if absent from duty, must not resume duty. (5) If a direction has been given to a member of staff under subclause (4), the nature of the leave, if any, to be granted to the member of staff during the absence from duty is to be determined by the appropriate Department Head after consideration of any relevant advice of HealthQuest. (6) A member of staff to whom a direction has been given under subclause (4) (b) must not resume duty unless the appropriate Department Head, on the advice of HealthQuest, approves in writing. (7) The appropriate Department Head is to give the health care professional providing a health assessment of a member of staff under this clause any requested information about the duties of the staff member's position that is reasonably required for the purpose of providing the assessment. 7 On 14 April 2003 Mr Ormonde's employer wrote to HealthQuest seeking an opinion, among other things, as to Mr Ormonde's fitness to undertake his normal duties ("the second referral"). The second referral included, as an attachment, an unsigned letter on Dr Purches' letterhead dated 3 December 2002 ("the December letter). As it turns out, Mr Ormonde wrote this letter in anticipation of Dr Purches signing it. 8 HealthQuest arranged for Mr Ormonde to see a psychiatrist, Dr June Donsworth on 28 April 2003. Dr Casolin contacted Mr Ormonde and suggested a further consultation with Dr Mahadev to explore the apparently conflicting assessments in the December letter with those of Dr Mahadev. Mr Ormonde refused to see Dr Mahadev and stated that Dr Purches' December letter was an unsigned draft and had no formal standing. Dr Casolin says that he understood Mr Ormonde to be saying that Dr Purches had prepared the letter but had not fully completed it or signed it. 9 Dr Donsworth completed her assessment of Mr Ormonde on 28 April 2003 and dictated the bulk of the report which is the subject of these proceedings. Dr Casolin says that he was reluctant to sign the report saying that Mr Ormonde was fit given the opinions expressed in Dr Purches' unsigned December letter. Dr Casolin contacted Dr Purches who told him, among other things, that he had not written that letter. After his conversation with Dr Purches, Dr Casolin changed the report to say that the medical certificate was "supposedly" written by Dr Purches. That change was made because Dr Casolin understood that the reference in the report to the medical certificate in paragraph 3 was a reference to the December letter and Dr Purches had told him that he had not written that letter. Mr Ormonde told Dr Casolin after the report had been finalised that he had written the December letter in anticipation of Dr Purches signing it. Content of the medical report 10 The content of the report is set out in full below. I have numbered each paragraph for ease of reference. These numbers were not included in the report. I have also italicised certain words and phrases. This emphasis is not in the original document. 1. Mr Ormonde was interviewed at HealthQuest by Dr Donsworth, consultant psychiatrist, on 28 April 2003. With Mr Ormonde's written, consent, the treating doctor, Dr Purches, was also contacted on 29 April 2000 to discuss Mr Ormonde's medical fitness. BACKGROUND 2. Mr Ormonde is employed as a Senior Policy Officer in the Conservation Economics Group of the National Parks & Wildlife Service. Mr Ormonde was previously assessed at HealthQuest on 10 January 2003 by Dr Mahadev. That assessment found that Mr Ormonde was suffering from recurrent depression, but was fit for normal duties as a Policy Officer working in the Conservation Economics Unit at Hurstville, or from his residence to reduce travel demands as requested by him. Dr Mahadev suggested psychological counselling and stress management via EAP, and said that Mr Ormonde may be assisted by reduced hours of 6 hours per day for 1-2 months to assist with travel demands. 3. On 9 April 2003, the Director General of the NPWS determined that Mr Ormonde was not fit for work and directed him to cease work immediately. There was a medical certificate, supposedly from Mr Ormonde's GP, Dr Peter Purches, in which it was stated that Mr Ormonde is suffering from chronic medical conditions requiring treatment over the next 3 months. The writer of this certificate then goes on to say that in his opinion, Mr Ormonde will be unable to undertake his routine duties during this course of treatment. He will require rest and a reduced workload over this period. 4. The referring letter from Helen Anderson dated 14 April 2003 outlines some of the behaviours of Mr Ormonde which have caused concern and asks a series of questions in relation to his medical condition. OPINION 5. Mr Ormonde declined to sign the authorisation allowing HealthQuest to disclose relevant medical information to his employer. However, recommendations regarding Mr Ormonde's work capacity can still be made to his employer without providing any new explanatory mediation information. In summary: 6. Mr Ormonde is fit to undertake his normal duties with no restrictions. He is also fit to work under the conditions outlined in earlier HealthQuest correspondence. There is no evidence that Mr Ormonde is currently suffering from symptoms of a depressive illness or any other illness which could affect his capacity to undertake his normal duties. 