New South Wales Medical Tribunal CITATION : DR CHRIS TSIOUTIS [1999] NSWMT 2 TRIBUNAL : Medical Tribunal PARTIES : DR CHRIS TSIOUTIS FILE NUMBER(S) : 40017 of 1999 CORAM: McGuire DCJ - Richards Dr, J G - Collier, Ms, A - Williams, Dr, A CATCHWORDS: LEGISLATION CITED: Medical Practice Act, 1992 Ex parte Tziniolis (1996) 84 WN9 (Part 2) page 275; CASES CITED: Bannister v Walton 30 April 1992 - unreported; Rejfek v McElroy (1065) 112 CLR 517 at 521; Briginshaw v Briginshaw (1938) 60 CLR 336 at 360-363 DATES OF HEARING: 15th December, 1999 DATE OF JUDGMENT: 15 December 1999 JUDGMENT: The Proceedings Chris Tsioutis, the applicant, has filed a document dated 16th June, 1999 entitled "Notice of Appeal under S.87 of the Medical Practice Act, 1992 and/or application under S.92 of the said Act". Filed in support is a statement dated 8th June, 1999. The Tribunal has treated the proceedings before it as an application made pursuant to S.92 of the Medical Practice Act 1992 (the Act) for review of an order of the Medical Tribunal of New South Wales made on 11th April, 1996 which is in the following terms: "The order of the Tribunal therefore is a finding that Dr Tsioutis is guilty of professional misconduct and the Tribunal orders that he be deregistered." The relevant terms of that application are as follows: 4. Grounds of appeal or application: a) Effluxion of time; b) The circumstances in which the deregistration occurred no longer prevail; c) Since April 1996 the Appellant has maintained and enhanced his medical knowledge in that he has practised in naturopathy, homoepathy and herbal medicine, has attended and participated in the following conferences:- i) in August 1996 in Queensland conference on Electro medicine - four (4) days; ii) in September 1996 on the Gold Coast conference on toxicity and environmental medicine - three (3) days; iii) in September/October 1996 worked abroad in Cyprus as a medical practitioner; iv) in November 1996 attended an international conference in Utah USA - attended workshop for advanced candidates on functional and environmental eletromedicine - two (2) weeks; v) in February 1997 completed twelve (12) month diploma course on herbal medicine; vi) in March 1997 attended the European Medical Acupuncture conference, Nicosia Cyprus. Also worked as a general practitioner in his brother's practise in Nicosia. vii) in May 1997 completed course in nutritional and environmental medicine by the ACNEM - one (1) week; viii) in August 1997 attended a four (4) day conference and workshop in Brisbane on energy medicine; ix) in August 1997 attended an international conference in Gerontology; x) During 1996 and 1997 the appellant attended the CHECK program (Continuous Home Evaluation of Clinical Knowledge) and completed same assessment results as yet are not available; xi) in March 1998 - the appellant attended a specialist training program in Melbourne - conducted by ACNEM - subject matters being allergies, detoxification and cancer. xii) in October 1998 the appellant attended a one (1) week General Revision Course conducted by the University of Sydney. xiii) in January 1999 completed the CHECK program of 1998 with a score of 94%. xiv) The appellant intends to attend the following programs:- a) Clinical Medicine update for General Practitioners to be held by the University of Sydney on 27 June 1999. b) Cardiology updated on 19 June 1999. c) International Congress on Natural Medicine in July 1999. d) Seminars to be held by ACNEM in September 199, subject matter being Chronic Fatigue and Psychotherapy and Nutrition. xv) Since the date of deregistration and until early January 1999 the appellant has been practising as a naturopath and nutritionist at Burwood. Since early January 1999 the appellant has ceased practising in Burwood and commenced practising from premises 129 Booth Street, Annandale. During the course of each week he would see approximately 15 people as naturopathic patients. 5. Since April 1996 the appellant has maintained and enhanced his medical knowledge by attending the CHECK (Continuous Home evaluation of Clinical Knowledge) program conducted by the Royal College of Physicians and has successfully completed the assessment of the annual revision seminar in Sydney conducted by the Royal College of Physicians. 6. Any further delay in the resumption of medical practice by the appellant will possibly result in a decline in his medical skills and knowledge; 7. The appellant can make a more significant contribution to the welfare of his patients and to the community generally if he is able to practise medicine. 8. The medical competence of the appellant has never been questioned. In 1995 he satisfactorily completed the conditions of the Recognisance into which he entered as a result of the sentence imposed in the District Court. His period of disqualification from participation in the Medicare Scheme expired in 1994. Accordingly, he has served his punishments for his infringements of the law, but continues to be punished by his deregistration. 9. Orders sought by the appellant are to be reinstated under the Medical Practitioners Act, 1992. The statement of the 8th June, 1999 is in the following form: "I, CHRIS TSIOUTIS , of 129 Booth Street, Annandale state:- 1. On 11 April 1996 the Tribunal made a finding that I was guilty of professional misconduct and ordered that I be deregistered. I respectfully request that the Tribunal review the position and permit my registration as a medical practitioner forthwith. 