Health Care Complaints Commission v Saldevar [2015] NSWCATOD 96
NSW Caselaw
Full text
Select any passage to save a personal note with optional tags.
Civil and Administrative Tribunal
New South Wales
Medium Neutral Citation: Health Care Complaints Commission v Saldevar [2015] NSWCATOD 96
Hearing dates: 9, 10 & 11 March 2015 and 14 August 2015
Date of orders: 14 August 2015
Decision date: 14 August 2015
Jurisdiction: Occupational Division
Before: F Marks ADCJ, Principal Member
Dr S Toh Professional Member
Dr V Sutton Professional Member
R Kelly Lay Member
Decision: The respondent is reprimanded.
Practice conditions are imposed in relation to the respondent's prescribing rights, audit, mentoring supervision, practice arrangements and review as set out below.
The respondent is to pay the applicant's costs of these proceedings.
Catchwords: Medical practitioner – whether practitioner guilty of professional misconduct – small cohort of patients – Held reprimand and imposition of practice conditions appropriate – costs order made
Legislation Cited: Health Care Complaints Act, 1993, ss 39(2), 90B(3)
Health Practitioner Regulation National Law (NSW), ss 125, 127, 139E, 145A, 149C
Health Practitioner Regulation (NSW) Regulation, 2010, Clause 7, Schedule 2
Poisons and Therapeutic Goods Act 1966, s28(3)
Poisons and Therapeutics Goods Regulation 2008, clause 38, clause 82
Health Records and Information Privacy Act, 2012, s25(1)
Category: Principal judgment
Parties: Health Care Complaints Commission (Applicant)
Dr Ferdinand Saldevar (Respondent)
Representation: Counsel:
C O'Donnell (Applicant)
G Butler (Respondent)
Solicitors:
Health Care Complaints Commission (Applicant)
Browns Legal Consulting (Respondent)
File Number(s): 1420224
Publication restriction: A non-publication order is made relating to anything that identifies any of the respondent's patients.
REASONS FOR DECISION
1. These proceedings are constituted by a Notice of Complaint which, as amended, is in the following terms:
The Civil and Administrative Tribunal of New South Wales has received a complaint from the Health Care Complaints Commission following consultation with the Medical Council of New South Wales in accordance with sections 39(2) and 90B(3) of the Health Care Complaints Act 1993 and section 145A of the Health Practitioner Regulation National Law (NSW) ("the National Law") THAT Dr Ferdinand Saldevar of 547 Kooringal Road, Wagga Wagga, NSW, 2650 ("the practitioner"), being a medical practitioner registered under the National Law.
COMPLAINT ONE
Is guilty of unsatisfactory professional conduct within the meaning of section 139B of the National Law in that he has:
1. Engaged in conduct that demonstrates that the knowledge, skill or judgement possessed, or care exercised, by the practitioner in the practice of medicine is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or
2. Contravened the Health Practitioner Regulation (New South Wales) Regulation 2010;
3. Engaged in improper or unethical conduct relating to the practice or purported practice of medicine
BACKGROUND TO COMPLAINT ONE
At all relevant times the practitioner practised as a general practitioner at KRS Health Family Medical Practice which was located at 547 Kooringal Road, Wagga Wagga, New South Wales.
PARTICULARS OF COMPLAINT ONE
Patient A
1. The practitioner, between 10 September 2010 and 24 March 2012, failed to conduct an appropriate assessment of Patient A prior to prescribing for Patient A the Schedule 8 drugs Hydromorphone and Oxycodone on the occasions referred to in Schedule A.
2. The practitioner, between 10 September 2010 and 24 March 2012, on the occasions set out in Schedule A, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient B Hydromorphone or Oxycodone, each a type C drug of addiction:
a. when the practitioner knew or should have known that Patient A was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
3. The practitioner, between 10 September 2010 and 24 March 2012, contravened the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient A in that he failed to record:
a. The patient's reason for consultation or presenting symptoms;
b. Information concerning the patient's medical history;
c. The results of any physical examination of the patient;
d. The diagnosis made by the practitioner;
e. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient B
4. The practitioner, between 4 September 2010 and 31 August 2012, failed to conduct an appropriate assessment of Patient B prior to prescribing for Patient B Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule B.
5. The practitioner, between 4 September 2010 and 31 August 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient B on the occasions referred to in Schedule B contrary to therapeutic guidelines in that Patient B was drug dependent.
6. The practitioner, between 4 September 2010 and 31 August 2012, failed to manage Patient B in accordance with an appropriate clinical plan developed for the patient.
7. The practitioner, between 4 September 2010 and 31 August 2012, on the occasions set out in Schedule B, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient B Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient B was a drug dependent person,
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
8. The practitioner, between 4 September 2010 and 31 August 2012, contravened the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient B in that he failed to record:
a. The patient's reason for consultation or presenting symptoms;
b. Information concerning the patient's medical history;
c. The results of any physical examination of the patient;
d. The diagnosis made by the practitioner;
e. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient C
9. The practitioner, between 1 September 2010 and 17 February 2011 prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient C on the occasions referred to in Schedule C contrary to therapeutic guidelines in that Patient C was drug dependent.
10. The practitioner, between 1 September 2010 and 17 February 2011, on the occasions set out in Schedule C, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient C Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient C was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health .
