New South Wales Medical Tribunal CITATION : Re the Medical Practice Act 1992 and Dr. Stuart Anderson [2004] NSWMT 3 TRIBUNAL: Medical Tribunal PARTIES : Health Care Complaints Commission Dr. Stuart Anderson FILE NUMBER(S) : 40003 of 2003 CORAM: Patten, DCJ - McInerney, Dr P - Smith, Mr RJ - Kotze, Dr B CATCHWORDS: Professional Misconduct LEGISLATION CITED: Medical Practice Act 1992 Law Society of NSW v Foreman (1994) 34 NSWLR 408; CASES CITED: Walter v Council of Queensland Law Society Inc (1988) 62 ALJR 153; Smith v New South Wales Bar Association (1992) 176 CLR 256; Wentworth v New South Wales Bar Association (1992) 176 CLR 239 DATES OF HEARING: DATE OF JUDGMENT: 13 February 2004 ORDERS: 1.That Dr Stuart Anderson is found guilty of professional misconduct. 2.That the name of Dr Anderson be removed from the Register of Medical Practitioners. 3.That pursuant to sec 64(3) of the Act there be no application for review of the above order for a period of 12 months. 4.That Dr Anderson pay the costs of HCCC JUDGMENT: IN THE MEDICAL TRIBUNAL OF NEW SOUTH WALES Deputy Chairperson: Judge D. Patten Tribunal Member: Dr Peter McInerney Mr Russell J Smith Dr Beth Kotze No. 40003 of 2003 Date of Determination: 13 February 2004 Re: DR STUART ANDERSON Reasons for Determination: The Tribunal has before it for enquiry a Complaint by the Health Care Complaints Commission (HCCC) against Dr Stuart Anderson of Niagara Park NSW. The Complaint, dated 13 February 2003, claims that Dr Anderson has been guilty of professional misconduct and/or unsatisfactory professional misconduct with s36 and s37 of the Medical Practice Act (the Act) in that he, "(i) has engaged in conduct which demonstrates a lack of adequate knowledge, skill, judgment or care in the practice of medicine, and/or (ii) has been guilty of other improper or unethical conduct relating to the practice of medicine. Particulars 1. From about 6 October 1995, the practioner failed to maintain appropriate professional boundaries in the professional relationship with Patient A in that: (a) he held hands with Patient A; (b) embraced Patient A; (c) placed one hand on patient's A buttock; (d) frequently had telephone conversations with Patient A of a personal nature; and (e) permitted a personal and sexual relation ship to develop with Patient A 2. From about October /December 1995 until the end of 1999, the practitioner inappropriately engaged in a sexual relation ship with Patient A, in circumstances where: (a) he continued to treat the patient, including for depression; and (b) he continued to treat Patient A's husband and children without disclosing the personal and sexual relationship with the patient to the husband." The Complaint has its origin in a letter written by the woman referred to as "patient A" in the complaint (and hereafter simply referred to as "A") in January 2000 to HCCC. The terms of the letter were formalised and expanded in a Statutory Declaration made by A on 28 August 2001. In view of admissions made by Dr Anderson, it is unnecessary to dwell at length upon the matters alleged by A, although some aspects are in contention and need to be mentioned. A was born on 10 December 1962 and with her husband (8) moved to Niagara Park during 1987. They became patients of Dr Anderson in that year and continued in that capacity until about the end of 1999. In the meantime A had given birth to 2 children respectively on 7 September 1989 and 9 September 1991. In or about October 1995, a consensual sexual relationship commenced between A and Dr Anderson and this continued for some 4 or more years. The relationship was conducted clandestinely and both A and Dr Anderson went to elaborate lengths to avoid their affair becoming public knowledge or known to their respective spouses. A described, in some detail, the events ~ which led to what is now accepted as an inappropriate relationship. Paragraphs 19-28 of her Statutory Declaration as admitted into evidence read: "On 22 September, I went to Dr Anderson's rooms. I spoke to Dr Anderson about waking at 2 am most nights and having difficulty returning to sleep, sometimes I would be awake for quite a few hours, I wasn't eating and I didn't feel like having sex with my husband. I spoke to him about the difficulties I had experienced with my mother and how demanding she was emotionally. I never went into a lot of detail about my relationship with my mother. I had also spoken very briefly to Dr Anderson about being a survivor of intra-familial child sexual assault. I did not provide all this detail to Dr Anderson at the consultation on 22 September 1995 however once the sexual relationship between Dr Anderson and I had progressed, I discussed my history of child sexual with him in more detail. I returned to see Dr Anderson on 27 September 1995 .for a follow up visit. He asked me quite a few questions about my quality of life. He recommended that I start taking the anti-depressant Aurorix because it wouldn't reduce my libido or interfere with the Coversyl I was taking to manage my blood pressure. He suggested that I come back the following week to see how I was responding to the anti-depressants and check my blood pressure. Sometime after 27 September 1995 and before 6 October 1995, I had gone to the After Hours General Practitioner' Cooperative and had a consultation with Dr Anderson. At this consultation, Dr