Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Bao-Quy Nguyen-Phuoc (No. 2) [2015] NSWCATOD 94 Hearing dates: 20 August 2015 Decision date: 14 September 2015 Jurisdiction: Occupational Division Before: F Marks ADCJ, Principal Member Dr L King Professional Member Dr S Howle Professional Member M Kelly Lay Member Decision: (1) The respondent is disqualified from being registered as a medical practitioner for a period of three years from this date. (2) The National Board with which the respondent was registered is required to record the fact that we would have cancelled the registration of the respondent in the National Register kept by it. (3) The respondent is prohibited from providing on a private or public basis alternative health services being naturopathy and/or intravenous vitamin therapy unless and until he is re-registered as a medical practitioner. (4) The respondent is to pay the costs of the complainant of these proceedings. Catchwords: Unregistered medical practitioner - Finding of professional misconduct - Held registration cancelled as if registered - Not to seek re-registration for 3 years - Prohibition order practising as a naturopath - Costs order made. Legislation Cited: Health Practitioner Regulation National Law (NSW), ss149C(4)(a), 149C(5), 149C(5A) Cases Cited: Health Care Complaints Commission v Nguyen-Phuoc [2015] NSWCATOD 81 Category: Principal judgment Parties: Health Care Complaints Commission (Applicant) Bao-Quy Nguyen Phuoc (Respondent) Representation: Counsel: W Hunt (Applicant) Solicitors: Health Care Complaints Commission (Applicant) B Nguyen-Phuoc (Respondent in person) File Number(s): 1420316 Publication restriction: Pursuant to Schedule 5D Clause 7 of the Health Practitioner Regulation National Law, publication of the name of or any information which would identify the original complainant and another patient cared for by the Respondent is prohibited. REASONS FOR DECISION 1. In our Reasons for Decision published on 7 August 2015 (Health Care Complaints Commission v Nguyen-Phuoc [2015] NSWCATOD 81), we found the respondent, Bao-Quy Nguyen-Phuoc, guilty both of professional misconduct and unsatisfactory professional conduct under the Provisions of the Health Practitioner Regulation National Law (NSW) ("the Act"). The nature and extent of the complaints brought against the respondent as found proven are fully described in our earlier decision. A further hearing on 20 August 2015 was conducted to receive evidence and submissions concerning what protective orders should appropriately be made following these findings. The following constitute our reasons for decision for the imposition of the protective and other orders which we have determined to make in these proceedings. The Evidentiary Material 1. We received in evidence on behalf of the respondent a number of character references. It is clear from the information contained in this material that the respondent has made a substantial and constructive contribution to the Sydney Vietnamese community and also to the Australian Vietnamese Health Professionals Association. He has also made a significant contribution to the work of the Vietnamese American Medical Association Forum and the Association of the Vietnamese Physicians of the Free World. He is highly regarded by members of these associations and generally as a hard-working, dedicated, reliable and helpful person. He has assisted the Scouting movement and has been prepared to volunteer as members of medical teams associated with scouting activities. He is also a good family person. 2. In particular, some insight into the respondent's character is provided by Dr Dinh Cuong Le, a general practitioner for some 20 years. He has known the respondent professionally since 1998 and personally since 2004, both being active in the Australian Vietnamese Health Professionals Association. Dr Le said in part: He is an honest, humble, respectful and friendly character who is always willing to share his encyclopaedic knowledge to one and all and is well regarded and admired by those who came to know him, not just in Sydney but all over the world. He demonstrated the ability to think laterally, applying a fresh perspective to any common problem. And it is his differing view that stimulates lively debate and progress. He is passionate about Medicine and the Art of Healing from what I have seen in the various exchanges and debates in the medical fora and from personal observation. The world of medicine would definitely be less interesting without Dr Nguyen Phuoc's contributions. Prior Complaints and Proceedings 1. The respondent has come to the attention of the relevant authorities previously, and has been the subject of prior proceedings in the Medical Tribunal of NSW (matter number 40028 of 2009). The Decision of 7 December 2010 and the reasons therefor of that Tribunal are relevant to our determination of the protective orders which should appropriately be made in the circumstances of these proceedings. In summary, the complaint dealt with by the Tribunal in those proceedings covered allegations of the inappropriate prescribing of steroids, Rivotril, Pethidine, Endone, and human growth hormone. These allegations covered a period of January 2004 to May 2006. The respondent was also alleged to have given intravenous Vitamin C treatment to a patient in circumstances which created a risk of harm, and furthermore was alleged to have failed to keep proper and/or adequate medical records in respect of 18 patients between March 2005 and May 2006. It was said that the respondent admitted "almost all of the factual matters underlying the Complaint" and, in addition, had conceded that his conduct constituted unsatisfactory professional conduct. He denied that he was guilty of professional misconduct. 