11. The practitioner, between about 1 September 2010 and about 6 August 2013, failed to comply with clause 38 and/or clause 82 of the Poisons and Therapeutics Goods Regulation 2008 by failing to keep records of the prescribing of drugs of addiction and/or prescribed restricted substances to Patient C as referred to in Schedule C.
12. The practitioner, between about 1 September 2010 and about 6 August 2013, failed to comply with section 25(1) of the Health Records and Information Privacy Act 2012 by failing to keep records of the prescribing of the Schedule 8 drugs to Patient C referred to in Schedule C for seven years from the date of the prescribing.
Patient D
13. The practitioner, between 1 December 2010 and 26 July 2011, failed to conduct an appropriate assessment of Patient D prior to prescribing Fentanyl transdermal patches, a Schedule 8 drug, for Patient D on the occasions referred to in Schedule D.
14. The practitioner, between 1 December 2010 and 26 July 2011, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient D on the occasions referred to in Schedule D contrary to therapeutic guidelines in that Patient D was drug dependent.
15. The practitioner, between 1 December 2010 and 26 July 2011, failed to manage Patient D in accordance with an appropriate clinical management plan developed for the patient.
16. The practitioner, between 1 December 2010 and 26 July 2011, on the occasions set out in Schedule D, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient D Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient D was a drug dependent person
b. without the proper authority of the Director-General of the Department of Health.
17. The practitioner, between 1 December 2010 and 26 July 2011, contravened the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient D in that he failed to record :
a. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient E
18. The practitioner, between 3 June 2011 and 28 July 2011, prescribed for Patient E Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule E and:
a. Failed to conduct an appropriate assessment of the patient prior to prescribing the medication;
b. Failed to contact the patient's previous or other treating medical practitioner.
19. The practitioner, between 3 June 2011 and 28 July 2011, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient E on the occasions referred to in Schedule E contrary to therapeutic guidelines in that Patient E was drug dependent.
20. The practitioner, between 3 June 2011 and 28 July 2011, failed to manage Patient E in accordance with an appropriate clinical management plan developed for the patient.
21. The practitioner, between 3 June 2011 and 28 July 2011, on the five occasions set out in Schedule E, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient E Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient E was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health.
22. The practitioner, between 3 June 2011 and 28 July 2011, contravened the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient E in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. The diagnosis made by the practitioner;
d. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient F
23. The practitioner, between 2 September 2010 and 31 August 2012, failed to conduct an appropriate assessment of Patient F prior to prescribing for Patient F Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule F and Oxycodone, a Schedule 8 drug, on the occasions referred to in Schedule F.
24. The practitioner, between 2 September 2010 and 31 August 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient F on the occasions referred to in Schedule F contrary to therapeutic guidelines in that:
a. The patient was drug dependent;
b. The practitioner prescribed the Fentanyl transdermal patches at an inappropriate frequency;
c. The practitioner failed to reduce the dosage in accordance with the recommendation of a specialist in 2011.
25. The practitioner, between 2 September 2010 and 31 August 2012, failed to manage Patient F in accordance with an appropriate clinical management plan for the patient.
26. The practitioner, between 2 September 2010 and 31 August 2012, on the occasions referred to in Schedule F, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient F Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient F was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
27. The practitioner, between 1 September 2011 and 3 September 2011, on the occasions referred to in Schedule F, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient F Oxycodone, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient F was a drug dependent person,
b. without the proper authority of the Director-General of the Department of Health.
28. The practitioner, between 2 September 2010 and 31 August 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient F in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient G
29. The practitioner, between 11 June 2010 and 11 March 2011, failed to conduct an appropriate assessment of Patient G prior to prescribing for Patient G Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule G.
30. (sic)
31. The practitioner, between 11 June 2010 and 11 March 2011, failed to manage Patient G in accordance with an appropriate clinical management plan developed for the patient.
32. The practitioner, between 11 June 2010 and 11 March 2011, on the occasions set out in Schedule G, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient G Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient G was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health.
33. The practitioner, between 1 July 2010 and 11 March 2011, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient G in that he failed to record:
a. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient H
34. The practitioner, between 28 August 2010 and 12 November 2011, failed to conduct an appropriate assessment of Patient H prior to prescribing for Patient H Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule H and/or Oxycodone, a Schedule 8 drug, on the occasion referred to in Schedule H.
35. The practitioner, between 28 August 2010 and 12 November 2011, prescribed Fentanyl transdermal patches and/or oxycodone, Schedule 8 drugs, for Patient H on the occasions referred to in Schedule H contrary to therapeutic guidelines in that Patient H was drug dependent.
36. The practitioner, between 28 August 2010 and 12 November 2011, failed to manage Patient H in accordance with an appropriate clinical management plan developed for Patient H.
37. The practitioner, between 28 August 2010 and 12 November 2011, on the occasions referred to in Schedule H, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient H Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient H was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
38. The practitioner, on 22 September 2011, on the occasion referred to in Schedule H, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient H Oxycodone, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient H was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health.
39. The practitioner, between 28 August 2010 and 12 November 2011, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient H in that he failed to record:
a. The patient's reason for consultation or presenting symptoms;
b. Information concerning the patient's medical history;
c. The results of any physical examination of the patient;
d. The diagnosis made by the practitioner;
e. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient I
40. The practitioner, between 10 February 2010 and 14 January 2011, failed to conduct an appropriate assessment of Patient I prior to prescribing for Patient I Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule I.