2. I crave leave to refer to material already before the Tribunal including:- a) the remarks on sentence of Herron DCJ of 24 August, 1993; b) the decision of the Medical Participation Review Committee dated 22 December 1993; c) references previously produced; d) the judgement of the Tribunal on 11 April 1996. 3. I have maintained and enhanced my medical knowledge by practising as a naturopath and nutritionist from April 1996 to January 1999 I conducted my practise at Burwood. Since January 1999 I have ceased to practise at Burwood and opened a practise in Annandale. During the course of each week both in Burwood and in Annandale I would consult approximately 15-20 people. 4. Since April 1996 I have maintained my expertise in the practise of medicine by working as a general practitioner in Nicosia in Cyprus where I am a registered medical practitioner and where my brother has a medical practise. I practise medicine there twice a year, the most recent period being February, 1999. 5. Since April 1996 I have maintained and enhanced my medical knowledge in that I have attended and participated in the following conferences:- a) in August 1996 in Queensland conference on Electro medicine - four (4) days; b) in September 1996 on the Gold Coast conference on toxicity and environmental medicine - three (3) days; c) in September/October 1996 worked abroad in Cyprus as a medical practitioner; d) in November 1996 attended an international conference in Utah USA - attended workshop for advanced candidates on functional and environmental electro medicine two (2) weeks. e) in February 1997 completed twelve (12) month diploma course on herbal medicine;] f) in March 1997 attended the European Medical Acupuncture conference, Nicosia Cyprus; g) in May 1997 completed course in Nutritional and Environmental Medicine conducted by the Australian College of Natural and Environmental Medicine; h) in August 1997 attended a four (4) day conference and workshop in Brisbane on energy medicine; i) in August 1997 attended an international medical conference in Adelaide on gerontology; j) in March 1998 attended a training program in Melbourne conducted by the Australian College of Natural and Environmental Medicine on allergies, detoxification and cancer; k) in October 1998 I attended a one (1) week General Revision Course conducted by the University of Sydney. l) in January 1999 I completed the CHECK program of 1998 with a score of 94% m) I intended to attend the following programs:- i) Clinical Medicine update for General Practitioners to be held by the University of Sydney on 27 June 1999. ii) Cardiology updated on 19 June 1999. iii) International Congress on Natural Medicine in July 1999. iv) Seminars to be held by ACNEM in September 1999, subject matter being Chronic Fatigue and Psychotherapy and Nutrition. 6. Since 1996 I have maintained and enhanced my medical knowledge by attending the CHECK (Continuous Home Evaluation of Clinical Knowledge) program conducted by the Royal College of General Practitioners and have successfully completed the assessment on each occasion. In February 1998 I attended the annual revision for general practitioners at the University of Sydney conducted by the Royal College of Physicians. 7. I conducted the practice at Burwood and now the practice in Annandale as a naturopath and nutritionist each morning. The income derived from this practice is insufficient to support my family. I wish to resume full time medical practice in order to earn sufficient income to properly support my family. I believe as a result of my experience over the past three years that the combination of orthodox and complementary medicine would be beneficial to my patients. 8. Since I ceased the practice of medicine I have considered alternative forms of employment. None of these option have provided me with complete satisfaction and my deep desire to practise medicine has been confirmed by my circumstances over the past three years. The practice of alternative medicine has provided me with a limited opportunity to treat people suffering from illness. However, the limitations upon that form of practise have also confirmed the necessity of being able to provide a complete service to patients in the form of traditional medicine. This position has caused me to appreciate even more the stupidity of my conduct which lead to the convictions against me, and to appreciate further the necessity to maintain standards of honest and integrity in all aspects of medical practise. If given the opportunity to resume practise, there is no likelihood that I would jeopardise my professional future in the same manner ever again. 