New South Wales Medical Tribunal CITATION : DR ALAN CAMPBELL McLEAY AND THE MEDICAL PRACTICE ACT OF NEW SOUTH WALES [2001] NSWMT 4 TRIBUNAL : Medical Tribunal PARTIES : DR ALAN CAMPBELL McLEAY AND THE MEDICAL PRACTICE ACT OF NEW SOUTH WALES FILE NUMBER(S) : 40016 of 2000 CORAM: Freeman, DCJ - Tucker, Dr, P - McInerney, Dr, P - Berglund, Dr, C CATCHWORDS: LEGISLATION CITED: MEDICAL PRACTICE ACT OF NEW SOUTH WALES CASES CITED: DATES OF HEARING: 14 May 2001 DATE OF JUDGMENT: 28 June 2001 JUDGMENT: REASONS FOR DETERMINATION AND ORDERS On 14 May 2001 the Tribunal commenced hearing a complaint brought by the Health Care Complaints Commission ("the complainant") against Dr Alan Campbell McLeay ("the practitioner"). The terms of the complaint, as amended from an earlier form, were, at the commencement of the hearing as follows:- DR ALAN CAMPBELL McLEAY, OF 38a Angus Avenue, Kandos, NSW 2848, ("the practitioner") being a medical practitioner registered under the Act: COMPLAINT ONE is guilty of unsatisfactory professional conduct and/or professional misconduct within the meaning of section 36 and 37 of the Act in that the practitioner contravened conditions imposed by a Professional Standards Committee convened on 29 January 1997, and subsequently varied on 7 July 1999. PARTICULARS 1. Failed to abstain from the use of alcohol on 6 March 1999 2. Failed to comply with condition 5 in that he failed to comply with Board Protocol for carbohydrate deficient transferrin and the collection of blood samples in that he: a. Failed to have blood drawn on the first Monday of each month b. Failed to have the blood collected under direct supervision c. Failed to have forwarded to the Medical Board nominated practitioner, Dr Harding Burns, each test result. 3. Failed to attend meetings of a local AA group between January 1997 and 7 July 1999. COMPLAINT TWO Has been convicted of an offence in New South Wales. PARTICULARS 1. At Rylstone Local Court on 11 June 1999 the practitioner was convicted of Drive with High Range PCA at Kandos, on 6 March 1999, pursuant to section 4E(1G)(a) of the Traffic Act, 1909. COMPLAINT THREE Has been guilty of unsatisfactory professional conduct or professional misconduct within the meaning of Sections 36 and 37 of the Act in that he: 1. Has demonstrated a lack of adequate knowledge, skill, judgment and care in the practice of medicine and/or 2. Has been guilty of improper and unethical conduct relating to the practice of medicine. PARTICULARS 1. The practitioner failed to inform the Medical Board nominated practitioner, Dr Harding Burns and the treating psychiatrist Dr Frukacz that he had been charged with and convicted of Drive with High Range PCA on 6 March 1999, and 11 June 1999, respectively. 2. The Practitioner failed to inform the Medical Board reviewers on 16 March 1999 that he had been charged with Drive with High Range PCA on 6 March 1999. 3. The Practitioner falsely informed the Medical Board reviewers on 16 March 1999 that he had not had a drink for two years. The amendments which had been made up to the first day of hearing were as to form only and introduced no further allegation. These amendments, accordingly, were made without objection. Indeed, at the commencement of the hearing, Ms Kiel for the practitioner admitted on her client's behalf that the complaints were valid at least insofar as unsatisfactory professional conduct was concerned and that the Particulars except for Particular 1(2)(c) under Complaint One were admitted. On the third day of the hearing, however, the complainant sought to add further particulars to Complaint One. This application was made pursuant to s5 ss2 of Schedule 2 of the Medical Practice Act. The effect of this application, once granted, was to add to Particular 1 of Complaint One the words "and between January 2001 and May 2001". It was thus alleged that the practitioner had consumed alcohol during this period as well as on 6 March 1999. Ms Kiel whilst not accepting the necessity to formally amend the Complaint and Particulars did not object nor did she seek any adjournment (other than to take instructions). The evidence upon which the complainant relies in relation to this allegation had come out in the course of the Tribunal hearing. There remain, therefore, two areas of dispute in relation to the facts which the Tribunal should find and a series of explanations on the part of the practitioner which the Tribunal must evaluate. BACKGROUND It is perhaps convenient to consider, firstly, the background to these proceedings. The practitioner first came to the attention of the Medical Board in 1987 with a complaint by the practitioner's second wife that he had a drinking problem. No further particulars were provided as requested and this matter went no further. The practitioner gave evidence that he was, in fact, relying on alcohol to "get to sleep" and to cope with the very great distress which had been occasioned him by his first wife. She had killed their two sons and had later suicided. In 1995 the Board received advice from Dr S Meagher that his employee, the practitioner, was at risk of problems from hazardous drinking. The practitioner was referred to Dr Harding Burns and ultimately a Professional Standards Committee was convened in November 1996 and, after an adjournment for further evidence, in January 1997. That Committee found "that the practitioner lacked insight regarding the impact of his drinking and motivation to change his drinking patterns". It concluded that it was concerned that the practitioner had persisted in his denial of his drinking problem until the latter part of his evidence:- "Faced with this degree of denial, the Committee considers that its orders should place strict conditions on Dr McLeay's behaviour in regard to his use of alcohol and that this is essential in order to protect the public." Having found that the practitioner suffered from an impairment which affected or was likely to affect his capacity to practice medicine the Professional Standards Committee imposed on his registration the following conditions:- 1. That Dr McLeay abstain from the use of alcohol. 