41. The practitioner, between 10 February 2010 and 14 January 2011, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient I on the occasions referred to in Schedule I contrary to therapeutic guidelines in that Patient I was drug dependent.
42. The practitioner, between 10 February 2010 and 14 January 2011, failed to manage Patient I in accordance with an appropriate clinical management plan developed for Patient I.
43. After 8 December 2010 the practitioner failed to appropriately manage or investigate serious medical conditions diagnosed by a specialist physician including:
a. bacterial endocarditis;
b. pulmonary infarction;
c. lung abscess;
d. chronic obstructive pulmonary disease.
44. The practitioner, between 10 February 2010 and 14 January 2011, on the occasions set out in Schedule I, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient I Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient I was a drug dependent person,
b. without the proper authority of the Director-General of the Department of Health.
45. The practitioner, between 1 July 2010 and 14 January 2011, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient I in that he failed to record:
a. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient J
46. The practitioner, between 4 September 2010 and 16 June 2012, failed to conduct an appropriate assessment of Patient J prior to prescribing for Patient J Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule J.
47. The practitioner, between 4 September 2010 and 16 June 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient J on the occasions referred to in Schedule J contrary to therapeutic guidelines in that Patient J was drug dependent.
48. The practitioner, between 4 September 2010 and 16 June 2012, failed to manage Patient J in accordance with an appropriate clinical management plan developed for Patient J.
49. The practitioner, between 4 September 2010 and 16 June 2012, on the occasions set out in Schedule J, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient J Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient J was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
50. The practitioner, between 4 September 2010 and 16 June 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient J in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. The diagnosis made by the practitioner;
d. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient K
51. The practitioner, between 11 November 2011 and 31 July 2012, failed to conduct an appropriate assessment of Patient K prior to prescribing for Patient K Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule K.
52. The practitioner, between 11 November 2011 and 31 July 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient K on the occasions referred to in Schedule K contrary to therapeutic guidelines in that Patient K was drug dependent.
53. The practitioner, between 11 November 2011 and 31 July 2012, failed to manage Patient K in accordance with an appropriate clinical management plan developed for Patient K.
54. The practitioner, between 11 November 2011 and 31 July 2012, on the occasions set out in Schedule K, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient K Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient K was a drug dependent person,
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
55. The practitioner, between 11 November 2011 and 31 July 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient K in that he failed to record:
a. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient L
56. The practitioner, between 21 October 2010 and 30 August 2012, failed to conduct an appropriate assessment of Patient L prior to prescribing for Patient L Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule L.
57. The practitioner, between 21 October 2010 and 30 August 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient L on the occasions referred to in Schedule L outside therapeutic guidelines in that Patient L was drug dependent.
58. The practitioner, between 21 October 2010 and 30 August 2012, failed to manage Patient L in accordance with an appropriate clinical management plan developed for Patient L.
59. The practitioner, between 21 October 2010 and 30 August 2012, on the occasions set out in Schedule L, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient L Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient L was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health.
60. The practitioner, between 21 October 2010 and 30 August 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient L in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. The diagnosis made by the practitioner;
d. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient M
61. The practitioner, between 16 November 2010 and 14 June 2012, failed to conduct an appropriate assessment of Patient M prior to prescribing for Patient M Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule M.
62. The practitioner, between 16 November 2010 and 14 June 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, for Patient M on the occasions referred to in Schedule M outside therapeutic guidelines in that Patient M was drug dependent.
63. The practitioner, between 16 November 2010 and 14 June 2012, failed to manage Patient M in accordance with an appropriate clinical management plan developed for Patient M.
64. The practitioner, between 16 November 2010 and 14 June 2012, on the occasions set out in Schedule M, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient M Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient M was a drug dependent person,
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
65. The practitioner, between 16 November 2010 and 14 June 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient M in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. The diagnosis made by the practitioner;
d. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
Patient N
66. The practitioner, between 1 September 2010 and 21 January 2012, failed to conduct an appropriate assessment of Patient N prior to prescribing Patient N Fentanyl transdermal patches, a Schedule 8 drug, on the occasions referred to in Schedule N.
67. The practitioner, between 1 September 2010 and 21 January 2012, prescribed Fentanyl transdermal patches, a Schedule 8 drug, to Patient N on the occasions referred to in Schedule N contrary to therapeutic guidelines in that Patient N was drug dependent.
68. The practitioner, between 1 September 2010 and 21 January 2012, failed to manage Patient N in accordance with an appropriate clinical management plan developed for Patient N.
69. The practitioner, between 1 September 2010 and 21 January 2012, on the occasions set out in Schedule N, failed to comply with section 28(3) of the Poisons and Therapeutic Goods Act 1966, by prescribing for Patient N Fentanyl transdermal patches, a type C drug of addiction:
a. when the practitioner knew or should have known that Patient N was a drug dependent person;
b. without the proper authority of the Director-General of the Department of Health (or Ministry of Health from 5 October 2011).
70. The practitioner, between 1 September 2010 and 21 January 2012, failed to comply with the Health Practitioner Regulation (New South Wales) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient N in that he failed to record:
a. Information concerning the patient's medical history;
b. The results of any physical examination of the patient;
c. The diagnosis made by the practitioner;
d. Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient.