9. I wish to explain my non-attendance before the Tribunal in April 1996. By that stage I had been a subject of investigation and prosecution for nearly six years. The situation had been traumatic to me in a professional and personal sense. The point was reached at which my health had deteriorated and by the time of the hearing before the Tribunal I could not face the humiliation that I would experience from another public exposure of the same facts without further risking my health. In a sense, I had lost the will to fight and in the end asked my solicitor to attend before the Tribunal as a sign of respect and in order to explain my position. I have never abandoned my desire to practise medicine. My health is now fully restored and my desire to practise medicine is stronger than ever." An order that the applicant be re-admitted to the register as a medical practitioner is dependant upon the applicant satisfying the Tribunal that he is now a fit and proper person to be registered. The application for review was treated as an application for an order that the appellant be registered. The onus is upon him to demonstrate: a. that he has overcome the defect of character which led to the conduct requiring his removal from the register; b. that he has now rehabilitated himself to such an extent that he is now a person of good character for the purpose of practising medicine. Legal Principles In considering whether the applicant has overcome the defect in his character which led to his deregistration and has rehabilitated himself, the Tribunal has applied the principles as set out in the following statements: a. Walsh JA in Ex parte Tziniolis (1996) 84 WN9 (Part 2) page 275 at page 286: "Reformations of character and of behaviour can doubtless occur, but their occurrence is not the usual but the exceptional thing. One cannot assume that a change has occurred merely because some years have gone by and it is not proved that anything of a discreditable kind has occurred. If a man has exhibited serious deficiencies in his standards of conduct and his attitudes, it must require clear proof to show that some years later he has established himself as a different man. The position is somewhat similar to that which exists when application is made by a barrister or a solicitor who has been found guilty of serious misconduct exhibiting a lack of proper standards, seeking reinstatement on the ground that, after a lapse of time, he has become a fit and proper person to be a member of a profession which requires qualities and standards in which he is known to be deficient. In such cases it has been frequently said that a heavy onus lies on the applicant - see Ex parte Clyne [1962] SR NSW 436 at 441 and cases there cited" b. Mahoney JA in Bannister v Walton 30 April 1992 - unreported. "The right to practice [medicine] affords to a practitioner privileges and opportunities which are not available to others. He is expected to maintain a relationship with patients who are affected by his character. The relationship is one which touches matters such as trust, confidence, confidentiality and right conduct. Clinical capacity is by no means the only consideration to which regard is to be had in determining whether a person is appropriate to practice medicine. It is necessary that the public be protected against those who, though having the appropriate skills do not have the character for the opportunities and privileges which the right to practice gives." Standard of Proof The standard of proof to be applied by the Tribunal is that referred to in Rejfek v McElroy (1065) 112 CLR 517 at 521. That standard was applied in Bannister v Walton (1993) 30 NSWLR 699 where it was held that the requirement is that the Tribunal be "comfortably satisfied on the balance of probabilities". The Tribunal must have regard to the gravity and importance of the matters which it is deciding in accordance with the principles stated in Briginshaw v Briginshaw (1938) 60 CLR 336 at 360-363. At pages 361 and 362 Sir Own Dixon stated: "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 obtained or established independently of the nature or 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 proved by inexact proofs, indefinite testimony, or indirect inferences." The Tribunal notes that one of the grounds of the application is "Effluxion of time". When considering this ground and the obligation cast upon the applicant to satisfy the Tribunal that he is now a fit and proper person to be registered regard was had to what was said by the Tribunal in Shariff , Medical Tribunal, 2 October 1990. "The principal issue to be determined by this Tribunal is whether the Applicant has proved that he is now of that good character which befits a person to practice medicine. The onus lies on him to establish that he now bears such good character. As a person whose name has been removed from the Register he has to accept that it has been found that he was guilty of conduct which showed a defect of character incompatible with membership of a self-respecting profession. It is necessary for the Applicant to satisfy this Tribunal that the defect which led to the conduct requiring such adverse finding has been overcome. Clear proof is required to satisfy the onus which lies on the applicant; one cannot rely merely on the effluxion of time." A similar statement was made by the Tribunal in Prakash "The onus is on the Applicant to satisfy the Tribunal on the balance of probabilities that he is now a fit and proper person to be registered. This onus requires him to prove that he is of good character and that he has overcome the defect in his character as shown by his previous dishonest and fraudulent conduct. It is a heavy onus as it is not easy of proof and one cannot rely merely on the effluxion of time. The Tribunal is well aware that the Applicant's deregistration occurred well over three years ago, however, he must do more than merely point to this fact, and to rely upon a course of good conduct subsequent to such deregistration. The Respondent has sought to