Medical Tribunal New South Wales Medium Neutral Citation: In the matter of Steven Goodman [2012] NSWMT 17 Hearing dates: 02/07/2012 Decision date: 04 July 2012 Before: Elkaim SC DCJ Dr S Gani Dr E Kok Professor H Lapsley Decision: Reinstatement order subject to conditions. Catchwords: Review of de-registration, current assessment of suitability for medical practice. Legislation Cited: Medical Practice Act 1992 Health Practitioner Regulation National Law (NSW) Cases Cited: HCCC v Dr Steven Goodman [2007] NSWMT 9 Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448 Re Mansoor Haider Zaidi [2006] NSWMT 6 Category: Principal judgment Parties: Steven Goodman (Applicant) Medical Council of New South Wales (Respondent) Representation: E Pike (Applicant) I Bourke (Respondent) Browns Legal & Consulting (Applicant) Crown Solicitors Office (Respondent) File Number(s): 40031/11 Publication restriction: No Judgment 1On 4 April 2007 the Medical Tribunal ordered that Dr Steven Goodman be removed from the Register of Medical Practitioners. It further ordered that he not be permitted to apply for re-registration for a period of three years. The decision may be found in Exhibit 1 at Tab 2. 2Mr Steven Goodman has now applied to have his name returned to the Register. This application is made by way of a review pursuant to Section 163A of the Health Practitioner Regulation National Law (NSW) No 86a. It is important to note at this stage that this is not an appeal against the original decision, rather it is a review conducted in the present circumstances. 3It is also significant that the very recent amendments to the above Act limit the Tribunal's powers to the making of a "reinstatement order" (Section 163B(1)(c)) which will enable the applicant to apply for registration to the National Board (Section 163B(3)). 4Mr Goodman has made the application for review. Accordingly the onus is on him to satisfy the Tribunal that a reinstatement order should be made. Background 5Mr Goodman was born in Australia in 1950. He studied medicine at Sydney University graduating (MBBS) in 1974. He then filled a number of posts, as described in his statement and curriculum vitae (Exhibit A, page 16). He relevantly commenced part-time practice as a general practitioner in Redfern in 1984. 6It was in this practice that his inappropriate prescription of Benzodiazepines began and continued for many years until 1999. The applicant remained at the Redfern practice throughout this period, although from October 1993 he also had a part-time position at the Emerton Medical Centre. 7The inappropriate prescribing is set out in detail in the 2007 decision of the Medical Tribunal. It is not seen as necessary to repeat it here. Suffice to say the applicant's practices in the prescription of Benzodiazepines were widespread, frequent and wholly misguided. Although he was influenced by the theories and practices of other doctors with whom he worked, he nevertheless clearly abdicated his responsibility towards the patients who called on him to sustain their various addictions. 8On 15 June 1999, at a Section 66 enquiry (Medical Practice Act 1992) the applicant was ordered to no longer prescribe or deal with Schedule 4D and Schedule 8 drugs. 9The applicant then practised at Ramsay Street Medical Centre in Haberfield, followed by the Prospect Medical Centre until about 2002. In April 2002 and continuing until his de-registration the applicant practised at the Majors Bay Medical Centre in Concord which was, and still is, owned by Dr Gertrude Peries. 10The reasons which led to the applicant's de-registration are well summed up in the following paragraphs from the Tribunal's decision: "156. Barely understanding the basis for the treatment and with no training, the respondent embarked on a course of conduct which amounted to using his drug addicted patients as guinea pigs. 157. The respondent knew at all relevant times that his course of prescribing posed significant risks to his patients and was contrary to everything he had learned about the proper practise of medicine. He knew full well the correct approach to prescribing benzodiazepines. 158. It was in the face of this knowledge that for a period of at least two years, the respondent prescribed massive quantities of benzodiazepines for his drug addicted patients and during that time two of his patients, one, a child, died of overdoses from a combination of drugs including benzodiazepines." 11Reading the passages the Tribunal obviously regarded the applicant's conduct as being of a most serious order leaving it no choice but to remove his name from the register of medical practitioners. The object of the application 12In order to succeed the applicant must establish, on the balance of probabilities, that he is now a fit and proper person to be registered as a medical practitioner. This includes persuading the Tribunal that the defects in his character and behaviour, that led to his previous conduct, have been addressed and are no longer a factor likely to resurface in his future as a medical practitioner. 13In reaching its conclusion, the Tribunal has kept in mind this statement of Walsh JA in Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448 at 461: "... 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." 