7. The behaviours listed on referral are not considered to be attributable to any medical condition and there is no existing medical condition requiring any special considerations from a human resource management perspective. 11 Dr Casolin said that as well as adding the word "supposedly" in the third paragraph, he inserted the second sentence in the first paragraph of the report. He cannot recall making any other substantive changes to the report as dictated by Dr Donsworth. In answer to a question from Mr Ormonde, Dr Casolin said that the report was not a "fitness to continue" assessment. Dr Casolin gave evidence that the opinion expressed in the letter that Mr Ormonde was fit for his normal duties with no restrictions, was and remains his honestly held medical opinion and he considers that he knew all the facts necessary to justify that opinion. Mr Ormonde's objections to the report 12 Mr Ormonde made it clear that he was not challenging the ultimate opinion as to fitness expressed in the report, but was saying that some of the factual statements in the report were incorrect and that the entire report was misleading. There were several bases for Mr Ormonde's claim that the report was incorrect or misleading. Some of these relate to the alleged defects in the procedures HealthQuest had followed, or failed to follow, when preparing the report. Mr Ormonde's other concerns relate to the content of the report itself. I will deal separately with the process and content objections. Process objections 13 The process objection was that the report was not a "fitness to continue" report as it purported to be, because various government guidelines and procedures were not followed when formulating the report. According to Mr Ormonde, the report is misleading because it purports to be a valid and legitimate report when it is not. For example, Mr Ormonde submitted that: - Dr Casolin did not seek any information from Dr Purches regarding his current medical condition, diagnosis or treatment. - No information regarding his work situation, its demands and requirements was obtained by Dr Donsworth. - The report did not address his employer's concern that he was a danger to other members of staff or to the public. - Dr Donsworth's interview did not follow any recognised or sanctioned test or evaluation of his fitness to undertake duties. - The questions asked by his employer when requesting the assessment did not conform to a "fitness to continue" assessment as stipulated in HealthQuest and other guidelines. 14 The Court of Appeal's decision in Crewdson v Central Sydney Area Health Service [2002] NSWCA 345 is the leading authority on the meaning of "incomplete, incorrect, out of date or misleading" in s 39(c) and s 44(a) of the FOI Act. As in the present case, Mr Crewdson's employer sought a report from HealthQuest pursuant to cl 17 of the Public Sector Management (General) Regulation 1996. Mr Crewdson submitted that an opinion expressed in the HealthQuest report that he was currently unfit for work and in need of further psychiatric assessment, was incorrect, out of date or misleading. The basis for that submission was that the examination was tainted by procedural unfairness, the doctor was biased, the opinion was incorrect and the report was beyond power because cl 17 did not authorise an interim report and because the doctors did not intend to find that he was unfit for work in terms of the special definition in cl 17(1). Mr Crewdson added that neither of the doctors involved in preparing the report was aware of the requirements of cl 17(1) or the nature of his duties as a residential care worker. Some of these process objections are identical to those raised by Mr Ormonde. Unlike Mr Crewdson, Mr Ormonde did not challenge the accuracy of the final opinion as to fitness. However, like Mr Crewdson, he challenged the fairness and validity of the process by which the report was produced and maintained that it was misleading because of fundamental flaws in that process. The Court of Appeal (Handley JA (with whom Ipp JA and Davies AJA agreed) concluded at [19] that: The alleged unfairness in the procedures which led to the appellant's psychiatric examination and in the course of that examination, including the alleged bias of Dr Roberts, do not raise issues directed to the accuracy of the statement. One cannot establish that a medical opinion is "incorrect ... or misleading" by establishing that the procedures followed were legally flawed or the doctor was biased. The opinion may still be correct. 