demonstrate that the Applicant has not addressed the defects in his character which gave rise to his misconduct, that he has no real insight into the gravity of his misconduct and has not behaved in a manner reflecting exemplary behaviour and change in his character. We will deal further with this aspect of the matter. Previous Proceedings The Applicant came before the Medicare Participation Review Committee which handed its judgment on the 22nd December, 1993. That judgment conveniently sets out relevant matters with regard to the Applicant's background and his conduct. It was frequently referred to during the course of the proceedings before this Tribunal and it is common ground that it is an accurate statement of the facts contained therein. The Tribunal has adopted the following extracts from the findings of the Committee. Such findings are entirely consistent with the material tendered by the Applicant, his evidence before this Tribunal and the material tendered by the Respondent. On 24 August 1993, the abovenamed practitioner was convicted on indictment of 48 counts under section 128B of the Health Insurance Act 1973. He was released, without a sentence being recorded, on a recognisance to be of good behaviour for two years on condition that he pay to the Commonwealth a penalty of $5,000.00. Section 128B creates the offence of knowingly making a statement which is false in a material particular. The amount of which the Health Insurance Commission was defrauded was $1,420.19. The 48 offences were committed between 28 March 1989 and 17 July 1990. The sentencing judge, Herron DCJ, on that occasion drew attention to the smallness of the amount involved in the fraud by comparison to the total earning of Dr Tsioutis from the Health Insurance Commission over the period, some $380,000.00. Commission records show that for the 12 months commencing on 1 October 1989, he earned just short of $350,000 from Medicare, almost two-thirds of this from standard - that is 5 to 25 minute - consultations. Having pointed this out His Honour went on to say: "It is beyond comprehension as to why this man should have resorted to petty theft … It represents however dishonesty and serious misconduct on the part of a medical practitioner. If he were to plead guilty to these offences he would, I would have thought, be in grave danger of being struck off the medical register." The subject facts behind the offences appear to have been these. Dr Tsioutis had been working very long hours in his two practices. He decided to take on an assistant and acquired a Dr A, newly graduated and still undergoing his residency, to work part time with him. Dr A was to be paid a percentage of the fees earned by him. Because of his youth and inexperience and Dr Tsioutis' established reputation, Dr As earnings under this contract did not satisfy him. Dr Tsioutis sought to divert earnings to him, first by recording some patients as having been seen by him who had actually been seen by Dr Tsioutis and second, by having him perform certain procedures, such as ECGs, on patients who had consulted with Dr Tsioutis. (This had the additional benefit of reducing the volume of ECGs performed by Dr Tsioutis.) In these cases two assignment forms would be completed and two claims made, one for each of the doctors. To obscure what was being done a false date would be put on one of them. A second modus operandi involved the receptionist/secretary with whom, at the time, Dr Tsioutis was romantically involved. She would prepare false claims for consultations that had never been held and Dr Tsioutis would knowingly complete them. The patient at the time of consultation would be requested to, and would, sign an additional assignment form which would then be filled in for another consultation on a different date. Usually, to obscure the fraud, the second form would be used to claim for a non existent consultation on another member of the family of the signor. The Committee disqualified the Applicant from participating in Medicare for a period of 9 months. The Tribunal which made the finding that the Applicant was guilty of professional misconduct and ordered that he be deregistered on the 11th April, 1996, made the following observations: "In my view the conduct of Dr Tsioutis, as demonstrated in the offences to which he has entered a plea of guilty, is such as to make the appropriate decision of this Tribunal a decision that he be deregistered in accordance with the Medical Practice Act. I say that because there are a number of offences to which he has pleaded guilty. They demonstrate that over a period he has committed a number of breaches of the law and they are breaches of a kind which indicate that he knew exactly what he was doing and they were deliberate acts. The authorities speak clearly of the need to support the schemes which have been put in place and which are of fundamental importance for the protection of the health of the community, and those schemes depend significantly upon the probity of the medical profession, and indeed it must be accepted that the medical profession is in a particular position of trust in respect of these schemes, and offences of this kind should properly be viewed by this Tribunal as a significant betrayal of that trust. It appears to me that the number and nature of these offences are such as to require a very positive statement of policy and practice by