2. That he contact a local AA group and attend their meetings. 3. To attend for treatment by a psychiatrist of his choice, experienced in treatment of alcohol abuse, at a frequency to be determined by the treating doctor. To authorise the treating psychiatrist to inform the Board of termination of treatment or if there is a significant change in health status. 4. To attend for review by a Board-nominated practitioner experienced in the management of drug and alcohol problems initially on a six monthly basis at the Board's expense. 5. That blood be taken for measurement of carbohydrate deficient transferrin levels at monthly intervals and for liver function tests every three months. The results of all tests to be forwarded to the treating and Board nominated doctors. 6. Attend a Review Interview at the Board in twelve months time. 7. These conditions may be varied at the discretion of the Board or the Health Committee after a period of twelve months. A review was conducted on 13 January 1998. At that time CDT test results were available for only five of the intervening months. These were, however, all within normal limits. The members of the Review Panel observed that the practitioner was:- "…somewhat oblique in his response to questions and at times perseverative… He continued to practice considerable denial of his past use of alcohol and the problems that it had caused him. He was certainly unconvinced as to the merit of continuing the CDT monitoring or the wisdom of abstinence from alcohol". Accordingly, that Review Panel regarded the practitioner as remaining vulnerable and at risk of relapse of alcohol abuse or dependence and needing to continue to comply with the conditions of his registration. Indeed the comment was made that:- "Dr McLeay also needs to appreciate the seriousness of his circumstances and the conditions of his registration and ensure that he complies rigorously with the requirement for monthly CDT monitoring with the results to go to the Board. Failure to do so must raise the question as to whether Dr McLeay maintained abstinence from alcohol at all times." A Review was considered necessary in six months and this was conducted on 6 August 1998. That Review Panel was impressed by the normal CDT results which were available supporting, as they did, the practitioner's claim of complete abstinence. It was agreed that he should be reviewed in eight months time after two further visits to Dr Harding Burns. The practitioner is reported to have told that Review Panel that "he sees his medical consultant Dr Frukacz in Mudgee approximately three-monthly". Dr Frukacz, in his report dated 4 April 1999, recorded that he had examined the practitioner on 12 October 1998 and that he had seen him on two earlier occasions either at Rylstone or at Mudgee. Dr Frukacz suggested that the practitioner should continue to see him at three to six monthly intervals or as required. This is not in accordance with the history given by the practitioner to Dr Harding Burns that following the consultation in October "Dr Frukacz has discharged him". It is noted that the next occasion on which the practitioner saw Dr Frukacz was 6 September 1999 that is after a gap of eleven months. In any event the Review Panel which interviewed the practitioner on 16 March 1999 informed him that there was concern about the absence of a report from Dr Frukacz in circumstances where he had "discharged" the practitioner and that there had been no CDT test results for six of the last twelve months. When asked about his alcohol consumption the practitioner told the Panel on 16 March 1999 that "he had not had a drink for two years". HIGH RANGE PCA It is a fact that on 6 March 1999 whilst driving his car at Kandos the practitioner was stopped by the Police and recorded a blood alcohol reading in excess of .150mg per 100ml of blood. His evidence is that that reading was ".2 something". He was convicted for this offence on 11 June 1999 and his appeal was later dismissed. Clearly Complaint Two and its Particulars are established. It follows necessarily that Complaint One Particular 1 (at least as it stood originally) is made out. The practitioner had failed to abstain from alcohol on 6 March 1999. It is also clear that all of the Particulars nominated under Complaint Three are also made out. He had failed to inform his treating psychiatrist, the Board nominated practitioner and the Board reviewers of his breach of this condition and of his conviction for this offence. He had lied to the Board's reviewers in telling them, ten days after his arrest, that he had not had a drink for two years. In explanation of these matters the practitioner gave evidence that he had been "very scared that the Board might take a very dim view". He conceded that he had