14The Tribunal has also endeavoured to apply the principles set out in Re Mansoor Haider Zaidi [2006] NSWMT 6 at paragraph 42: "[1]The purpose of the jurisdiction which is exercised by the Tribunal is not for punishment or further punishment of the former practitioner. Instead the Tribunal's jurisdiction is for the protection of the public which deals with medical practitioners on the basis that they are members of an honourable profession who can be expected without reservation to conduct the affairs of their patients with honour and in whom the patients can place unbounded confidence. What is in question in an application for reinstatement to the Medical Register is whether an applicant is fit and proper to be held out to the rest of the profession, to patients and to the whole of the community as a person worthy of their confidence. [2]An applicant who seeks to establish fitness to have his name restored to the Register having been earlier removed from it bears the onus of proving the case. It is a heavy onus and the question whether the applicant is a fit and proper person, is one to be trusted to exercise the high responsibilities of the profession is one to be determined on solid and substantial grounds and as an applicant for reinstatement to the Medical Register he is in a more disadvantageous position than an original applicant. He must in effect displace the decision for deregistration which has been made. That decision involves the judgment that the applicant is probably permanently unfit to have his name on the Register. As a consequence, presumptions of fitness which might arise otherwise than from an absence of contrary suggestions can no longer advantage him, precisely because of the removal of his name from the Register on the basis of unfitness. [3]The ultimate issue is whether the Tribunal can conclude on the basis of all the evidence that an applicant is now a fit and proper person to join other members of an honourable profession in the responsible and trusted activities which are involved in the work of the medical profession, what is at stake is not so much the reputation of the applicant but the Tribunal's assessment of his character, uprightness, honour and trustworthiness. In the case of some offences committed over an extended period with deliberate intent and resulting in serious distress to patients it will be very difficult to contemplate any circumstances in which the name of the offender will be restored to the Register. [4]It is not a question of what an applicant has suffered in the past. It is a question of his worthiness and his reliability for the future. What in this respect the Tribunal must determine is whether it is satisfied that for the future the applicant will act in accordance with the high standards and responsibilities of the profession. It is difficult to decide what a man will do in the future and the decision in a particular case is to a greater or lesser extent dependant upon the Tribunal's assessment of the applicant. In making that assessment, it may draw inferences from what he has done in the past, and in particular, what led to his being removed from the Register. An understanding of that may assist the Tribunal to determine what are his standards and his understanding of a practitioner's responsibility, and from this, what he is apt to do in the future. Where what has been done in the past has been sufficient to indicate his probably permanent unfitness the Tribunal will require solid and substantial grounds for the conclusion that his standards have changed, his character has been reformed and that he will act honourably." The applicant's evidence 15There is a comprehensive statement from the applicant in Exhibit A. He details his acceptance of his wrongdoing and his efforts to fill the large gap that obviously existed in his knowledge and appreciation of the treatment of addicted persons. 16The applicant gave oral evidence. The sentiments expressed in his statement were apparent during his time in the witness box. Nothing emerged in cross-examination to contradict the contents of his statement. The Tribunal accepts the genuineness of his oral and written evidence. 17This acceptance does not, of itself, establish the requirements for a reinstatement order. Also of great importance are the views of those practitioners who have closely observed him, or treated him, both before and after 2007. 18The Tribunal believes the views of Dr Diamond, who has seen the applicant from July 2007 to October 2011, carry a good deal of weight. His report commences at page 29 of Exhibit A. He was not required for cross-examination. Dr Diamond specifically addresses the issues of concern in an application of this nature. He tracks Mr Goodman's progress from being "staggeringly insightless" to "being aware of his psychological makeup and personality and gaining an understanding of his drives, motivations and propensity for acting these out in a dysfunctional manner". 19In relation to his character, Dr Diamond concluded in this way at page 25 of his report: "8. Has Mr Goodman now achieved a "reformation of character" such as would warrant the Tribunal now considering him as fit to practise medicine? My view is that Mr Goodman has now achieved sufficient reformation of character to warrant the Tribunal to consider him as fit to practise medicine. He has done this in the ways I have described in my previous answers. He has moved from a position of detachment and insightlessness. His pathological conflict avoidance and lack of understanding about his overwhelming need to be placatory and to be accepted are understood to be unacceptable constituents of his character. He expresses different views about protecting others from harm caused by his character flaws. He understands the responsibility he carries in relation to others. It means that Mr Goodman has now reached a position where he is genuinely troubled by what he has done in the past and is determined not to repeat such conduct. These changes occur to the extent that, in my view, Mr Goodman is a changed man by way of being a reformed character. He is unlikely to repeat conduct of the sort that had him deregistered in the first place." 