this Tribunal to the profession and that statement is that where there has been such a betrayal of trust there should be a deregistration." Application for Review It was accepted by the Medicare Participation Review Committee that the Applicant was of good character prior to his offences. Character references were placed before the Tribunal which deregistered the Applicant. This Tribunal has carefully considered the references placed before it which included all of the references placed before the various bodies which considered the conduct of the Applicant including the Professional Standards Committee. Whilst this Tribunal has no difficulty in accepting the propositions that the Applicant was of good character prior to his criminal offences, that he was a busy, hardworking, devoted practitioner and that he has performed the activities and undertaken the courses and programs detailed in his application, it is noted that no recent statements as to his character have been furnished. The Tribunal is prepared to accept that he has assiduously sought to educate himself in the manner described in his statement to the Tribunal and to maintain and to enhance his medical knowledge. The Tribunal is acutely aware that the Applicant has been subjected to a variety of penalties which have undoubtedly caused him extreme concern and distress. He was subject to Committal proceedings and the prospect of a trial before the District Court. No doubt he appeared on a number of occasions before a Magistrate and before the District Court and underwent the traumas involved in the Sentence Indication proceedings and the sentencing hearing before Judge Herron. He was then faced with the hearing before the Medicare Participation Review Committee, the Professional Standards Committee, the Medical Tribunal hearing, albeit that he did not attend that hearing and the hearing before this Tribunal. Whilst the Tribunal is not appraised of full details of the Applicant's financial losses as a result of suspension and deregistration, it is patently obvious that the curtailment of his income and the expenses involved in legal representation on numerous occasions would have cost him dearly. Furthermore, the Tribunal readily accepts that he has been subject to the embarrassment and humiliation of criminal convictions and deregistration with the attendant grave damage to his reputation in the eyes of his former patients, friends and medical colleagues and the consequent lowering of his status in the community. The duty of this Tribunal however is not to determine whether he has been sufficiently punished for his transgression. This body has no function equivalent to a Court of Appeal which might reduce or confirm some form of penalty. It is our task to determine whether he has been rehabilitated to such an extent that he is now fit to be restored to the register for the purpose of resuming as a medical practitioner. Background of Practitioner The Applicant is of Greek extraction. He was born in Cyprus on the 12th February, 1951 and obtained his medical degrees in Athens. Upon migrating to Australia he passed examinations entitling him to practice medicine here in 1978. Having completed his residency at St. Joseph's Hospital he remained on the staff there until entering private practice in 1980. As at 1989 when the offences commenced he conducted two practices, one in Campsie, the other in Strathfield. Clearly he was an extremely busy practitioner and attracted a large clientele. His services were much sought by the Greek community. The Applicant completed course in Iridology, Homoepathy, Acupuncture, Musculo-skeletal medicine, manipulation and the like. His application sets out his activities with regard to pursuing a medical education since his deregistration in 1996. It is to be noted that he worked as a general practitioner in his brother's medical practice in Nicosia. The Applicant had placed before the Medical Tribunal which deregistered him a statutory declaration of the 31st March, 1996 to which was annexed a copy of a statement submitted by him to the Medicare Participation Review Committee. Paragraph 5 and 6 of that statement are in the following terms: 5. The circumstances of the charges to which I pleaded guilty vary considerably but almost all of them arose from the situation which occurred in 1989 and 1990 as a result of my affair with Mrs X and my employment of Dr A. 6. A substantial number of the offences occurred because of the actions of mrs X. I became aware that from time to time she was obtaining from patients who spent long periods of time with me in my surgery an additional assignment form to that which the patients signed upon their arrival at the surgery, and, presumably in order to avoid attracting the attention of the Health Insurance Commission, was marking the second assignment form in the name of another family member shown on the Medicare card from which the imprint was taken. I assume Mrs X intended to act in my best interests and out of our emotional attachment. She did not initially inform me of her actions, but I was told of it later. I told her to stop the practice as it would get me into trouble. I assumed that she had stopped but I regret now that I did not check with her again that that was the case 9. Further, after 12 February when Dr A received 50% of fees for services provided by him, I was concerned that Dr A was not earning