Anderson had asked me how I was feeling. I told him that I felt good and that I have never felt as good since starting the medication. I told him that I had made an appointment to see him on 6 October 1995 about my anti-depressant medication and my blood pressure. I returned to Dr Anderson's rooms on 6 October 1995. When I went in, I sat down. He asked me how I was. I told him that I was good, but thought that these tablets, referring to the Aurorix, were "going to get me into trouble". He said, "Is it anyone I know?" And I said, "Yes, it's you". He pushed his chair back from his desk and said "Shit". He then spoke about how we were both married. I told him that I knew this and that I knew that he didn't have time to have a relationship. We sat there for a couple of minutes and then he put his hand across the table towards me and I took his hand. We didn't say anything whilst we were holding hands. We then let go of each other's hands and he took my blood pressure. I thanked him and got up to go. As I got to the door, he motioned with a hand gesture to come back. I walked back; he hugged me close to his body and placed one hand on my buttock. We embraced for a few second, maybe a couple of minutes. We didn't say anything during the embrace. I then left his room." Following this event, according to A, there were a number of telephone calls initiated by Dr Anderson leading to a meeting at a look-out known as Presidents Hill where there was fellatio performed by her and cunnilingus by him. Thereafter, there were a number of sexual contacts between them culminating in full sexual intercourse which occurred, according to A in Dr Anderson's surgery, before the end of November 1995. They continued their sexual relationship at various places including their respective homes. It ended about November or December 1999 when, as it appears, it came to the knowledge of their spouses. So far as the evidence relates, Dr Anderson was not notified of A's complaint until April 2001. The delay seemingly was caused by A writing to HCCC on 3 February 2000 withdrawing the complaint made the previous month and before it was notified to Dr Anderson. However, she subsequently changed her mind and in February 2001 requested the reopening of the complaint. A copy of her Statutory Declaration was sent to Dr Anderson on 4 September 2001 and he responded by letter dated 13 October 2001. In relation to the allegations, he said: "The central substance of the allegation, namely, that I engaged in a relationship with (A), including a sexual relationship, is true. At the time of this relationship, I knew that such contact between a medical practitioner and a patient was completely inappropriate and, in fact, this was the subject of a number of discussions between myself and (A) prior to the commencement of any physical relationship. There are quite a number of specific points made by (A) in her statutory declaration which I would dispute or explain in different terms. I accept entirely that these points do not change the fact that my conduct in this instance was inappropriate. However, I do wish to make a number of points: i. I first saw (A) as a patient in 1988. In 1989 she attended childbirth classes conducted by my wife and subsequently a reunion of that class at my home as a guest of my wife. ii Between 1988 and 1995 her consultations were mainly routine GP consultations. There was some social contact between our respective families during this period which I did not regard as unusual in this area. There was no improper contact or motive for contact during this period. iii. In September 1995, (A) consulted me in relation to depressions arising from the death of her mother. Coincidentally, I was experiencing considerable stress at this time both at home and at work. iv. This combination led to some personal discussions between (A) and myself which were, I appreciate, inappropriate. This did not occur on 6 October 1995 as stated in the statutory declaration but in fact on or around 2 November 1995. It was frankly discussed between myself and (A) that it was inappropriate for a doctor to have a relation ship with a patient other than a proper doctor-patient relationship. (A) said on a number of occasions that this was ridiculous and that the relationship had nothing to do with my being a doctor. v. In December 1995 a sexual relation ship did commence. Thereafter, there was no further physical contact until about April 1996. in the intervening time I tried on a number of occasions to bring the relationship to an end. vi. During a period of about 9 months from the start of 1996, I consistently tried to bring the relationship to an end but to my regret, agreed on several occasions to "one more encounter" on the understanding that this would bring the situation to a close. vii. One such occasion was actually referred to in paragraph 46 of the statutory declaration. However, this activity occurred at (A)'s request, not mine, as she has stated in the statutory declaration. viii. Ultimately, in around November 1996, I gave up attempting to resist the relationship which then continued until the middle of 1999. During this time I experienced feelings of fear, anxiety and powerlessness. ix. During this time (A) continued to see me as her general practitioner. Whilst I realise that this was entirely inappropriate, the matters recorded in