2. We note for present purposes, the allegations concerning inappropriate keeping of medical records and that one of the allegations in those proceedings was that the respondent has prescribed human growth hormone to a close family member. 3. The Decision deals with the respondent's previous history with the then NSW Medical Board. In February 2006, he was found liable to repay to Medicare in excess of $105,000 following a finding of inappropriate practice in respect of services provided by him to patients between 1 January and 30 December 2001. 4. On 16 October 2008, a Performance Review Panel concluded that following a performance reassessment on 10 March 2006 the respondent's professional performance has been unsatisfactory. Certain practice conditions were imposed on his registration which we shall refer to shortly. We note that the Panel decision results from a process which commenced in January 2004 when concerns were expressed about the respondent's medical record keeping, clinical judgement and patient management. 5. Practice conditions were initially imposed on the respondent effective from 3 October 2006. He was prohibited from possessing, supplying, administering or describing any Schedule 8 drug, benzodiazepines, anabolic/androgen steroids, and Schedule 4 appendix D restricted substances. He was also required to take certain precautions before administering intravenous Vitamin C treatment on patients with a known history of certain renal problems. Between 16 October and 30 November 2008 the practice conditions were varied to require the respondent to complete certain courses dealing with managing depression and to prepare an information sheet to be given to all current and prospective patients concerning the respondent's approach to the provision of complementary healthcare, his view of the benefits of taking vitamins in large doses, and the risks and potential harm of doing so, with a provision for signed acknowledgement by the patient. He was required to undergo a further professional performance reassessment. 6. Amended conditions were imposed from 1 December 2008 which, in general terms, noted the completion of the requirement to attend the courses on managing depression. 7. The catalyst for the proceedings before that Tribunal was a complaint by a specialist nephrologist whose patient had consulted the respondent and to whom he had administered large doses of intravenous vitamin C over three days. The specialist said that this treatment had contributed to the rapid decline of the patient's renal function which had not recovered, and she had been placed on permanent dialysis therapy earlier than would otherwise have been necessary. The respondent conceded that he was unaware that high doses of vitamin C could cause harm of this kind. Furthermore, although he had taken blood to test the kidney function of the patient, he had not waited for the results before administering the first dose. The respondent accepted that he should have called the specialist and discussed the proposed treatment with him. We note that these circumstances are similar to those which applied to patient A in these proceedings, which we have described in our earlier decision. It seems that the respondent has learned little from his proven and admitted misconduct in the earlier proceedings. 8. The reasons for decision by the earlier Tribunal explain in general terms the circumstances surrounding each of the patients the subject of the complaints before it. For our purposes, it is only necessary that we refer to some features of some of the complaints, because there is a striking similarity in the approach to the practice of medicine which applied in those proceedings and those with which we are dealing in these proceedings. 9. The respondent conceded that he had prescribed, dispensed or administered anabolic/androgen steroids to patients in excessive quantities and for a purpose outside recognised therapeutic standards. He did so to allow patients to increase their muscle bulk or because they were complaining of fatigue. He said that he was ignorant to the fact that the prescription of these substances was unlawful. The respondent conceded that he had prescribed intramuscular injections for certain conditions for a long period, and that he was not aware of any scientific basis for the treatment although he thought it might assist in the build-up of certain muscle bulk. He admitted prescribing another substance to three patients in quantities and/or for a purpose not in accordance with recognised therapeutic standards of what was appropriate in the circumstances. Furthermore, he had prescribed 880 tablets of a benzodiazepine in the 14 months between 3 March 2005 and 17 May 2006 to a patient when he knew that the patient abused alcohol and cigarettes, was dependent on benzodiazepines and Endone and was in chronic pain, and without having established a clear management plan. There were other instances noted in the Tribunal's reasons where treatment had been afforded without the establishment of a management plan, benzodiazepine had been administered in circumstances which had created an addiction and for no recognised therapeutic reason. Furthermore, he admitted that he had failed to keep proper and/or adequate medical records for 18 patients between March 2005 and May 2006. The deficiencies included: Failure to refer to the indication for dose, frequency or duration of treatment and no detailed outline of symptoms or examination findings…. not having sufficient detail to be able to assess progress and no overall management plan…., legibility…., a mention of a substance in the notes after it had been dispensed and used by 2 patients for more than one month, and a failure to record an assessment of a patient's mental state or psychiatric history when referring to a "generalised anxiety disorder. 