sufficient income because he had very few patients of his own and my patients were slow to forego treatment by me and to place their confidence in him. I was anxious to retain his interest in the practice as I was hopeful that he would eventually purchase it. Therefore on some days when Dr A was working at the hospital, I would use his surgery to see a patient while another patient was preparing in my surgery, and I would obtain an assignment form from the patient in his name in order to generate income for him. A substantial number of the counts in the indictment come within this category (counts 22-32)." The clear impression gained from the Applicant's explanation to the original Tribunal in his statement is that his fraudulent conduct was substantially brought about (a) because of the actions of Mrs X and (b) some form of altruism on the Applicant's part in assisting Dr Artemi. He conveniently glossed over the fact that he was receiving a financial benefit. In the course of that statement he claimed that he pleaded guilty to all of the charges before Judge Herron for the sake of having the matter finalised and that some of the counts were denied. For example, charges involving attendances upon his parents by Dr A. Further, that he was suggesting that his mother and father would support his claim. Yet before this Tribunal he agreed that that claim was false. He also agreed that his claim in the statement with regard to Dr A wasn't true. In his evidence before this Tribunal he was prepared to agree that he did deliberately falsify claims to obtain money from the government yet when asked whether he embarked upon a deliberate scheme to obtain money he replied "no". He was cross examined as to various instances of dishonesty to which he had pleaded guilty with a view to ascertaining whether he had any realisation of the extent and seriousness of his misconduct. He persistently gave evasive answers and gave the clear impression that he didn't want to unequivocally admit his dishonesty. At the conclusion of the second day of this hearing it became apparent that it was necessary for Mr Lynch representing the HCCC, to cross examine Mr Tsioutis in relation to each of the matters in respect of which he had entered guilty pleas before Judge Herron in order to ascertain just what criminal conduct he was now acknowledging. It was agreed that he would instruct his legal representatives as to what matters he now conceded and as to what matters were in dispute. This difficulty has now been resolved by a written acknowledgment of the charges which are no longer in issue. The Applicant was insistent that the false claim ceased after he had a discussion with his receptionist, Mrs X in July and that he had threatened to dismiss her before becoming aware of the investigation into his count. On the other hand, he conceded that he wasn't sure whether that discussion occurred before he knew that she had been approached by the HIC However, he subsequently agreed that he knew that the HIC had spoken to her by the time she was sacked. When it was suggested to him that the reason he sacked her was that the HIC suspected irregularities he claimed that he sacked her after she confessed to him. The Tribunal holds no doubt that the lady was sacked not because of her dishonesty, but only after the practitioner became aware of pending investigation. Any "Confession" would not have revealed much that wasn't fully known to him. The Applicant gave this Tribunal the distinct impression that he was prepared to give answers which he considered to be most suitable to his interests. It is a matter of concern that he was prepared to cast substantial blame upon Mrs X and to some extent on to Dr A and to seek to distance himself from any involvement with much of their conduct. He was at pains to explain his conduct by the combination of factors. He was under a great deal of strain at home, he was working lengthy hours in his practice, he was influenced by Mrs X and his sexual relationship with her and he was endeavouring to assist Dr A. Dr A didn't commence working in the practice until January or February 1990. As to whether his dishonest conduct coincided with the existence of his relationship with Mrs X it is difficult to say as he gave varying estimates of the length of his sexual relationship with her. It is difficult to accept him as a reliable raconteur. At one point he sought to explain Mrs Xidas's actions on the basis that he felt that she was being kind to him by pushing the occasional few dollars his way. Further, that she continued to do this even though he had told her not to. Mrs X of course was aware of his income of approximately $350,000. The applicant was repeatedly taken to the question of whether he had made false representations in the statement which was placed before the various disciplinary bodies and the Medical Tribunal in 1996. He claimed in that statement: "There was certainly no occasion when an assignment form was signed without a service being provided". He eventually agreed that he was inventing consultations which hadn't occurred - that that's how the fraud occurred in some instances. He was forced to concede that that claim was deliberately false when he signed the statement. It follows that he allowed that false statement to be considered by the Medicare participation Review Committee. When it was put to him that he had deliberately lied to