been "foolish - very foolish" but described his lapse as being the product of a very stressful experience with a patient. This patient was a person with schizophrenia who in a floridly psychotic state had confessed to the grisly killing of another patient - a confession which later enquiries established to have been accurate. The practitioner said that this encounter was on a Friday morning. He had consulted his legal advisers and that evening had drunk two to three glasses of white wine. The following day, after surgery, he had consumed a like amount of white wine and after this, he had been apprehended at a random breath testing station. This, he said, was the only occasion (or strictly speaking two occasions) on which he had failed to abstain from alcohol. When questioned about his failure to advise the Board reviewers there was however this revealing exchange:- "Q. You admit then that you didn't tell the Board, and you didn't tell Dr Harding Burns or Dr Frukacz of the high range PCA charge and conviction? A. No. It was never discussed. I was never asked about it." This attitude of perceiving the Board and the medical practitioners he was consulting as being somehow complicit in the concealment of his offence by not asking him is of some concern to this Tribunal. This is but one of a number of examples of the practitioner seeking to avoid his own responsibility by blaming others or alleging some failure of communication or complaining of a lack of clarity or definition in the wording of the conditions by which he was bound. There has been a marked lack of candour at best and, at worst, an attitude of positive deception exhibited by the practitioner. Thus the statement to Dr Harding Burns and apparently to the Review Panel of 16 March 1999 that Dr Frukacz had "discharged" him is a statement not borne out by that doctor's reports. The practitioner had omitted to tell any of the Review Panels that he was not attending AA meetings, as required, or at all. Dr Harding Burns opined that this is not a particularly significant breach because he accepts that in a country area such as Rylstone where the practitioner is situated there are problems. Anonymity is virtually impossible. The group which does meet at Rylstone meets, it is said, in an hotel. The value of the AA program varies according to the degree of commitment on the part of the member and since the practitioner's commitment to this organisation is obviously low he has not, in Dr Harding Burns' opinion, lost much in failing to attend. The Tribunal accepts the views of Dr Harding Burns and does not regard the practitioner's failure to attend AA as being, in all the circumstances, a very grave breach in itself. Of much more concern is the fact that the practitioner concealed his non-attendance from the reviewers and did not take the opportunity to raise with his treating psychiatrist or the Board nominated practitioner or the reviewers themselves the practical difficulties in complying with this condition. It appears that once these practical difficulties were made known the obligation to attend was removed. This was recommended by the Review Panel of 7 July 1999. Thus the condition itself was recognised as not being of particular importance. The practitioner's lack of candour about his non-observance of this condition is, however, of continuing concern. Far more serious, still, is the situation which has obtained in relation to the practitioner's CDT testing. Condition 5 as imposed by the Professional Standards Committee on 29 January 1997 read as follows:- "That blood be taken for measurement of carbohydrate deficient transferrin levels at monthly intervals and for liver function tests every three months. The results of all tests to be forwarded to the treating and Board nominated doctors." The practitioner acknowledged that he had received and had read a copy of that Committee's determination and furthermore that he had received and read a copy of the Medical Board's Handbook for Impaired Registrants. This contained an explanation of the purpose of the monitoring program. Amongst other points made it is specified that:- "A principal objective of the monitoring program is to move the practitioner towards accepting responsibility for his or her own health and to demonstrate a level of insight that should protect against a recurrence of the problem." The handbook spells out the role played by the Board nominated practitioner and the form and purpose of the review interviews. The following passage appears:- "The Board review interview also provides the impaired practitioner with an opportunity to clarify any matters relating to their conditions, to relay any requests to the Health Committee and to demonstrate a continued commitment to their rehabilitation." Annexed to the handbook is a copy of the Medical Board's protocol for CDT testing. Amongst the requirements of that protocol are:- "2. Blood is to be collected under direct supervision. Most of the major pathology laboratories are able to draw the blood sample or alternately a nominated practitioner may draw the sample for direction to the appropriate facility. 4. Blood should be drawn on the first Monday of the month, unless otherwise specified in the conditions of registration. 