20What is especially compelling about Dr Diamond's report is that he does not suggest that Mr Goodman be allowed to return to practise without condition or supervision. He formulates, commencing on page 25 of his report, a series of both practice and health conditions which the Tribunal agrees, with some 'fine tuning', are appropriate and necessary. It is also noteworthy that Dr Diamond is prepared to provide the continuing psychiatric review that he recommends. 21The proposed conditions gain support from Dr Messner, also a psychiatrist, who was asked to review the application by the Crown Solicitors Office. Her report, dated 6 February 2012, is behind Tab 4 in Exhibit 1. Dr Messner was provided with a comprehensive range of relevant information. In addition, she saw the applicant in January of this year and conducted a detailed interview with him. She referred to the applicant's candid involvement in the discussion and specifically noted, "at no time in the interview did Mr Goodman try to deflect the responsibility or blame from himself". 22Ultimately, Dr Messner stated that she agreed with the conditions proposed by Dr Diamond to "ensure that Mr Goodman is not working in an isolated fashion, that he is supported with an appropriate group of respected peers and is supervised regularly". She continued: "I agreed with the recommendation that his Schedule 8 and Schedule 4D prescribing rights remain withdrawn. I support the suggestion that he continue to see a psychiatrist or other mental health professional for clinical review and has ongoing review at the Medical Council." 23Dr Messner concluded in this way: "Mr Goodman acknowledges his professional misconduct, expressing remorse and shame regarding it. He described the process of re-education he has undertaken to address the deficits in his practise of medicine. He acknowledges the weakness in his personality, his understanding of how they have impacted on his practise previously, and ways he intends to prevent further potential difficulties. In my opinion it is appropriate for Mr Goodman to be re-registered, with appropriate conditions." 24The involvement of Dr Peries has already been mentioned. She has provided a report dated 31 August 2011. She recalls the applicant's work in her practice and the effects on him of his de-registration. She describes this action as "a wake up call that spurred Dr Goodman into action". She then sets out the many activities in which he participated "enhancing his knowledge and skill base and the professional approach to the practise of medicine". 25She came to the view that the applicant "now has the required professional qualities to practise as a GP". 26Importantly Dr Peries stipulates her consent to meeting the supervisory requirements suggested by Dr Diamond. Her practice also appears to meet the parameters within which Dr Diamond suggests the applicant be allowed to work. 27Dr Peries gave oral evidence. She reaffirmed her commitment to act as a supervisor and to monitor the progress of the applicant. In particular she agreed to have regard to the matters set out in paragraph 3.a of the proposed conditions of practice. 28The Tribunal is satisfied that Dr Peries is able to provide the necessary level of supervision envisaged by the conditions. 29There are two other opinions that require mention. The first is a report of Dr Alex Wodak, the Senior Staff Specialist in the Alcohol and Drug Service at St Vincent's Hospital. Dr Wodak's report is dated 21 March 2012 and commences at page 56 of Exhibit A. 30Dr Wodak describes the involvement of the applicant in various courses and activities falling within his specialty and also the applicant accompanying Dr Wodak on his 'rounds'. Dr Wodak concluded in this manner: "Mr Goodman seemed interested in the clinical problems and approaches we discussed. He seemed to have gained some insight that his previous approach had been superficial and reckless. I believe he has learned some painful lessons from this experience. If permitted to practise medicine again, I believe he will be much more cautious in difficult areas of medicine. It may be wise under these circumstances if he continues for a period to have some supervision and regularly discusses difficult cases with a more experienced colleague." 31It will be seen that Dr Wodak, like Drs Diamond and Messner, suggests supervision of the applicant. 32Dr Conigrave is the Senior Staff Specialist in Addiction Medicine at Royal Prince Alfred Hospital. She has provided a report dated 5 March 2012 (Exhibit A, page 58). She also details her contact with the applicant and with two of her colleagues. She states: "He was humble about any shortcomings in his own past approaches, and open to learning new approaches to managing and limiting difficult patients". She concluded "I was satisfied that Mr Goodman obtained it with understanding of the approaches used in this unit to manage drug seeking behaviour and to treat drug dependence". These comments are more important as an indication of the applicant's appreciation of his past wrongdoings than seen in support of any suggestion that he might become involved in treating drug dependant patients in the future. Conclusion 33The gravity of the applicant's behaviour which resulted in his de-registration demands that this Tribunal examine his application for review with care and caution. Having regard to the principles set out above, and in the light of the evidence in support of the application, the Tribunal is of the view that it should succeed. 