the patient progress notes reflect, as they were, ordinary and genuine medical consultations. I did raise with (A) on several occasions that it was not appropriate for me to continue to see her as a patient. She rejected this suggestion and I did not insist on this matter as I should have. x. In November 1999, the relationship between (A) and myself became known to our respective spouses. Since that time there have been numerous hostile encounters involving (A) culminating in an apprehended violence order being made against (A). xi. Obviously, the situation has been devastating for both families. I have undergone counselling in the company of my wife and intend to undergo further counselling in relation to my conduct as a medical practitioner." In a formal statement dated 8 October 2003, apparently prepared for the purposes of the hearing before the Tribunal, Dr Anderson elaborated upon his behaviour in these terms: "I do not wish to make excuses for my misconduct. There are none. However, I believe that it is important to understand why I conducted myself in this way, when I have always regarded myself, and believed I was regarded by others, as a good and decent medical practitioner. In late 1995 I was working very hard. I felt under a great deal of stress. I felt unappreciated. I had little affection at home. I lacked close personal confidants. I kept my feelings to myself. It was against this background that (A) declared a romantic interest in me. We both openly ) acknowledged at the time that no such thing could occur. However, the inappropriate conversations continued in what seemed to be a mutual consolation about similar grievances. There is no doubt that if I had any intention to continue in this way I would and should have immediately terminated the professional relationship and referred (A) to another GP. I didn't do it, no doubt, at least in part, if not exclusively, because I had no intention of continuing the relationship. What happened was unplanned and impulsive. It was apparent that we enjoyed the conversations and had the capacity to excite each other. One thing slowly led to another, with the relationship becoming physical after about one month, undoubtedly encouraged by the reassurances that her interest in involvement had nothing to do with me being a doctor, I that the issue of influence was ridiculous, that she I would never do anything to hurt me and if either of us wanted to stop there would be no resistance. I repeat that I know that, regardless of any encouragement by a patient, it remains wholly my responsibility to ensure that no impropriety occurs. Despite the excitement and attraction, at about two months from the first suggestion I realized the magnitude and stupidity of what I had got myself involved in. (A) had perceived (correctly) my lack of enthusiasm to continue and asked if I wanted to stop. I agreed and thanked her for her understanding. The following day she contacted me and made it clear that she wasn't able to easily let go. I was weak and easily capitulated. I was also very anxious that if I didn't do as she wished she would inform my wife and I was concerned to keep the relation ship from her for obvious reasons. I accept now that I was not powerless to terminate the relationship, that I could have done so at any time, facing any consequences which, after all, were the result of my actions. I have reflected at great length on how this course of events could have taken place. I believe that my style of practice may have contributed. I have always been friendly towards my patients, attempting to not be in an elevated position, possibly reducing the doctor- patient separation, trying to make patients feel comfortable and encouraging their participation in decisions. In the past I had encouraged discussion of subjects outside the professional relationship. I had disclosed information about myself to patients in these discussions. I had thought that this practice conformed to my genuine desire to assist my patients, avoiding judgment or discrimination. I can now see that such an approach blurs the boundaries between doctor and patient. Similarly, I have had dual relationships with many of my patients some of whom I met outside the practice and then sought me out. None of those relationships was of a sexual nature. However, I was friendly with, several patients with whom I would come into contact in the local community, in the church, in sport and elsewhere. Again, I now recognize that this sort of dual relationship may tend to blur the professional boundaries and should be avoided if possible. Another factor that may have contributed to my conduct is that I failed to deal properly with the difficulties I was having in my marriage and the stress at work. I was not decisive at an early stage before the sexual relationship developed. I was no doubt flattered by (A)'s remarks and I was also concerned not to cause her any discomfort or embarrassment. I was weak and self-centred, not having the strength to go through with terminating the relationship irrespective of the consequences. At the time I lacked an adequate framework of close confidants who would be in a position to provide sensible reflection, guidance and accountability. I foolishly thought I could deal with it myself. Plainly I had an inadequate understanding of the potential for harm. I