15 Although this comment relates to the accuracy of a medical opinion, the Court of Appeal made a similar, but more general statement at [24]: The appellant's attempt to use the Act as a vehicle for the collateral review of the merits or validity of official action should be rejected in any event. The Act is concerned with the accuracy of official records, not with the merits or legality of the official action recorded in them. Compare Re Resch and Dept of Veterans' Affairs (1986) 9 ALD 380, 386, 387 (Hall DP) and Hewitt v Grabicki 794 F 2d 1373 (9th Circuit 1986), 1378. 16 Similarly, in this case, it is not open for Mr Ormonde to use the FOI Act as a vehicle for the collateral review of the merits of validity of official action. That is what he is attempting to do by raising objections to the process. On the basis of the reasoning of the Court of Appeal in Crewdson, I do not accept that Mr Ormonde's process objections, even if accepted, render the report incorrect or misleading in a material respect Content objections 17 Paragraph 1, second sentence. This sentence states that: "With Mr Ormonde's written consent, the treating doctor, Dr Purches, was also contacted on 29 April 2003 to discuss Mr Ormonde's medical fitness." Mr Ormonde objects to two aspects of this sentence. Firstly, he says that Dr Casolin contacted Dr Purches about a draft letter dated December 2003, not about his current fitness. Secondly, Mr Ormonde says that he did not authorise HealthQuest to contact Dr Purches about those matters. 18 Dr Casolin's evidence about the reason he contacted Dr Purches does not support Mr Ormonde's submission. Dr Casolin says that he telephoned Dr Purches regarding the medical conditions contained in Dr Purches' letter. Mr Ormonde did not challenge that evidence in cross-examination and it is supported by Dr Casolin's handwritten note of the conversation he had with Dr Purches. That note says, in part, "Discussed case with Dr Purches." Mr Ormonde was not a party to the conversation Dr Casolin had with Dr Purches and I have no difficulty in accepting Dr Casolin's uncontested evidence in relation to the content of that conversation. The fact that other matters such as whether Dr Purches wrote the December letter were also discussed does not make that part of the sentence relating to the content of the conversation incorrect or misleading. 19 Mr Ormonde's second point was that he only authorised HealthQuest to contact Dr Purches about his current medical condition, treatment and diagnosis and not about non-medical matters such as who wrote the December letter. That objection has both a process and a content element. As to process, I understand Mr Ormonde to be saying that Dr Casolin should not have contacted Dr Purches to ask him whether he wrote the December letter because he did not give him permission to do so. For the same reasons as are set out above in relation to the more general process objections, I find that any "unauthorised" conduct of Dr Casolin does not make the report incorrect or misleading. 20 Mr Ormonde's content objection is that it is incorrect for Dr Casolin to say that he had Mr Ormonde's written consent to contact Dr Purches about non-medical matters when he did not. Mr Ormonde signed an authorisation on 28 April 2003, the same day that he was examined by Dr Donsworth. The authorisation allowed HealthQuest to discuss "relevant medical information" with Dr Purches. Mr Ormonde's point, as I understand it, was that the discussion of whether Dr Purches wrote the December letter is not "relevant medical information." I do not accept that submission. HealthQuest had a copy of the December letter which was on Dr Purches' letterhead. It was reasonable for Dr Casolin to assume that Dr Purches had written that letter but not signed it. He rang Dr Casolin to inquire about the content of the letter. That discussion concerned "relevant medical information." In the course of the discussion Dr Purches advised that he did not write the letter. Consequently, that part of the sentence which states that Dr Purches was contacted with Mr Ormonde's written consent is not incorrect or misleading. 21 Paragraph 3, first sentence: According to Mr Ormonde, when the Director General directed him to cease work, it was not on the basis that he was unfit for work, but that he constituted a danger to other staff or the public. There is a short answer to this submission. Clause 17(1)(a) of the Public Sector Employment and Management (General) Regulation 1996 deems that a staff member is "not fit for work" in certain circumstances including "where the health of the member of staff may render the member of staff a danger to other members of staff or to the public." Consequently, the comment that the Director General of the NPWS determined that Mr Ormonde was "not fit for work" is not incorrect or misleading. 