5. CDT results must be forwarded to both the treating practitioner and Board nominated practitioner or any other person(s) as specified in the conditions of registration." It is noted that a copy of the decision of the Professional Standards Committee and the copy of the handbook were forwarded to the practitioner by letter from the New South Wales Medical Board dated 28 February 1997 and in that letter itself the conditions of his registration and details required for compliance were spelt out. At the first review on 13 January 1998 as already noted the panel raised with the practitioner the absence of some test results and the question which would arise if he did not "rigorously" comply with the testing requirements. "Normal CDT results" were a factor which favourably impressed the second review panel on 6 August 1998. Missing CDT reports were the object of specific concern reached by the third review panel on 16 March 1999. The Review interview of 7 July 1999 recorded that:- "Dr McLeay told the panel that the blood for his monthly CDT and three monthly liver tests is collected monthly by one pathology service, but he has arranged for it to be sent to the laboratories of another pathology service. For part of the day of collection, the blood samples can be in his care." As at 22 October 1999 the Review Panel's report reads:- He stated he had been most particular in obtaining blood test results and was changing the means of collection so that they were more satisfactory for the Board." In the report of review interview conducted on 19 December 2000 the following passage appears:- "Asked how the blood samples were taken and processed, Dr McLeay said they were taken at the local hospital. He took them back to his surgery where they were centrifuged and refrigerated until picked up by the courier to be taken to GCL in Sydney. At this point Mr Hogan said he would have to consider advising Dr McLeay not to respond to this line of questioning, since this was one of the issues in the complaint to the Medical Tribunal instigated by the Board. However the reviewers pointed out that if Dr McLeay was currently breaching the conditions it would be in his best interests for him to have conformed for some time before the complaint was heard by the Medical Tribunal. After the reviewers had explained the necessity for a secure 'chain of custody' Dr McLeay commented on how difficult it was for a solo rural GP to comply, and asked would it be appropriate for the blood to be taken by a registered nurse. The reviewers advised that it would be appropriate, provided it was formally taken at the hospital and not by his wife, and that the sample was held and processed by the hospital in the normal way and transported by courier to the laboratory." THE FACTS There was extensive cross-examination during which the practitioner continued at times to equivocate. The following emerged as his sworn version of the reality in relation to the CDT testing. On the very first occasion in early 1997 blood had been drawn by an employee of the laboratory pathology service at Kandos. This sample had then been returned to the practitioner who had taken it away, centrifuged it, prepared it for transportation and forwarded it to General Clinical Laboratories (GCL). Mr Boswell, supervisor of GCL had then arranged for the liver function tests and for the forwarding of a further portion of the sample for CDT testing. At first this was sent to the Hunter Immunology Unit in Newcastle. On subsequent occasions the sample was sent to Concord Hospital which was the only remaining centre at which CDT testing was undertaken. Since October 1999 no CDT testing has been available anywhere in New South Wales. From the second occasion, ie, about March 1997, onwards, the practitioner drew his own blood, centrifuged it, packed it and forwarded it to Mr Boswell. On occasions, not always, one of the collection nurses from the local pathology laboratory was present to witness the drawing of the blood but otherwise had no oversight of the sample. This continued until about November 2000. It is manifest that the "normal CDT results" on which such store has been placed are entirely worthless. There can be no guarantee of the integrity of any sample submitted for any testing prior to December 2000. It ultimately emerged that since December 2000 the practitioner has complied with the protocol. A sample of his blood has been drawn by a representative of Dubbo Pathology and that sample has not thereafter been in the custody of the practitioner. The results of testing from December 2000 to May 2001 are, therefore, valid and valuable in the insight they provide. When these results were finally produced they showed alarmingly raised levels of GGT and other liver enzymes in the results for February 2001. These levels have since decreased. Dr Staraj the former principal pathologist at GCL and Dr Harding Burns expressed the view that the most likely explanation for these test results is that the practitioner engaged in some significant alcohol consumption between the test in December which was normal and the test on 1 February 2001. In the absence of CDT testing it is not possible to be scientifically certain that the insult to the practitioner's liver was from alcohol rather than from some other cause such as viral infection or even his consumption of Celebrex. The latter is, however, less likely as an explanation because of his use of Celebrex both before and after February 2001. No symptoms of illness were reported by the practitioner as temporally coinciding with the February test results. Mr Boswell, with his background as a medical