1. In determining what protective orders were necessary, the Tribunal accepted expressions of contrition by the respondent proffering admission of almost all of the complaints particularised against him. In its reasons, the Tribunal said that it was: …concerned at the number of occasions on which the various entities responsible for the monitoring of the professional performance of medical practitioners have made adverse findings concerning the professional conduct of Dr Nguyen-Phuoc. These findings have arisen out of his conduct in unrelated areas of practice including the role of complementary medicine in a general practice, dangerous prescribing practices and poor record-keeping. The Tribunal is satisfied that this is consistent with Dr Nguyen-Phuoc having had, at least in the past, a cavalier attitude to compliance with the usual standards expected from medical practitioners. The Tribunal then noted that the respondent had said: …on a number of occasions while giving evidence that this experience (which commenced in 2006) had been life changing so that he had gained sufficient insight into his conduct to enable the Tribunal to be comfortably satisfied that he will not in the future repeat any of the conduct which is the subject of the Complaint. The Tribunal accepted that evidence. 1. In due course we will compare the conduct complained of in the prior proceedings with that which is the subject of these proceedings. As will be seen, the "life changing" experience of the respondent asserted in submissions he made to the prior Tribunal does not appear to have effected any appropriate change in his conduct as we have described it in these proceedings. 2. The Tribunal found the respondent guilty of professional misconduct, imposed a reprimand, and varied the practice conditions which applied to his registration. Significantly, he was required to be subject to then level 3 supervision and for this purpose was prohibited from practising alone, and was required to practice in an approved group practice of at least three practitioners with one other practitioner always on-site. The Gravity of the Conduct in These Proceedings 1. We have described the misconduct of the respondent which we have found to have been established to the requisite standard in detail in our reasons for decision. It is not profitable to restate them in detail. However, we must emphasise that the summary which we are about to set out should not detract in its brevity from the nature and extent of the findings as we have made them. 2. In essence, the findings covered three separate areas of complaint, namely inappropriate conduct as a medical practitioner, deficiencies in clinical records and improper and unethical conduct in issuing prescriptions for medication whilst his registration was suspended. The findings covered instances where the respondent had failed to make appropriate contact with the treating medical practitioner of a patient, in failing to appreciate that a patient had a severe cognitive physical disorder and its consequences, in the use of inappropriate testing mechanisms for a number of conditions, in prescribing a thyroid extract in lieu of thyroxine which was a more acceptable product, in administering thyroid hormone therapy where there was no clinical basis to do so, in a lack of reasonable understanding of partial adrenal insufficiency and the need to clearly establish the diagnosis, in failing to warn patients of the adverse effects of administering hydrocortisone, and in knowingly issuing prescriptions to patients whilst suspended from practice. 3. In order to describe the behaviour of the respondent, and our understanding of what motivated him to misconduct himself in the manner which we have found, we repeat paragraphs [130] - [133] of our earlier decision: [130] It is clear to us from the whole of the evidence that essentially the respondent is an intelligent, passionate man who cares deeply about his patients. He has developed a strong, but narrow, belief system which directs his clinical practice in a way that is inconsistent with orthodox Australian general practice. So much can be gleaned from the evidence of the expert witnesses given in the proceedings. [131] The respondent has used his knowledge of human physiology to create a belief in his interpretation of symptoms, signs and pathology reports that is out of step with his peers in general practice. He uses references which are often not peer-reviewed, but are opinion pieces, whilst ignoring more rigorous references which dispute his beliefs. He is able to interpret facts in such a way as to fit his own paradigm of illness. This has resulted in him developing a narrow range of diagnostic possibilities for many of his patients. It has enabled him to interpret symptoms, signs and especially pathology reports in a way that fits his diagnoses rather than in a more orthodox manner. For instance, he interprets, to suit his belief, blood levels that are within the normal range as being abnormal if the results are either towards the low or high end of the normal range. He also interprets the small changes in normal laboratory levels, which are due to the inherent variability of the testing mechanism, as being highly significant. He then uses these diagnostic paradigms to construct a management plan using medications that are therapeutically powerful, and so are potentially dangerous when used in an unorthodox manner. When we say "unorthodox", we mean used in a manner that is inconsistent with published therapeutic information. For