believed, albeit wrongly, that by allowing things to take their course I was minimizing harm. I now recognize that I was deluding myself. " It is to be observed that Dr Anderson denies his personal relationship with A commenced, as she asserts, on 6 October 1995. He claims that their first inappropriate conversation took place on 2 November 1995 and that there was no sexual contact until December. This discrepancy is important in one aspect of the case, in that, according to Dr Anderson's notes on two occasions late in November 1995, A's husband B consulted him in respect of psychological or emotional matters including reduced libido. If this in fact occurred after he commenced a sexual relationship with A, it would seem to the Tribunal very much an aggravating circumstance. In evidence, Dr Anderson claimed that his notes of consultations with A respectively on 6 October 1995 and 2 November 1995 suggested to him that nothing untoward occurred on 6 October as on that date he made express reference to her comment that her libido had increased with the medication he prescribed. On the other hand his note of 2 November merely recorded that he rechecked her blood pressure, "basically because I really didn't know what to write." A was not required for cross-examination and, accordingly, the Tribunal is not aware of the basis upon which she confidently asserts that there was the beginning of an inappropriate relationship on 6 October 1995. Dr Anderson's explanation of why he puts the date somewhat later seems cogent, but, on any view of the matter, by 2 November the boundaries between a professional and personal relationship had been crossed, rendering it highly inappropriate for Dr Anderson to give advice to B which touched on his relationship with his wife. This inappropriate behaviour continued over the next 4 years while Dr Anderson treated A, B and their children. The treatment of A included prescriptions of Aurorix for mood control, depression, stress and "various relationship issues" and also for conditions attributable to sexual activity. In the opinion of the Tribunal, all the particulars of the Complaint have been established to the requisite standard of proof. That such proof may, and should, lead to a finding of professional misconduct is made manifest by the legal authorities which bind this Tribunal, reinforced by such promulgations as the AMA Position Statement issued in 1994, which states, inter alia, "a doctor who engages in any type of sexual activity with a patient is guilty of professional misconduct", and by the Policy Statement Medical Practitioners and Sexual Misconduct", contained in the Medical Board Newsletter issued on 11 April 1997 to similar effect. Dr Anderson did not suggest that he was unaware of the wrongfulness of his conduct or that it did not amount to misconduct. The Tribunal finds him guilty of professional misconduct within sections 36 and 37 of the Act. It remains to be considered what orders should follow the above finding. In that connection, there were a number of subjective matters advanced on behalf of Dr Anderson. He asserts, in effect, that his character has reformed and that he is unlikely to re-offend, dealing with this aspect in paragraphs 38 to 50 of his statement, as follows: "I can assure the Tribunal that should I be permitted to continue to practice I will not re-offend. I am acutely aware of the pain and damage that I have caused and that can be caused by a doctor violating the trust of his patients in this way. I am also alive to the extent of the damage, beyond (A), herself, to her family, to other patients, the community and the medical profession, let alone to my wife and children. I am much more cognisant of why it is wrong (rather than just knowing that it is not ethically and professionally acceptable), e.g. I recognize the potential for abuse of influence or knowledge gained, inequality of power, the breach of the trust to not behave this way and the likelihood of loss of objectivity in treating the patient. I am much more aware of the factors that can increase vulnerability and the warning signs that professional boundaries are being eroded. I also know how awful my conduct personally made me feel (unrelated to the complaint and without consideration for the trauma which still lies ahead), including how offensive it was to my firmly held Christian belief. I have also witnessed the devastating effects on my wife of its disclosure. This in itself is an extreme deterrent. I am essentially a very moral person. I am gravely disappointed in myself. I have wrestled with feelings of self-disgust. I have been utterly humiliated. I have committed myself to counselling and to continuing psychotherapy with Dr Les Darcy. Through counselling and much soul searching I believe I have gained a good deal of insight in to why what happened happened. I have also done a lot of reading on sexual misconduct and boundary violations generally. I well understand my professional obligation to ensure that proper professional boundaries are not crossed. For about three years, until December last year, I was a member of a home fellowship group convened by my local church. The leader of the group is a trained and practicing counsellor. We have had numerous informal discussions about my misconduct and the question of boundary violations in general. I believe that those