22 Paragraph 3, second and third sentences. These sentences refer to "a medical report supposedly from Mr Ormonde's GP . . ." Dr Casolin said that because the two documents look similar, there was a mistake made when the report was dictated because the report referred to Mr Ormonde requiring treatment over the next 3 months, when that comment was in the September 2002 certificate and not the December 2002 letter. At the hearing Dr Casolin agreed with Mr Ormonde's submission that the reference in the report is to the September certificate from Dr Purches, not the December letter. 23 The agency submitted that the reference to the medical certificate in the third paragraph of the report is a reference to a combination of matters taken from both the September certificate and the December letter. Mr Casolin thought at the time he signed the report that Dr Donsworth was referring to the December letter. That is the letter that Dr Casolin asked Dr Purches about when he rang him. Because that letter says nothing about a period of 3 months, it is clear that Dr Donsworth was either referring only to the September certificate or to parts of both the September certificate and the December letter. The agency submitted that the reference is to both the certificate and the letter. Initially, HealthQuest had taken the view that the reference to the medical certificate was a reference to the December letter and amended the report by adding the following notation: The document described by Dr Casolin as a medical certificate was in fact an unsigned draft letter prepared by the applicant and subsequently withdrawn. 24 During the course of the hearing, HealthQuest offered to add the following further sentence: The draft letter does not refer to "medical conditions requiring treatment over 3 months." The reference to treatment over 3 months can be found in a medical certificate signed by Dr Purches and dated 26 September 2002. 25 Having now examined the September certificate, which was not available during the course of the hearing, the words used in that certificate are virtually identical to those used by Dr Donsworth when she dictated the report. Although Dr Donsworth did not give evidence, I am satisfied that she was referring exclusively to the September certificate in the report when she dictated that part of the report. No reference is made to any of the information in the December letter and the reference is to a single certificate. Dr Casolin mistakenly thought that Dr Donsworth was referring to the December letter. That is why he inserted the word "supposedly" in the report after ringing Dr Purches. Even if Dr Casolin's evidence is accepted that this part of the report was consistent with comments made in both the certificate and the December letter, the report does not refer to the December letter. 26 Given this finding the use of the word "supposedly" in the third paragraph is incorrect because there is no doubt that the September certificate was written by Dr Purches. An appropriate amendment would read as follows: The reference to a medical certificate from Mr Ormonde's GP, Dr Peter Purches, in the third paragraph of the report is a reference to a certificate dated 26 September 2002 written by Dr Purches. When reading this paragraph the word "supposedly" should be deleted. 27 Fifth paragraph, first sentence. This sentence states that: "Mr Ormonde declined to sign the authorisation allowing HealthQuest to disclose relevant medical information to his employer." According to Mr Ormonde, he only refused to give HealthQuest permission for medical information from his general practitioner to be transmitted to his employer. According to Mr Ormonde, HealthQuest had authority to convey to his employer anything that he told HealthQuest in the course of the assessment. 28 The only authorisation which was in evidence before the Tribunal was the authorisation signed by Mr Ormonde and dated 28 April 2003. That authorisation has two parts. The first part authorises HealthQuest to discuss relevant medical information with Dr Purches. The second part of the authorisation relates to the disclosure of relevant medical information to his employer. The second part of the authorisation states as follows: This authorisation allows HealthQuest to disclose relevant medical information to your employer. This means only medical information that impacts on your ability to undertake your job. If you choose not to sign this, recommendations regarding work capacity can still be made to your employer without providing any explanatory medical information that is currently unknown to them. (Emphasis added.) 29 Mr Ormonde did not sign this authorisation which relates specifically to relevant medical information. I do not accept Mr Ormonde's submission that HealthQuest was authorised to convey to his employer anything that he told HealthQuest in the course of the assessment. If that information can be regarded as "relevant medical information" then HealthQuest was not authorised to convey it to his employer. Dr Casolin's comment that "Mr Ormonde declined to sign the authorisation allowing HealthQuest to disclose relevant medical information to his employer" is not incorrect or misleading. In any case, if the disclosure was not authorised, that is a matter of process and does not affect the accuracy of the report. 