COMPLAINT TWO
Is guilty of professional misconduct within the meaning of section 139E of the National Law in that he has:
(i) Engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration, or
(ii) Engaged in more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of his registration.
BACKGROUND TO COMPLAINT TWO
As for Complaint One.
PARTICULARS OF COMPLAINT TWO
Complaint One and the particulars thereof are relied upon, both individually and cumulatively.
1. The respondent admitted in writing, tendered in the proceedings, that he was guilty of each of the complaints and their particulars, and that he was guilty of professional misconduct. Consequently, these reasons for decision deal substantially with what consequential orders should be made upon a finding of professional misconduct which we made in the course of issuing an interim decision on 11 March 2015.
Evidentiary Background
1. A large amount of documentary material was tendered into evidence. In addition, an expert retained by the complainant, Dr Emery Kertesz gave evidence, as did the respondent. The narration which follows is based upon the evidence given in the proceedings.
2. The respondent was born in the Philippines in 1964. He completed a medical degree in the Philippines in 1989. He emigrated to Australia in 1990 where he entered into a number of internships involving rotations in surgery, medicine, paediatrics and obstetrics in regional hospitals. He spent about six months in an emergency department. The respondent then undertook further medical study at Sydney University and worked at WorkCover where he was involved in the respiratory unit establishing mobile unit screening for asbestosis. He conducted screening tests between 1992 and 1997. In that year he completed his AMC exams and undertook an internship at a regional hospital. He moved to Wagga Wagga in 1998 to commence in general practice. He commenced the RACGP program in 1999 and completed it in 2003. During this period he was a registrar at KRS Health in Wagga Wagga and also for one year in a general practice in Junee. After commencing work at KRS Health, he eventually became a partner with Drs Keith and Burgess. The respondent said that his usual working hours were from 9am to 5pm, Monday, Wednesday and Friday, 12 noon to 7pm Tuesday and Thursday and Saturday mornings. He also participated in an afterhours clinic once every four weeks. He said that he had a significant number of patients in nursing homes and visited them after 5pm on weekdays and sometimes during lunch hours. He said he would do 3 to 5 home visits each week. He usually sees about 40 patients each day. He said that initially he mostly saw young families and their young children but now his patients tended to be middle-aged and elderly.
3. The respondent made specific mention of the group of patients whose details are contained within the Notice of Complaint. He said that they were not a typical part of his patient population or practice. He had had some very limited experience and exposure to treatment of genuine and non-genuine chronic pain sufferers in his early practice but virtually no formal training in the management of drug dependent patients or in the management of patients with serious chronic pain.
4. The respondent said that he came to treat the patients who are the subject of the Complaint when his then partner, Dr Peter Keith, who was treating a significant number of chronic pain and drug dependent patients ceased being allowed to prescribe S8 drugs in about 2007. He also "inherited" a number of patients with similar conditions from another doctor who had left the practice. In essence, the respondent said that although he had had informal discussions with colleagues in the same clinic about managing these patients he did not appreciate that he would need to acquire specialised training and skills to deal with them. Stating as follows:
I realise now that I was naive. Among other things I realise now that when I took on this group of patients I had inadequate training and skills to make the important judgement about whether a patient was "drug dependent". I also now realise that I had virtually no specific understanding of the legal requirements for such prescribing. To the best of my knowledge I had previously prescribed S8 medications only very rarely for a few years before 2008.
1. Furthermore, the respondent said that in 2008 he had very little knowledge about the potential abuse of fentanyl patches. He was not aware that fentanyl could be extracted from these patches and injected. He was not aware that there was a market amongst drug users of fentanyl patches.
2. Although he found the management of these patients very difficult and challenging, he determined to manage them as best he could rather than to exclude them from the practice. He described himself as "soft hearted". Steps were taken within the practice to create protocols for dealing with patients who were more concerned about acquiring drugs than the management of any underlying painful condition. He became aware of techniques such as requiring patients to return patches before new ones were issued so that they could be inspected for evidence of tampering, entering into patient contracts, accessing a doctor shopper helpline and endeavouring to wean patients off high levels of drug usage. He also referred patients to a pain management clinic run by Dr Todhunter in Albury, with limited success for reasons which we do not need to consider.
3. The respondent first came to the attention of authorities concerning his prescribing of drugs of addiction after an officer of the New South Wales police force at Wagga Wagga complained to the Pharmaceuticals Service Unit of the NSW Ministry of Health about the number of fentanyl patches prescribed by the respondent. An investigation carried out disclosed that over 2000 prescriptions for drugs of addiction had been prescribed by the respondent between 1 September 2010 and 1 September 2012, 589 of these having been dispensed to 29 patients who were or had been on an opioid treatment program without being authorised to do so under the Poisons and Therapeutic Goods Act. They were likely to be drug dependent persons. The complaints the subject of these proceedings relate to 14 of these patients. After being interviewed by officers in November 2012, the respondent voluntarily relinquished any authority to prescribe Schedule 8 drugs. A practice condition was subsequently imposed on 26th February 2013 by the Medical Council of NSW which is attached to the registration of the respondent.
4. The details and particulars of the misconduct are contained in the Complaint. Because the respondent has admitted each and every one of the particulars contained in the Complaint, it is not necessary that we deal in any detail with any of them. This is particularly because the respondent has conceded that his conduct should be characterised as professional misconduct.