the Medicare Participation Review Committee, he replied "I have no comment on that. I cannot comment". It is unnecessary to demonstrate chapter and verse the various inconsistencies in the applicant's evidence before this Tribunal and the inconsistencies between what he said here and in his various statements. Suffice it to say that he was evasive in the extreme. He obfuscated and it is impossible to escape the conclusion that he was less than frank before this Tribunal. The essential difficulty posed by this conduct is that it was virtually impossible to establish a platform of his understanding of what he had done so that a comparison could be made between the applicant's past and present character and attitude. The statement that he made in 1993 contained such representations as "I could assure the Committee that I did not embark upon a deliberate scheme to wrongfully claim moneys in such a minor amount. I can offer no other excuse for the irresponsible attitude shown by me permitting these wrongful claims to be made other than the personal turmoil in which I found myself at the time which caused a temporary loss of judgment on my part". "Again I did not instruct Mrs X to engage in this activity but I turned a blind eye to what was going on and I was irresponsible in failing to prevent it". "A substantial number of the offences occurred because of the actions of ms X. I became aware from time to time she was obtaining from patients who spent long periods of time with me in my surgery an additional assignment form to that which the patient signed upon their arrival at the surgery ….. She did not initially inform me of her actions but I was told of it later. I told her to stop the practice as it would get me into trouble. I assumed that she had stopped but I regret now that I did not check with her again that that was the case." It is clear that the applicant did deliberately falsely claim moneys from the government and he eventually admitted that before this Tribunal after the proposition was put to him a number of times. When questioned as to his knowledge of Mrs X conduct he agreed that he did not tell anybody that he had threatened to sack Mrs X when he learned of her actions. He made the claim, that he was debating whether to inform the HIC about the situation at the time that he was approached by investigators. He advances the reason for him not having volunteered that he was making false claims, was a concern that he would not be believed. His misconduct involved systematic fraudulent actions over a prolonged period and it only ceased when he realised he was under investigation. The Tribunal does not accept his claim that he considered informing the authorities of the offences. As to whether they would have continued but for his detection, this Tribunal has no way of knowing and upon that question it makes no finding. However, there is nothing before the Tribunal which would persuade it that the applicant intended to cease his criminal conduct. The issue of the Applicant's acceptance of the gravity of the conduct giving rise to his deregistration is a matter of vital importance in determining whether there has been any marked change of attitude. If he is not able to demonstrate a full realisation of the enormity of his fraudulent and criminal conduct, that he has insight into the gravity of his transgression then this Tribunal would be unable to accept that there has been some marked improvement in his character. Sufficient to justify his restoration to the register of practitioners. Unless he knows that what he did was wrong; he could well repeat his actions in ignorance. The applicant was asked whether he practiced medicine when he visited Cyprus last year. He stated that his brother was a doctor in Cyprus and that he usually went there for three or four weeks to assist him. There is no question that he was a qualified practitioner in that country. When asked "Did you inform the Cypriot or the Greek Medical Board or equivalent of the fact that you had been de-registered in Australia in New South Wales?" he replied "I did speak to them, but they were not interested in what happens to another country". He gave the information to a Health Ministry Receptionist in 1996. He described this receptionist as being a mature lady who seemed to know what she was saying. Ms J gave evidence before this Tribunal wherein she confirmed the accuracy of a letter and statutory declaration provided to the New South Wales Medical Board. It was the effect of her evidence that she had consulted the applicant for a condition of her ovarian cyst. She understood the applicant had attended the Gerson Institute and she was desirous of obtaining the Gerson diet which she believed would assist her condition. She consulted him on the 11th June, 1998. There is no need to detail her discussions with the applicant save and except when she spoke to him about a notice indicating that there was no medical rebate for consultations with him. He explained at length about how the Medical Board had been pestering him about his important work in alternative medicine. So much so, that in fact he had resigned his medical licence for a period of time in order to be able to work in peace on his investigations. He also mentioned that he had "rung the Medical Board and he was getting his licence back in October, 1998". He suggested to her that she write to an organisation