instance, the use of doses of hydrocortisone equivalent to the body's endogenous production of cortisol (which the respondent says are "physiological doses") from the adrenal gland, when blood results show that the adrenal gland is producing a normal amount of cortisol itself. This has the potential to cause adrenal suppression which, if it becomes permanent, would lead to iatrogenic Addison's disease. [132] The respondent appears to have a powerful and unshakeable belief in his interpretation of the physiology of the human body, and is unable to consider that he may be wrong. As such he is practising medicine, not as a complementary practitioner in the sense that we have earlier described it, but in a manner inconsistent with that of his general practitioner peers, and in a manner which is potentially dangerous, as described in the expert evidence of Professor Carter. The respondent's medical records are, on the evidence, often confusing in understanding the respondent's diagnosis and management plans. They appear to us to assume a great deal of knowledge and application on the part of the respondent without there being any need to reduce it to writing. They seem to confirm an impression of the respondent's inability to think broadly, and laterally, about possible diagnoses and treatments. The shortcomings in the respondent's records as identified in the expert evidence which we have previously set out would not permit, in many cases, another medical practitioner, perhaps even one practising complementary medicine, to readily understand and deal with a patient without reverting to a basic examination and investigation of the patient's circumstances. [133] Significantly, for the outcome of these proceedings, based on the expert opinion of Professor Carter, the respondent in having exposed his patients to a pharmacologically active agent in the absence of any accepted clinical or biochemical evidence of a disease recognised in orthodox medical practice, has created a potential for harm. In the case of thyroid extract, possible increased risk of osteoporosis, and in the case of hydrocortisone iatrogenic adrenal suppression after 4 weeks. To fail to make an accurate diagnosis of adrenal insufficiency with a short synacthen test compounds the potential for harm. 1. It is clear that in his practice of complementary medicine during the period with which we are concerned in dealing with the complaints the subject matter of these proceedings, namely May 2010 to April 2013, the respondent undertook a treatment regime which was inconsistent with orthodox medical practice, potentially exposing his patients to harm, and in many respects his clinical records were significantly deficient. It is equally clear that his misconduct was, in general terms, "more of the same" when compared with the misconduct found against him in the earlier Tribunal proceedings. Notwithstanding his professed "life changing" insight into the deficiencies in his practice which he asserted to the members of the earlier Tribunal, his assertion was not carried into effect. One must question whether he was genuine when promising that he would practice medicine safely and with due regard to his record keeping to the members of the Tribunal which must have been a motivating factor in the decision to impose a reprimand rather than a more severe protective order. Or perhaps the respondent is incapable of change. In either event, there has been no marked improvement in his conduct, and there is no evidence that he is likely to change. We again refer to the candid comments of Dr Le which we have earlier set out. The respondent's "differing view" seems to be firmly entrenched. 2. In addition to this course of conduct is the most serious misconduct which was the subject of Complaint Three, namely, issuing prescriptions after his registration was suspended for a significant period. We described the respondent's actions in this regard as being "both disgraceful and dishonourable and inconsistent with the standards of conduct which are expected by the community of medical practitioners registered to practice as such within New South Wales." (at [141]). The Respondent's Oral Evidence in the Stage 2 Hearing 1. The respondent had filed a document in the nature of submissions, but which also contained evidentiary material. He was cross-examined on that material and also elaborated on matters contained within his submissions. The respondent said that he had accepted our reasons for decision "in the main" and asked that he should be able to continue to practice medicine, albeit "with modifications." 2. The respondent sought to reopen the circumstances pertaining to the issue of two prescriptions the subject of Complaint Three. We declined to allow this to occur because, as the respondent candidly conceded, it did not really matter whether there were less instances when, at the least, there were nine occasions when prescriptions were issued while he was suspended. 3. The respondent said in his written material that he would seek to practice more traditional medicine and work with others in the field "and learn how to be acceptable as integrative practitioners." He said he would abandon the use of some of his tests and would not prescribe Hysone unless indicated by testing, and would restrict the circumstances in which he would administer Armour Thyroid Extract. We find this latest statement astonishing when the expert evidence given in the proceedings was that Armour Thyroid Extract should not be used and that thyroxine only should be administered. 