5. A stark example of the respondent's treatment of this group of patients is provided by the fentanyl patches prescribed for a patient known as Patient C. A schedule attached to the Complaint is in the following terms:
Drug Date Prescribed Date Dispensed Dose Schedule Quantity
4 D or 8
Fentanyl patch 7/08/2010 7/08/2010 8 5
Fentanyl patch 1/09/2010 1/09/2010 8 5
Fentanyl patch 4/09/2010 4/09/2010 8 5
Fentanyl patch 9/09/2010 9/09/2010 8 5
Fentanyl patch 15/09/2010 15/09/2010 8 5
Fentanyl patch 18/09/2010 18/09/2010 8 5
Fentanyl patch 7/10/2010 7/10/2010 8 5
Fentanyl patch 11/10/2010 11/10/2010 8 5
Fentanyl patch 15/10/2010 15/10/2010 8 5
Fentanyl patch 19/10/2010 19/10/2010 8 5
Fentanyl patch 23/10/2010 23/10/2010 8 5
Fentanyl patch 27/10/2010 27/10/2010 8 5
Fentanyl patch 30/10/2010 30/10/2010 8 5
Fentanyl patch 5/11/2010 5/11/2010 8 5
Fentanyl patch 10/11/2010 10/11/2010 8 5
Fentanyl patch 15/11/2010 15/11/2010 8 5
Fentanyl patch 30/11/2010 30/11/2010 8 5
Fentanyl patch 14/12/2010 14/12/2010 8 5
Fentanyl patch 22/12/2010 22/12/2010 8 5
Fentanyl patch 15/01/2011 15/01/2011 8 5
Fentanyl patch 22/01/2011 22/01/2011 8 5
Fentanyl patch 1/02/2011 1/02/2011 8 5
Fentanyl patch 9/02/2011 9/02/2011 8 5
Fentanyl patch 17/02/2011 17/02/2011 8 3
1. Each of these patches was 100mg. Each of the patches was intended to be worn for a period of 3 days. By reference to the schedule it will be seen that between the period 1 and 18 September 2010, the respondent prescribed 25 patches for this patient, constituting a total dosage which should have lasted the patient 75 days. The respondent conceded that he really did not have any answer as to why he would have prescribed such an excessive amount of this drug within this period. He proffered that some of the patches may have fallen off, that the patient had returned five of them, and that some may have been lost. All of these were proffered by way of hypothesis. The stark reality is that the respondent knowingly prescribed a supply of these patches which, if worn as intended, would have led to an overdose, but which could have become part of the illicit drug trade engaged in by drug dependent persons. This is more than the conduct of someone who is "soft hearted" and represents naivety to an absurd extreme. We should emphasise that the circumstances which attended this patient are also replicated in general terms in the case of the other patients whose details form part of the Complaint against the respondent.
2. Evidence was given as part of the respondent's case by Dr Rod Burgess who, at one stage, was a partner in the practice, and remains an employee having retired from the partnership. He gave evidence concerning his understanding of the overall nature of the practice of the respondent, and we shall return to this later in these reasons for decision. Tellingly, however, Dr Burgess became aware in 2007 that his fellow partner, Dr Keith, had received a complaint from the HCCC concerning the treatment of a migraine sufferer with pethidine. This was exacerbated because Dr Keith was discovered prescribing narcotics without an appropriate authority. Dr Burgess said that in 2007 steps were taken throughout the whole of the practice to deal with issues concerning the prescribing of narcotics including the need to obtain specific authorities, referral to a pain specialist, introduction of patient-doctor contracts, starting low on analgesics, and the like. He said that the respondent participated in these discussions. It is clear, therefore, that as at 2007 the respondent was aware of the nature and extent of problems associated with endeavouring to treat patients who were, or were suspected of, being dependent on drugs.
3. The conduct of the respondent was examined by Dr Emery Kertesz who was retained by the HCCC to give an expert opinion about the respondent's practice. After examining the respondent's files and reporting on them in detail, Dr Kertesz made the following comments in connection with the treatment by the respondent of the patients the subject of these proceedings:
* Dr Saldevar did not apply for authority to prescribe S8 medications to known or suspected dependent patients.
* He did not do an adequate history, examination or perform relevant special tests to confirm his provisional diagnoses on initial contact with the patient.
* He made no effort to ascertain the drug status of patients early in his management of them by performing Urinary Drug Screens.
* He failed to contact previous GPs, relevant health workers, pain specialists and the like to build up an accurate picture of the patients he was prescribing S8 medications to.
* He failed to keep an accurate mathematical record of the number of prescriptions he wrote and the dosages that he was prescribing to individual patients.
* He failed to comply with section 28 of the Poisons and Therapeutic Goods Act, by prescribing S8 drugs to known or suspected addicted patients without gaining an authority from the Director-General of the NSW Department of Health allowing him to do so.
* He appeared to prescribe S8 medications because the patient was requesting him to do so without any formal guidance or management plan in place for the patient's appropriate management.
* He appeared to ignore the recommendations of specialists to whom many of his patients were referred either by him or one of his colleagues.
* He failed to utilise the Medicare Australia increased quantities hotline to allow more accurate and exact dispensing of the S8 medications to his patients.
1. These are major oversights in the performance of General Practice specifically in the difficult areas of chronic pain and addiction medicine. The discipline of Addiction Medicine carries with it the responsibility of patient care and concern but more specifically the responsibility of knowing, understanding and carrying out the rules and requirements of prescribing drugs of addiction and also prescribing in accord with NSW State Legislation. This cannot be taken lightly and all practitioners who undertake S8 prescribing need to be aware of their responsibilities to themselves their patients and to the law governing that prescribing.