scientist, endeavoured to propound the view that alcohol was less likely as an explanation for these test results than other causes such as viral infection etc. The Tribunal was unimpressed with his exposition. He is a long time close friend of the practitioner. The determination of the likely cause of these test results is one more for a medical practitioner to make in the context of clinical presentation. Mr Boswell's scientific background is not really such as to equip him for this task. The conclusion of the Tribunal is that he was doing his best for his friend but his opinion is not persuasive. ONUS AND STANDARD OF PROOF It is appropriate at this stage to detail the legal principles under which the Tribunal operates. The standard is that referred to in Rejfek v McEloy (1965) 112 CLR 517 as applied in Bannister v Walton (1993) 30 NSWLR 699. In that latter case it was held that the requirement is that the Tribunal be "comfortably satisfied on the balance of probabilities". In applying such standard the Tribunal has had regard to the gravity and importance of the matters to be determined by it in accordance with the principles set forth by Dixon J in Briginshaw v Briginshaw (1938) 60 CLR 336 at 361-362:- "Except upon criminal issues to be proved by the prosecution it is enough that the affirmative of an allegation is made out to the reasonable satisfaction of the Tribunal. But reasonable satisfaction is not a state of mind that is attained or established independently of the nature and consequence of the fact or facts to be proved. The seriousness of an allegation made, the inherent unlikelihood of an occurrence of a given description, or the gravity of the consequences flowing from a particular finding are considerations which must affect the answer to the question whether the issue has been proved to the reasonable satisfaction of the Tribunal. In such matters 'reasonable satisfaction' should not be produced by inexact proofs, indefinite testimony, or indirect inferences." On the basis of the evidence of Dr Staraj and the opinion of Dr Harding Burns which the Tribunal accepts the Tribunal is comfortably satisfied that some time before 1 February 2001 the practitioner engaged in the consumption of alcohol and this to a hazardous level. The amended Particular 1 of Complaint One is established. There remains, for completeness, the issue of Particular 2(c) of Complaint 1. The practitioner gave evidence to the effect that he did not believe there was any personal obligation on him to forward the results of his blood tests to Dr Harding Burns. This was, basically, for two reasons. Firstly Dr Harding Burns received, because of his connection with Concord Hospital, the results of all CDT testing conducted there and consequently had access to the test results of the practitioner. Secondly, there was nowhere in the instructions given to the practitioner a direction that he should forward test results. He had understood it to be sufficient for him to authorise the laboratory to forward a copy of its report to the Medical Board. He did not forward these results or ask the laboratory to forward these results to Dr Frukacz although he was the treating psychiatrist because he did not think that Dr Frukacz would understand them. He at times seemed to have difficulty accepting that Dr Frukacz was his treating doctor because "he never offered any treatment." "Treatment usually means that either tablets or something is given out." Could this really be the view of a registered medical practitioner in relation to his treatment by a psychiatrist? The Tribunal regards this as specious. In fact nowhere in the directions given to the practitioner following the Professional Standards Committee determination was there a requirement that the test results be sent to the Medical Board. The requirement was then that they were to be forwarded to the treating and Board nominated practitioners. To the Panel which conducted the review on 7 July 1999 Dr McLeay "undertook to ensure that Dr Frukacz received copies of the CDT and liver function results as well as copies going to Dr Harding Burns and the Board". The practitioner clearly failed to comply with his undertaking. It should, in any event, have been obvious that Dr Harding Burns' access to CDT test results from Concord Hospital was not the same as him receiving the full range of test results. In fact the performance by the practitioner has been singularly unimpressive throughout the hearing. The Professional Standards Committee and the first Review Panel both expressed concerns about the practitioner's lack of insight. When cross-examined before the Tribunal he did not accept that Dr Harding Burns was correct in his opinion that "the practitioner has a significant and long standing alcohol dependence". The Tribunal certainly accepts this opinion. The practitioner said that he had told the Professional Standards Committee that he had suffered from alcoholism because "that was the way in which I felt I had to answer" although he believed his answer to be not true. He still does not believe he has a continuing problem with alcohol. This refusal to accept that he has a problem is gravely disturbing. The practitioner has displayed the full range of denial and deception. He persisted in defending his method of blood collection as being "the best available" and showed either an unwillingness or an inability to perceive that the integrity of the sample was of prime