discussions increased my insight and my understanding. My wife and close friends (who are aware of the affair and with whom I am more able to confide these days) are able to further increase my accountability. I have also entered a mentoring relationship with another GP, Dr James Lucas. He is a person of high moral standards in whom I feel I can confide. He is older and more experienced than I. With him I will be able to and propose to discuss any boundary issues that may continue to exist or which may arise in the future. I also propose to talk to him about any stresses I may experience in connection with my practice. Finally I intend to increase my supervision and professional contact. I realize that working in isolation is undesirable. I am planning to move to a proposed new group practice at Lisarow, which would enable me to continue the care of my long term patients. The possibility of working in a new location more distant to my home to reduce incidental non-professional contact with patients is another option, which could be explored. Four years have passed since the relationship with (A) came to an end. I am thoroughly chastened. I believe I have learned a great deal since and I am a different and a better person for it. I respectfully request the Tribunal to permit me to continue to practise medicine where I feel I have a great deal to give.'" A number of persons provided testimonials in support of Dr Anderson and gave evidence on his behalf. They included medical practitioners who have know him for lengthy periods and spoke highly of him as a competent, caring and highly respected practitioner whose conduct, which brings him before the Tribunal, in their opinion was quite out of character with the person they know. The Tribunal does not doubt the genuineness of their beliefs but pauses to note that the misconduct was not committed on an isolated occasion but over a period of some years. The Tribunal also notes that, although in his letter to HCCC of 13 October 2001, Dr Anderson told it that he intended to explore through counselling "why under a particular combination of circumstances, I made such a serious error of judgment", he did not, so far as the evidence relate, do anything in that connection until he consulted Psychiatrist, Dr Les Darcy, as recently as 18 August 2003. Dr Darcy has continued to treat him and in a report dated 19 November, said: "I have continued to see (Dr Anderson) and I have seen him on five occasions now, most recently on 5,12 November 2003. He is feeling more settled and finds he is able to carry on with his work quite well. He feels good when he has a file in his hand and is about to help a patient. He feels this may have something to do with easing his conscience to be useful. He is getting on not too badly at home. He and his wife are talking more and I have asked him not to be defensive but to let his wife express her feelings and not feel that she is doing harm to him. He has now told his parents about his situation and although they are bewildered they are supportive and have been good listeners to him. He hasn't told his children of the situation. His wife has slipped behind in her University studies and this places pressure on her and makes her more irritable. Although I feel he is coping with his situation quite well and I believe this is because of his good personality structure and the fact that he still feels he is able to be valuable to his patients. I have not heard him say anything critical of (A). He is receiving no medication. To answer your specific questions, Dr Anderson does continue to -' express genuine regret and insight into his conduct. I do still hold the opinion that it is extremely unlikely that Dr Anderson would behave in such a manner again. I will continue to see him." Dr Robert Fisher, also a Psychiatrist, saw Dr Anderson once only, on 24 July 2003, at the behest of his solicitor. He concluded a lengthy and comprehensive report to the solicitor in these terms: "In your letter of the the July 2003, you ask me to comment on the likelihood of any reoccurrence by Dr Anderson of this type of behaviour. I do not believe that anyone could give a meaningful reassurance that there would be little likelihood of a re-offence by Dr Anderson, however on the information available it would appear that this was a one-off infraction and Dr Anderson does appear to be insightful and to have suffered some serious repercussions as a result of his behaviour. In addition he does not appear to be suffering from any major psychiatric illness, which might make him more liable to re-offend. He does appear, on the evidence presented, to be a person who has had strong ethical and moral influences in his life and to have attempted to live his life according to good principles. All I could say is that in the absence of those factors which might increase the risk, that Dr Anderson might be considered to be less likely to be recidivistic. I believe it is important that Dr Anderson continue in supportive psychotherapy and he will probably need to address the ongoing difficulties that exist in his marriage. If he is deregistered he may require extra support to deal with the gamut of consequences of that outcome. In the event that he was not deregistered and was permitted to continue in medical practice it may be more appropriate that he be employed in a general