2. As we have previously indicated, in an interim decision of 11 March 2015 we formally found the respondent guilty of professional misconduct. We also determined to impose practice conditions for reasons which are set out in the interim decision. In summary, the conditions covered the following matters:
1. the right to prescribe schedule 8 medications was removed
2. the respondent was required to complete a course conducted by Monash University and titled "Issues in Prescribing", a course in record-keeping and a pain management master class.
3. the respondent was to submit to an audit of his practice.
4. the respondent was to submit to mentoring and level B supervision.
1. During the course of the interim decision we made it clear that we were concerned that we did not have sufficient information available to us to allow us to make any determination about whether the respondent could continue to practise medicine safely, albeit excluding the treatment and care of any person who was, or was likely to be, dependent upon drugs of addiction. Furthermore, dependency in this sense can extend beyond the use and abuse of opioids, to such every day substances as nicotine, alcohol, codeine and the like. The nature and extent of the inadequacies and failures of the respondent were described in summary terms in our interim decision. The only evidence then available to us about the current practice of the respondent was that given briefly by him, and which we have summarised above, and that given by Dr Burgess. Dr Burgess was of the opinion that the respondent was a competent and capable practitioner. However, he had only had access to about a dozen of the respondent's patients over some years on the occasions that he had seen them whilst the respondent was absent on holidays and the like. We were not prepared to come to any concluded view on the basis of scant information and evidence of this kind.
2. We should also make it clear that where a medical practitioner has been found guilty of professional misconduct, the burden of demonstrating that he or she should be permitted to continue to practise medicine, albeit with restrictions by way of practice conditions and the like, will fall on the medical practitioner. It is not the responsibility of the HCCC to demonstrate that the medical practitioner is not able to practice medicine safely even on a qualified basis. This would require the HCCC to establish a negative proposition. It would require it to make extensive enquiries about all of the circumstances pertaining to the practice of the medical practitioner. It would impose an unreasonable and inappropriate burden on the HCCC. We rejected the submission made on behalf of the respondent to this effect during the course of the proceedings. The circumstances pertaining to the practice of the medical practitioner are particularly within his knowledge and the burden should fall on him accordingly.
3. The proceedings were stood over for a further, second stage, hearing on 14 August 2015, by when the respondent would have undertaken the courses and submitted to audit, mentoring and supervision.
The Further Course of the Proceedings
1. a number of documents were tendered into evidence at the adjourned hearing including the report of the auditor, Dr Jon Fogarty, a supervision report of Dr Guirguis, recommendations made to the practice in which the respondent was engaged as part of a risk advisory service conducted by Avant, and evidence of a number of regional clinical review meetings attended by the respondent. In addition, the respondent gave oral evidence.
2. In his report conducted on 3 June 2015, Dr Fogarty noted that he sat in on four consultations conducted by the respondent with patients. Overall, Dr Fogarty was concerned that the consultations were "largely directed by the patient." There were aspects of three of the consultations which Dr Fogarty found unsatisfactory, namely a failure to refer to high blood pressure in one patient, a superficial consultation with another and a failure to wash his hands before and after administering a flu vaccination coupled with a failure to warn of possible side-effects of the vaccination and asking the patient to remain at the surgery for observation.
3. Dr Fogarty also selected at random 20 clinical notes covering a period of the prior 10 months, and made comments about each of them. Overall, there was a failure to record one or two items for each patient and in some cases the records were inappropriately brief.
4. In his summary, Dr Fogarty noted that the observed consultations were carried out in a courteous and unhurried manner. The respondent appeared to be well liked and well respected by the patients but he thought that there was "a rather passive approach to consulting." After discussion with the respondent he noted that he appeared to have a good insight into his limitations in dealing with difficult patients. Significantly, Dr Fogarty thought that the medical notes of the consultations made by the respondent:
…were of a poor standard and were below the level expected of an experienced General Practitioner. Very limited examination findings apart from blood pressure, pulse and weight were recorded. No clear provisional diagnoses were recorded in the progress notes.
1. There were other shortcomings noted of the same kind. In his recommendations, Dr Fogarty advised the respondent to utilise care plans as an active part of his medical management of patients and to extensively broaden his medical notes, with formal assistance in this regard.
2. We note that as a result of the report of Dr Fogarty, a committee of the Medical Council determined to conduct a further audit in six months' time and advised the respondent that it was highly desirable that he complete the recommended training to improve his medical records prior to the next audit.
3. The supervisor report of Dr Samih Guirguis covered meetings which he had had with the respondent on 17 and 26 May, 9 and 23 June and 17 July 2015. The report contains details of the patient cases discussed at each meeting. In summary, Dr Guirguis said that there were no instances of non-compliance with the respondent's practice conditions and he had not encountered any particular difficulties of work during the period supervised. He had no concerns for the respondent's clinical performance or general health and, in referring to clinical performance and progress said:
He has been working very hard over the last months and his clinical performance is very good, continuing to manage his big number of his patients efficiently.