in Queensland to obtain various preparations. He provided her with what could best be described as an order form. This clearly contained the name and address of the applicant. He was described as Dr Chris Tsioutis. All members of the Tribunal accepted Miss J as an honest and reliable witness as to the essential features of her evidence with regard to what he told her as to him resigning his medical licence for a period of time in order to be able to work in peace on his investigations. His failure to advise the Cypriot authorities as to his deregistration and his lies to Miss J are to some extent understandable, however they assume greater importance when coupled with his behaviour before this Tribunal. Mr Hastings SC submitted that the circumstances which led to the applicant's deregistration was not such as to prevent his re-registration. He was guilty of comparatively minor criminal offences and a modest sum was involved. Whilst he did not wish to quarrel with the findings of the Tribunal which had de-registered the applicant, he submitted that such findings were not such as would justify a life disqualification. Subject to the qualification that re-registration at this time is not justified, with respect, the Tribunal agrees with these submissions. It further accepts the proposition that the applicant is competent, that he has a fervent desire to resume practice, that he has continued to pursue medical education and that he has the added knowledge of alternative medicine. Mr Hastings quite frankly acknowledged that there was an obligation upon the applicant to establish that he had changed. He submitted that the applicant had acknowledged that his conduct was wrong and stupid and that he fully appreciated the seriousness of his conduct. Further, that there would be no reason to suspect a repetition of the offences which were committed some 9 - 10 years ago. He urged this Tribunal to accept the proposition that the applicant's conduct involved a peculiar and singular event bought about by his association with Mrs X. She was the dominating partner in their relationship who had substantially controlled the administration of the practice. Because of the severance of his relationship with her and the cessation of all contact, the Tribunal could be confidence that he would not repeat his previous aberrant conduct. The applicant has been constantly reminded of the consequences of his offences committed so long ago by his contact with the police, his appearances before a Magistrate and the District Court, the subsequent proceedings before the Professional Standards Committee and the Medicare Review Committee, the deregistration application before the Tribunal in 1996 and the hearing before this Tribunal. Mr Hastings pointed to the fact that there have been no indiscretions since 1990 and at this stage the Tribunal could be completely satisfied that the applicant was a fit and proper person to resume medical practice. True it is that the amount involved in his fraudulent conduct was not large, however, there were numerous instances of dishonesty of which he was fully aware and in which he participated despite his claims that Mrs X was acting without his authority and knowledge. Whilst the Tribunal acknowledges that the applicant's conduct was such that he should not be precluded from ever seeking to be restored to the register, it is by no means satisfied that the applicant has fulfilled the obligation cast upon him to satisfy the Tribunal that he is now a fit and proper person to be registered as a practitioner. This Tribunal considers that he did not display a frank acknowledgment of his full involvement in his offences and it was not to his credit that he sought to cast substantial blame upon Mrs X and to a lesser extent upon Dr A There has been no supporting evidence placed before us by way of testimonials or statements as to his character which would demonstrate any change of attitude, any alteration of his character since he was deregistered in 1996. It is open to the applicant to conduct his application in whatever manner he deems fit however the Tribunal expected that he would have produced evidence from witnesses who could describe his change in character and attitude, and perhaps psychiatric evidence demonstrating his insight into his actions and an opinion that there had been a genuine change in his attitude. It is of course open for this Tribunal to accept the evidence of the applicant himself as demonstration of contrition if it is felt that such contrition is genuinely expressed. He doesn't need to call supporting evidence if his claims of reformation reflect that he has established himself as a different person; that he has reformed his character and that it is unlikely that he will behave in the manner previously demonstrated. The Tribunal has no hesitation in finding that at the present time the applicant is not a fit and proper person for registration. He simply hasn't satisfied the onus cast upon him to satisfy the Tribunal that he has overcome the defects of character which led to his deregistration and that he has rehabilitated himself and that he should now be regarded as of good character and fit to be restored to practice. Accordingly the Tribunal declines to make a reinstatement order and dismisses the 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. 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