34The Tribunal specifically finds that the applicant is now a fit and proper person to practise as a registered health practitioner in accordance with the provisions of the Health Practitioner Regulation National Law (NSW) No 86a. 35In addition to the conditions proposed by the Medical Council, the Tribunal also thinks it necessary that the applicant be required, if in need of medical treatment (not of a psychological nature) to consult an independent general practitioner. 36The applicant agreed to all of the suggested conditions. Final Orders 37The Tribunal makes these orders: (a)The Tribunal makes a reinstatement order in respect Mr Steven Goodman pursuant to Section 163B(1)(c) of the Health Practitioner Regulation National Law (NSW) No 86a. (b)The Tribunal Orders that, pursuant to Section 163B(4) of the above Act, Mr Steven Goodman's registration be subject to the practice and health conditions set out in Annexure A. (c)The Tribunal orders that the applicant pay the costs of the Medical Council of NSW. Annexure "A" Mr Steven Goodman MT 40031/11 Practice Conditions 1.Not to prescribe, possess, supply, administer, handle or dispense any Schedule 8 drug, Schedule 4 Appendix D drug, or any drug falling under a similar classification in any other State or Territory of Australia. His prescribing authorities for the above drugs are to remain withdrawn. 2.To work only in a group practice (group is defined as 3 or more other medical practitioners) with at least one other practitioner always on site. 3.To nominate a supervisor prior to commencing employment, to be approved by the Council, to monitor and review his clinical practice and compliance with Practice Conditions in accordance with Level 2 Supervision as contained in the Council's Guidelines for Supervision. The supervisor is to be provided with a copy of the Council's Guidelines for Supervision and a copy of all relevant decisions. Any costs associated with the supervision arrangement are to be borne by the practitioner. The practitioner is to ensure that: (a)He and the supervisor meet on a fortnightly basis for at least one hour, the first meeting to occur within one fortnight of being advised by the Council that his nominated supervisor has been approved. At each meeting they are to review his work progress and address: o case reviews, o new patient assessments o record keeping o interactions with difficult patients o management of patients with difficult conditions (b)At each meeting, the supervisor completes a record of matters discussed at the meeting in a format prescribed or approved by the Council. (c)The supervisor forwards to the Council, initially on a monthly basis and subsequently as determined by the Council, a Supervision Report in a format prescribed or approved by the Council. 4.The supervisor is authorised to inform the Council immediately if there is any concern in relation to the practitioner's compliance with the supervision requirements, compliance with other conditions of registration, clinical performance or if the supervisor relationship ceases. 5.In the event that the approved supervisor is no longer willing or able to provide the supervision required, details of a replacement supervisor are to be forwarded for approval by the Council within 21 days of the cessation of the original supervisory relationship. 6.To provide the Council with written evidence of his continuing professional development and maintenance of vocational competence relevant to his current or proposed employment. Initially such reports to the Council are to be forwarded at six monthly intervals. Health Conditions 1.To attend a psychiatrist of his choice for review, at a frequency to be determined by the psychiatrist and Dr Goodman. To authorise the psychiatrist to inform the Council of failure to attend, termination of the relationship or if there is a significant change in health status (including a significant temporary change). 2.To attend for review by the Council Appointed Psychiatrist on a three monthly basis or as otherwise directed by the Council, at the Council's expense. 3.To attend a Review Interview at the Council in 3 months or as otherwise directed by the Council. 4. To consult an independent general practitioner in respect of his own physical health concerns. Review Orders Orders that the above conditions may be altered, varied or removed by the Council and the Council is the appropriate review body for the purposes of Division 8 of Part 8 of the National Law. However, should Dr Goodman seek to change or remove the conditions imposed as a result of this Tribunal's order when his principal place of practice is anywhere in Australia other than in New South Wales, Sections 125 to 127 inclusive of the Health Practitioner Regulation National Law are to apply, so that a review of this condition can be conducted by the Medical Board of Australia. ********** DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 06 July 2012