1. The respondent tendered a written statement dated 12 August 2015 which contained a number of annexures. He said that he had attended a number of courses and provided evidence to this effect. He also said that he would act on the criticisms and suggestions of Dr Fogarty. He did not agree that he exhibited a "passive approach" as observed by Dr Fogarty and said that he attempted to adopt a mutual, shared approach to decision-making with patients. He agreed that he would be more definite and assertive. He rejected some of the criticisms of Dr Fogarty about certain patients and, certainly, we agree in some respects with this. He did agree that he had failed to wash his hands after giving the flu vaccination and that he had not discussed the side effects or asked the patient to remain in the surgery for observation. The respondent was unable to comment in detail on the specific criticisms of his medical records made by Dr Fogarty because there was no identification of the names of the patients. In any event, he said that he was endeavouring to improve his record keeping but noted that other reviews of this area of his practice had been generally acceptable.
2. The respondent's written statement referred to a number of systems introduced in the clinical practice where he is engaged aimed at enhancing medical record keeping, improving personalised care plans and otherwise improving the quality of the practice of medicine at the clinic. He said that the completion of a large number of courses had assisted him in improving his practice and his awareness of any deficiencies.
3. In oral evidence, the respondent said that he was now able to assist patients in pain management without necessarily making recommendations for Schedule 8 drugs. He is currently involved in creating a protocol for use in nursing homes and is involved with seven nursing homes in the Wagga Wagga area. He sits on a local Aged Care Committee.
4. There was evidence that the respondent, despite restrictions on his practice conditions, had prescribed a Schedule 8 medication. He explained that he had done so inadvertently, and was merely following a direction given by a treating psychiatrist that the particular drug should be made available to that patient. He said that if a patient sought Schedule 8 medication from him, he would recommend that the patient consult another medical practitioner.
5. In general terms, the respondent said that he sees about 40 patients a day, usually on a Friday or Monday and less during the remainder of the week.
6. There was a discussion between the respondent and members of the Tribunal concerning his overall patient numbers. We were endeavouring to ascertain what proportion of the approximately 20 patients who were the subject of complaints which gave rise to these proceedings bore to his overall patient numbers. The respondent thought that he had about 5000 active patients and there were about 40,000 active patients in the whole clinic. This is a significant portion of the population in the Wagga Wagga area. The respondent said that many patients attended more than one group of medical practitioners. Assuming, for the purpose of consideration, that the respondent has, say, 2500 regular patients, we observe that the cohort of 20 patients represents a small portion of them.
Consideration
1. The orders which can be made consequent upon a finding of professional misconduct are set out in section 149C of the Health Practitioner Regulation National Law (NSW) ("The National Law"):
149C Tribunal may suspend or cancel registration in certain cases [NSW]
(1) The Tribunal may suspend a registered health practitioner's registration for a specified period or cancel the registered health practitioner's registration if the Tribunal is satisfied—
(a) the practitioner is not competent to practise the practitioner's profession; or
(b) the practitioner is guilty of professional misconduct; or
(c) the practitioner has been convicted of or made the subject of a criminal finding for an offence, either in or outside this jurisdiction, and the circumstances of the offence render the practitioner unfit in the public interest to practise the practitioner's profession; or
(d) the practitioner is not a suitable person for registration in the practitioner's profession.
1. Whether and to what extent the Tribunal should order suspension or cancellation of the registration of the respondent will depend upon a consideration of principles which are well accepted and well known. The overriding consideration is, of course, provided by the National Law namely the protection of the health and safety of the public. We are concerned also that in determining what course of action to take we need to protect the integrity of the medical profession by maintaining proper ethical and professional standards. Although the power to make orders is primarily protective in nature, and not punitive, it is obvious that removing the right to practice or suspension will have a punitive effect.
2. We should first observe that the professional misconduct of the respondent, which he has freely admitted, and which we have found, is of a very serious kind. Medical practitioners are entrusted with the administration of drugs of addiction which are, of themselves, dangerous when used inappropriately and which are coveted by addicts in the community. It is difficult to believe that the respondent was so naive that he was unaware of the degree to which he was succumbing to the demands of his patients, albeit they may have been regarded as difficult to deal with. Although the respondent sought to explain his difficulties partly on the basis that he misunderstood that the authority to prescribe these drugs reposed in the total practice rather than in the individual doctor, we do not accept his explanation. We are concerned that he so readily appears to have believed his patients concerning the number of patches that they required. Given this scenario, and without more, we would be justified in cancelling or suspending the respondent's registration.
3. However, there are some features which would militate against such a drastic course of action in favour of the respondent. We accept that he "inherited" a small and distinct cohort of patients who were not representative of his general patient profile. Obviously, he was ill-equipped to deal with them, but he has now ceased treating patients who are, or are likely to be, addicted to drugs. Furthermore, the respondent has taken positive steps to improve his practice of medicine, and continues to do so.
4. Given that the respondent has abandoned all ability to prescribe drugs of addiction, which we accept, there are no other circumstances which would create any concern that for some years the respondent has practised medicine in some manner which would create some risk to the health or safety of any existing or potential patient. On this basis, there is no justification in either cancelling or suspending the respondent's registration. Circumstances which have occurred subsequent to the professional misconduct of the respondent have, in effect, overtaken the need to remove him from practice. Nevertheless, we are of the opinion that it is necessary in the interests of the health and safety of the respondent's patients generally, and as a measure to ensure the integrity of the profession that he be reprimanded and that limitations be imposed upon the respondent's practice of medicine. Although the complainant submitted that the Tribunal would be justified in either cancelling or suspending the respondent's registration, the complainant also submitted that, in all the circumstances, it would not be inappropriate to permit the respondent to continue to practise medicine, albeit with certain restrictions and subject to certain practice conditions.