importance. When taxed with his statements to the Board reviewers concerning the method of blood collection he replied variously that he was not asked (!), that the reviewers had "got it wrong" or that the system he had devised was the best available anyway. The Tribunal rejects these propositions and concludes, as indicated earlier, that the practitioner is being either extraordinarily naïve or deliberately deceptive. His actions have thrown into doubt the proposition that he has been abstinent since 1997 even with the exception of the known occasions on which he has not. It is not, of course, the complainant's case that the practitioner has been regularly or even often affected by alcohol during that time. The evidence of Mr McLeish and Mr Huggett who both speak very highly of the practitioner would militate against any such proposition. It is, however, the complainant's case that the practitioner has been deceptive and has either deliberately or at the very best thoughtlessly destroyed the value of the Board's monitoring program. He has certainly taken alcohol and to a significant level on at least three occasions as demonstrated by the evidence. His ingestion of alcohol, his concealment and denial of this and in particular his actions in thwarting the Board's programme to monitor and assist him indicate a lack of judgment and constitute, because of the element of dishonesty, professional misconduct. He still has difficulty accepting either the existence of his own condition or the need to have it monitored and treated. In those circumstances there is ample room for concluding that the practitioner's patients are potentially at risk. The complainant asks that the practitioner be suspended. The Tribunal is of the view that that is indeed the appropriate order to make. Much concern has arisen as to the duration of any suspension. The Rylstone-Kandos area will be deprived of the services of the practitioner who it would appear functions, mainly at least, in an acceptable fashion. This militates against a prolonged suspension. The risk inherent in his lack of insight and deliberate absence of cooperation with the Impaired Registrants Program argue in favour of a long suspension. In the end the Tribunal has determined that it is likely that a suspension will bring home finally to the practitioner the seriousness of his condition, the need to cooperate completely with the Board's program and the foolishness of his former unhelpful attitudes. Accepting that suspension will make this clear to the practitioner the Tribunal has decided that he be suspended for a period of three months. Of course, on his resumption of practice there will remain the need for a prolonged and intensive regimen of monitoring and treatment. The conditions under which he should be registered need to be spelt out in terms about which there can be no possibility of confusion or misunderstanding. Those conditions are:- 1. That Dr McLeay abstain totally from the use of alcohol. 2. To attend for treatment by a psychiatrist of his choice, experienced in treatment of alcohol abuse, at a frequency to be determined by the treating doctor. To authorise the treating psychiatrist to inform the Board of attendance as required, of termination of treatment or if there is a significant change in health status. 3. To attend for review by a Board-nominated practitioner experienced in the management of drug and alcohol problems initially on a three-monthly basis at the Board's expense. 4. To attend a general practitioner of his choice within one (1) month of today's date and thereafter at intervals of not less than three (3) months (or more frequently as determined by that general practitioner). 5. The treating general practitioner is to be responsible for the ordering of blood tests. These tests are to be for liver function and MCV (mean corpuscular volume). For these tests blood is to be drawn by either the treating general practitioner, his employee, or an authorised employee of the Pathology Service which is conducting the tests. At no time is the practitioner to have custody of the sample. These tests are to be performed sometime during the first week of each calendar month. The practitioner is to authorise his treating general practitioner to request that the pathology laboratory send the results of all tests to the treating and Board-nominated doctors and to the Medical Board. 6. The practitioner is to notify the Medical Board within fourteen (14) days of today's date of the names and addresses of the general practitioner he has selected and his treating Psychiatrist so that a copy of these conditions can be forwarded by the Board to those practitioners. 7. These conditions may be varied at the discretion of the Board or the Health Committee after a period of twelve (12) months. COSTS Clearly these proceedings have been brought about by what the Tribunal has determined has been the repeated and prolonged series of failures on the part of the practitioner to face up to his responsibilities under the Impaired Registrants Scheme that is to adhere to the conditions upon his registration. There is no reason in these circumstances why costs should not follow the event. ORDERS The orders of the Tribunal are:- 1. That the practitioner is suspended for a period of three (3) months. 2. The practitioner is to pay the complainant's costs of and incidental to this application. 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.