4. He also said that he would need to improve his clinical notes, that he might seek work as a locum especially in remote areas, or he might usefully serve in the Army Reserve. In cross-examination, the respondent conceded that he had not made any inquiries about the availability of such alternative work. 5. In his evidence, the respondent remained passionate about his practice of medicine and the fact that he was able to offer some hope where orthodox medicine might have no answers. He compared the substances which he administered to his patients in the practice of complementary medicine to circumstances where orthodox medicine offered treatment such as chemotherapy to patients suffering from cancer "with no or little hope and yet with terrible side effects." The respondent conceded that much of his treatment may have had a placebo effect, but he said that if complementary medicine can offer something without harm he would still offer it. 6. In explaining his conduct in issuing prescriptions while suspended, the respondent adopted the view that he did this for the benefit of his patients with an approach along the lines that "the ends justify the means". What Protective Orders Are Appropriate 1. It is clear to us when considering the misconduct of the respondent which we have found, and which we have characterised as professional misconduct and comparing it against the background of the findings of misconduct of the earlier Tribunal, that there is a consistent pattern of misconduct of the same or relevantly similar kind. In the context of the proceedings before us there is the added factor of the circumstances involving the issue of prescriptions whilst suspended from practice. The continuation of a course of conduct which involves professional misconduct does not provide any comfort that the respondent might alter his practice of medicine so as to avoid in the future the potential for harm which we have identified and the inappropriate and unlawful conduct which we have described. We have repeated our earlier observations concerning our understanding of the respondent and the manner in which he practises medicine as set out in paragraphs [130] - [133] of our earlier decision. His powerful, deep seated and unshakeable belief in the practice of complementary medicine is unlikely to be displaced, at least in the near future. So much is clear from his failure to learn following the adverse findings against him by the previous Tribunal, and, sadly, corroborated in his evidence given on 20 August 2015 during the course of this second stage hearing. 2. The practice of medicine is regulated primarily for the protection of the public. Only persons who are appropriately qualified and with the requisite training and expertise are permitted to practice medicine. The community is entitled to expect high professional standards from those who are entrusted with administering to the care of their health and well-being. The community is also entitled to expect high standards of morality and compliance with the regulatory framework which applies to the practice of medicine. Flagrantly breaking the law, even for the avowed purpose of assisting patients is conduct which is significantly below the standard expected of medical practitioners by the community. The respondent has been unable to advance any acceptable reason which could, in any way, justify why he issued prescriptions to patients for a considerable period of time after he was suspended from practice. The public is entitled to be protected from serious misconduct of this kind. 3. Given all of the circumstances concerning the professional misconduct of the respondent as we have described it, and given that that misconduct has occurred in circumstances which are indicative of a continuing course of misconduct described in the earlier Tribunal decision, the protection of the public mandates that the cancellation of the respondent's practice should be continued. We note that the respondent's registration was suspended on 10 July 2013 and that he voluntarily surrendered his registration on 6 February 2015. Accordingly, the respondent has not been registered for a period of a little over two years. The respondent is not currently registered as a medical practitioner. However, by section 149C(4)(a) of the Act we are empowered to make a declaration that had the respondent been registered his registration would have been cancelled. 4. The complainant submitted that an appropriate protective order would involve the cancellation of the respondent's registration, and we have agreed that in all the circumstances that such an order should be made. The complainant further submitted that we should indicate that the respondent should not be permitted to reapply for registration for a further period of two to three years. During the course of hearing submissions we indicated that an appropriate additional period during which the respondent would be prohibited from reapplying for registration might be of the order of two years. Having reviewed in some detail the misconduct of the respondent referred to in the earlier Tribunal decision and having had the benefit of comparing that misconduct with that which we have considered in the course of dealing with these proceedings, we are of the opinion that the additional period should be three years from the date of this decision. 