5. The parties were able to reach sensible agreement about a set of practice conditions which should appropriately apply and about the totality of the orders which the Tribunal should make. Included in the orders is that the respondent pay the costs of the complaint, which we formally find is an appropriate order to make in the circumstances of these proceedings. The following orders represent the agreed position of the parties, and the orders which the Tribunal has made in the proceedings.
Orders
1. The practitioner is reprimanded
Prescribing Rights
1. Not to possess, supply, administer or prescribe any "drug of addiction" (Schedule 8 drug) as defined by the Poisons and Therapeutic Goods Act 1966 (NSW).
Audit
1. Dr Saldevar is to submit to audit of his medical practice, by a person nominated by the Medical Council of NSW as follows:
1. An audit is to be conducted within 6 months of today's date and a second audit is to be conducted within 6 months of the first audit and then further audits as required by the Medical Council of NSW;
2. The auditor is to assess Dr Saldevar's compliance with good medical record keeping standards and legislative requirements;
3. The auditor is to pay particular attention to: history taking and assessment, investigations and analysis of test results, diagnosis, prescribing, treatment plan and follow up, and utilisation of care plan as an active part of medical management of patients;
4. Dr Saldevar is to authorise the auditor to provide the Medical Council of NSW with a report on their findings;
5. Dr Saldevar is to meet all costs associated with the audit and any subsequent reports.
6. The auditor will be nominated by the Medical Council of NSW.
7. The auditor will conduct an overall practice performance review and inspect medical records, observe patient consultations, review his drug register and inspect his drug storage facilities.
Mentoring
1. Within twenty eight (28) days the Practitioner is to provide for approval by the NSW Medical Council the name and professional address of a registered medical practitioner who has agreed to act as his professional mentor.
2. The nature and frequency of contact with the mentor is to be determined by the mentor in accordance with the NSW Medical Councils guidelines:
1. The Practitioner is to authorise the mentor to report, in an approved format, to the NSW Medical Council every three (3) months which is to include the fact of contact, and any concerns as to his professional conduct.
2. The Practitioner is to authorise the mentor to notify the NSW Medical Council of any: failure to attend; termination of the mentoring relationship against the advice of the mentor; or any other matter the mentor considers appropriate.
3. The Practitioner will meet with the mentor for an initial period of twelve (12) months from the date of the first consultation and as subsequently determined by the Council.
4. In the event that the approved mentor is no longer willing or able to continue as mentor, he is to nominate another mentor for approval by the NSW Medical Council within 28 days of the cessation of the original mentor relationship.
5. Dr Saldevar is to be responsible for any costs associated with the mentoring process.
6. The meetings should include discussion concerning the issues highlighted in the Reasons for Decision and any personal and/or medical practice issues that may arise.
Supervision
1. The Practitioner is to practise under Category B supervision in accordance with the Medical Council of NSW's Compliance Policy (Supervision) (as varied from time to time) and as subsequently determined by the appropriate review body.
2. The supervisor is to be provided with a copy of the Medical Council of NSW's Compliance Policy and a copy of the Tribunal's Decision. The practitioner is to be responsible for all costs associated with the supervision arrangement. The practitioner is to ensure that:
1. He and the supervisor meet on a fortnightly basis for at least two (2) hours, the first meeting to occur within one month of being advised by the Medical Council of NSW that his nominated supervisor has been approved.
2. At each meeting they address the matters highlighted as concerns identified in the Tribunal's Reasons for Decision and in particular: history taking and assessment, investigations and analysis of test results, diagnosis, prescribing, treatment plan and follow up, and utilisation of care plan as an active part of medical management of patients;
3. At each meeting, the supervisor completes a record of matters discussed at the meeting in a format prescribed or approved by the Medical Council of NSW.
4. The supervisor forwards to the Medical Council of NSW, on a three monthly basis a Supervision Report in a format prescribed or approved by the NSW Medical Council.
5. The supervisor is authorised to inform the Medical Council of NSW 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.
6. In the event that the approved supervisor is no longer willing or able to provide the supervision required, details of a replacement supervisor are forwarded for approval by the Medical Council of NSW within 21 days of the cessation of the original supervisory relationship.
Practice Arrangements
1. The practitioner is to practise only in a group practice approved by the Council where there are at least three medical practitioners (excluding the practitioner).
2. The practitioner is to consult no more than 30 patients per day exclusive of nursing home patients except in the case of emergencies.
Review
1. These conditions may be altered, varied or removed at the discretion of the Medical Council of NSW and the Medical Council is the appropriate review body for the purposes of Part 8 of the Health Practitioner Regulation National Law (NSW).
2. Sections 125 and 127 of the Health Practitioner Regulation National Law (NSW) are to apply while the practitioner's principal place of practice is anywhere in Australia other than New South Wales so that a review of these conditions can be conducted by the Medical Board of Australia.
3. The practitioner authorises and consents to any exchange of information between the Medical Council of NSW and Medicare Australia where such exchanges are necessary to facilitate the monitoring of compliance with these conditions.
Costs
1. The respondent is to pay the applicant's costs 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: 16 September 2015
Related laws
No related documents linked yet.
You've got 21 of 22 free Acts left this visit. Sign up anytime for Facts, Related, and study briefs too.