30 Sixth paragraph, first two sentences. Mr Ormonde submitted that the opinions in this paragraph were contradictory. If he is fit to undertake his normal duties with no restrictions, how can he be fit to work under the conditions previously outlined in earlier HealthQuest correspondence, namely to work from home or to work reduced hours? Dr Casolin gave evidence that he did not think these conclusions were inconsistent and that Mr Ormonde was fit to work in a range of situations. 31 A conclusion that Mr Ormonde is fit to undertake his normal duties with no restrictions is consistent with a finding that there is no need for him to be accommodated in any way such as by working from home or working reduced hours. A conclusion that Mr Ormonde is fit to work subject to those conditions implies that he needs some accommodation to undertake his duties. Given Dr Casolin's view that Mr Ormonde was fit to undertake normal duties with no restrictions, it was unnecessary to add that Mr Ormonde was also fit to work from home or reduced hours. Although the second conclusion is unnecessary, that does not make it incorrect or misleading. Dr Casolin's clear conclusion is that Mr Ormonde is fit to undertake his normal duties with no restrictions. 32 Sixth paragraph, last sentence. This sentence reads: "There is no evidence that Mr Ormonde is currently suffering from symptoms of a depressive illness or any other illness which could affect his capacity to undertake his normal duties." According to Mr Ormonde there was evidence that he is currently suffering from symptoms of such an illness. That evidence includes the fact that he is taking medication, his conduct as described by his employer in their letter of referral and the content of other medical reports. Dr Casolin highlighted the fact that the opinion in the report related to "symptoms" of a depressive illness, not the illness itself, and that it was qualified by the second part of the sentence. The qualification is that any symptoms that Mr Ormonde may be suffering from do not affect his capacity to undertake his normal duties. Reading the sentence as a whole, I find that the reference to "symptoms of a depressive illness" is qualified by the second part of the sentence. Consequently the report does not say that Mr Ormonde does not have a depressive illness or that he does not have symptoms of a depressive illness. It merely says that there is no evidence that he is suffering from the symptoms of any illness which could affect his capacity to undertake his normal duties. Even if there was evidence of symptoms of a depressive illness, that does not make the opinion expressed in that sentence misleading or incorrect. 33 Paragraph seven. The final paragraph of the report states that: "The behaviours listed on referral are not considered to be attributable to any medical condition and there is no existing medical condition requiring any special consideration from a human resource management perspective." Mr Ormonde submitted that the behaviours listed on the referral letter, including anger, frustration and hostility all fall within the standard range of symptoms described in the literature on depression. The report does not say that these behaviours are never symptoms of depression. It says that in Mr Ormonde's case they are not attributable to any medical condition. Mr Ormonde disagrees with that opinion. The decision of the Court of Appeal in Crewdson at [33] and the Appeal Panel's decision in Secretary, NSW Treasury v C (GD) [2004] NSWADTAP 6 at [103] make it clear that an expert opinion will not be incorrect unless all or some of the factual material underlying the opinion is incorrect. Mr Ormonde did not challenge the factual basis underlying the opinion, but merely asserted that other experts would disagree with him. That is not enough to make the opinion incorrect. 34 Mr Ormonde also submitted that there is an existing diagnosis of recurrent depression confirmed by HealthQuest in January 2002. The report does not say that there is no diagnosis of depression, merely that any medical condition does not require any special consideration from a human resource management perspective. For that reason, the report is not incorrect or misleading in that respect. Orders Having found that the report is not incorrect or misleading except in one respect, the Tribunal makes the following orders: The agency's decision to amend paragraph 3 of the report of Dr Casolin dated 30 April 2003, but otherwise to refuse to amend the report, is affirmed except that the content of the amendment in relation to paragraph 3 is varied to read: The reference to a medical certificate from Mr Ormonde's GP, Dr Peter Purches, in the third paragraph of the report is a reference to a certificate dated 26 September 2002 written by Dr Purches. The word "supposedly" should be deleted from this paragraph.