5. The complainant also sought a prohibition order in wide terms which would preclude the respondent from providing a number of health services on a private or public basis until he is reregistered as a medical practitioner. Such an order is capable of being made under section 149C(5) and 149C(5A) of the Act which are in the following terms: 149C Tribunal may suspend or cancel registration in certain cases [NSW] (5) If the Tribunal suspends or cancels a registered health practitioner's or student's registration and it is satisfied the person poses a substantial risk to the health of members of the public, it may by order (a "prohibition order") do any one or more of the following- (a) prohibit the person from providing health services or specified health services for the period specified in the order or permanently; (b) place specified conditions on the provision of health services or specified health services by the person for the period specified in the order or permanently. Note: Section 102(3) of the Public Health Act 2010 provides that it is an offence for a person to provide a health service in contravention of a prohibition order. (5A) The power of the Tribunal to make a prohibition order under subsection (5) extends to a person who is no longer registered if the Tribunal decides under subsection (4) that it would have suspended or cancelled the person's registration if the person were still registered. 1. In its amended form, the complainant said that the relevant order should prohibit the respondent from providing on a private or public basis alternative health services limited to naturopathy, and/or intravenous vitamin therapy until he is reregistered as a medical practitioner. 2. In support of his submission that such an order should be made, counsel for the complainant emphasised that the respondent had a large cohort of loyal former patients and that he had access to his patients' records on his home computer, as conceded by the respondent in evidence. Even though the respondent might give advice to anyone concerning matters about which a person such as a naturopath may give advice, the perception of any of his former patients who consulted him may well be that they were consulting someone who was formerly a medical practitioner with appropriate qualifications, albeit someone who was no longer registered. A similar concern was expressed with respect to persons who might consult with the respondent for such advice, especially if they became aware of his medical qualifications, even though he did not profess to be registered. Having been so consulted, there was a danger that the respondent might to some extent give advice including diagnosis and non-prescription medication, which reflected his approach to the practice of complementary medicine, including the potential for harm to which we have previously referred. 3. We had some initial reservations about whether it was appropriate to make a prohibition order prohibiting the respondent from practising as a naturopath. As we understand it, the practice of naturopathy is entirely unregulated, there are no particular qualifications, and hopefully any treatment administered is not capable of inflicting harm. (We should not be taken to have assumed in any way that naturopathy is beneficial). On this basis, why should the respondent be precluded from endeavouring to earn a living, albeit that he has not said that he wished to pursue any such practice? 4. After some concerned consideration, we have determined to accede to the complainant's request, for the following reasons. If the respondent came into contact with a person and gave advice for reward about any aspect of that person's health or well-being, he would bring to bear on that advice his knowledge as a medical practitioner. Utilising such knowledge could potentially put the respondent in breach of the Act because he would not be registered as a medical practitioner. Furthermore, if such a person was aware that the respondent had formerly practised as a medical practitioner, or possessed an MB BS university degree, that person might well assume that he or she was receiving care at that level. The protection of the public would preclude these circumstances arising in the case of the respondent, based upon the nature and extent of the misconduct which we have found against him. We acknowledge that, in doing so, the respondent will thereby be deprived of an alternative potential source of income. However, this is an unfortunate result of the circumstances which have mandated the making of a prohibition order. Costs 1. The complainant sought a costs order in its favour. This is a costs jurisdiction and the normal principle applies that a successful party is entitled to a costs order unless there are compelling circumstances to the contrary. The respondent said that his impecuniosity was an impediment to the making of a costs order. As is well established, this is not an appropriate reason for declining to make a costs order, but may well be a reason, if established, for some appropriate arrangement between the respondent and the complainant to pay costs by instalments. We propose to make a costs order accordingly. Orders 1. In consequence of the findings of professional misconduct which we have made, our finding that if the respondent were still registered as a medical practitioner we would have cancelled his registration, and other findings as set out earlier in these reasons for decision, we make the following orders: 1. The respondent is disqualified from being registered as a medical practitioner for a period of three years from this date. 2. The National Board with which the respondent was registered is required to record the fact that we would have cancelled the registration of the respondent in the National Register kept by it. 3. The respondent is prohibited from providing on a private or public basis alternative health services being naturopathy and/or intravenous vitamin therapy unless and until he is re-registered as a medical practitioner. 4. The respondent is to pay the costs of the complainant of these proceedings. I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales. Registrar 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: 14 September 2015