hospital setting under supervision for a period of at least one or two years and that if he has contact with female patients that he always has a female chaperone present when engaging in physical examination of such patients." Dr Anderson gave oral evidence and was searchingly cross-examined upon it by Ms Eastman, counsel for HCCC. In answer to a question by his counsel, Ms Katzmann SC, he said, "'I would again sincerely like to express my apologies to (A) and her husband for the exceptionally poor judgment and poor conduct that I submitted them to while they were my patients. I acknowledge that it is entirely my responsibility to make sure such breaches of boundaries don't occur in my practice and I acknowledge the hurt and distress they have been caused and apologise for that." As to the personal and professional background of Dr Anderson, he was born on 13 January 1959 and graduated M.B.B.S from The University of Sydney in 1982. He did his internship and residency at Gosford Hospital and from 1986 has been in general practice in the Gosford area, an area, which, according to the evidence is ill served by medical practitioners. However, that fact is irrelevant in the opinion of the Tribunal to the issues before it, as otherwise the Tribunal would, in effect, be accepting that differing professional standards might apply to medical practitioners depending upon their geographical area of practice. In her submissions to the Tribunal, Ms Katzmann contended that the circumstances do not require an order for deregistration, pointing to evidence of contrition, the demonstration of insight into the behaviour complained of and to evidence that Dr Anderson is unlikely to re-offend. The Tribunal accepts that the evidence establishes that Dr Anderson has gone some distance towards re-establishing his character, demonstrated to be seriously deficient by the circumstances of this case. However the Tribunal is not persuaded that he has fully discharged the heavy onus which the law places upon him. Indeed, the condition suggested by Dr Fisher if Dr Anderson be permitted to continue in practice seems to reinforce this view, Moreover, the protective jurisdiction, which the Tribunal exercises, is not limited to a determination whether the community needs protection from this particular medical practitioner. Cases such as Law Society of NSW v Foreman (1994) 34 NSWLR 408 establish that the jurisdiction to protect the public encompasses the promotion of proper standards of conduct and of public confidence in the profession. In Foreman's case, speaking of a solicitor, Mahoney JA, at 440 said: "What then, are the purposes of the orders to be made and the considerations to be taken into account? It has been said that disciplinary procedures and the orders made in the course of them are directed not to the punishment of the ~ solicitor but to the protection of the public. This, of course, is true. The protection of the public has been described as, for example, the primary purpose or a primary object of such proceedings: Walter v Council of Queensland Law Society Inc (1988) 62 ALJR 153 at 157E; 77 ALR 228 at 235; Smith v New South Wales Bar Association (1992) 176 CLR 256 at 270 per Deane J; or one of the primary objects of the proceedings and the orders made: see Wentworth v New South Wales Bar Association (1992) 176 CLR 239 at 251. In the relevant sense, the protection of the public is in my opinion not confined to the protection of the public against further default by the solicitor in question. It extends also to the protection of the public against similar defaults by other solicitors and has, in this sense, the purpose of publicly marking the seriousness of what the instant solicitor has done." The transgressions of Dr Anderson established in this case were very serious. A was vulnerable and Dr Anderson exhibiting grievous deficiencies of character took advantage (perhaps unwittingly) of that vulnerability. He compounded this by continuing the improper relationship established for some 4 years and further compounded it by continuing to treat A and her family, especially her husband during that period. Ms Eastman submitted that the only proper order is that Dr Anderson's name be removed from the register. The Tribunal accepts the correctness of this submission, on the grounds that it is not persuaded that Dr Anderson has proved that his character is fully re-established, to mark the Tribunal's grave disapproval of his conduct and to demonstrate, for the benefit of other practitioners, the consequences that normally will flow from such conduct. However, the Tribunal adds that, in its opinion, Dr Anderson should not, for all time, be prevented from continuing in his profession. The Tribunal believes it appropriate, in that regard, to order that at least 12 months elapse before there is an application for review of its order that his name be removed from the register. The findings and orders of the Tribunal are: 1. That Dr Stuart Anderson is found guilty of professional misconduct. 2. That the name of Dr Anderson be removed from the Register of Medical Practitioners. 3. That pursuant to sec 64(3) of the Act there be no application for review of the above order for a period of 12 months. 4. That Dr Anderson pay the costs of HCCC 5. Exhibits may be returned. 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.