Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Hudson [2019] NSWCATOD 38 Hearing dates: 20, 21 February 2019 Date of orders: 14 March 2019 Decision date: 14 March 2019 Jurisdiction: Occupational Division Before: J Millbank, Senior Member L Gregory, Senior Member K Mawson, Senior Member M Maher, General Member Decision: (1) Pursuant to findings of unsatisfactory professional conduct and professional misconduct, under s149C(4)(a) of the National Law if the practitioner was still registered as a nurse the Tribunal would have cancelled his registration; (2) Pursuant to s149C(4)(b) of the National Law the practitioner is disqualified from being registered as a nurse for a period of 1 year from the date of this decision; (3) Pursuant to s149C(4)(c) of the National Law, the Tribunal requires the Nursing and Midwifery Board to record the fact that had he been registered the Tribunal would have cancelled Mr Hudson's registration for a period of 1 year from the date of this decision; (4) Pursuant to s 149C(5A) of the National Law, the practitioner is prohibited from providing health services as defined by s 4 of the Health Care Complaints Act 1993 (NSW) for a period of 1 year from the date of this decision; (5) The Respondent to pay 80 per cent of the Applicant's costs of these proceedings pursuant to cl 13(1) of Sch 5D of the National Law as agreed or as assessed under the Legal Profession Uniform Law Application Act 2014 (NSW); (6) A non-publication order under s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the name of Patient A listed in the schedule to the complaint and any other patient named in evidence. Catchwords: TRADES AND PROFESSIONS – nursing – mental health nursing – sexual relationship with former patient – impairment – recurrent psychotic condition Legislation Cited: Health Practitioner Regulation National Law (NSW); Health Care Complaints Act 1993 (NSW); Cases Cited: Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336 Grant v Health Care Complaints Commission [2003] NSWCA 73 Health Care Complaints Commission v Firth [2015] NSWCATOD 118 and [2015] NSWCATOD 84 Health Care Complaints Commission v Hollis [2019] NSWCATOD 6 Health Care Complaints Commission v Nelson [2019] NSWCATOD 22 Health Care Complaints Commission v Philipiah [2013] NSWCA 342 Qasim v Health Care Complaints Commission [2015] NSWCA 282 Texts Cited: Nursing and Midwifery Board of Australia, Code of Professional Conduct for Nurses in Australia (2008); Nursing and Midwifery Board of Australia, A Nurse's Guide to Professional Boundaries (2010) Category: Principal judgment Parties: Health Care Complaints Commission (Applicant) Nathan Hudson (Respondent) Representation: Counsel: L Thomas (Applicant) Mr Hudson was self represented. Solicitors: Health Care Complaints Commission (Applicant) File Number(s): 2018/00266952 Publication restriction: A non-publication order under s 64(a) of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the name of Patient A listed in the schedule to the complaint and any other patient named in evidence. REASONS FOR DECISION Background 1. Mr Hudson first registered as a nurse in 2013. From August 2013 to February 2017, the practitioner worked as a registered nurse in the Mental Health Inpatient Unit (the unit) of Manning Base Hospital (the hospital). 2. This matter concerns Mr Hudson's past actions in having a sexual relationship with a former patient in 2016, and his current mental health. 3. Patient A is a woman with complex and serious mental health diagnoses, as well as a chronic physical illness, who was also living in a domestic violence relationship. Between 2013 and 2015, Patient A had five admissions to the unit. On two of those occasions she was under the direct care of Mr Hudson. 4. Patient A received on-going support from a caseworker at the hospital, whom she was seeing in October 2016 when she saw and approached Mr Hudson standing outside the hospital. 5. Complaint 1 of unsatisfactory professional conduct alleges both conduct below the standard and improper or unethical conduct. This complaint concerns the practitioner's conduct in exchanging phone numbers with Patient A, meeting up for coffee, inviting her to his home and having a sexual relationship with her for four to six weeks from October 2016, during which he also smoked cannabis in her presence and provided her with cannabis. Mr Hudson admitted all of the particulars in this complaint. 6. Complaint 2 is that the matters above, both individually and cumulatively, amount to professional misconduct. 7. Complaint 3 is that the practitioner has an impairment within the meaning of s 5 of the National Law by reason of a cannabis use disorder in conjunction with a substance induced psychotic disorder or a recurrent psychotic condition. 8. The practitioner has experienced four separate psychotic episodes resulting in hospitalisation. 9. In 2008, following cannabis use, Mr Hudson was admitted to hospital for one month. His diagnosis at that time was schizophreniform psychosis. He was prescribed anti-psychotic medication upon discharge. 10. In 2009, following use of cannabis and cessation of the anti-psychotic medication, Mr Hudson was admitted to hospital for over two months. On this occasion his diagnosis was schizophrenia, schizoaffective disorder or bipolar. He was discharged on a community treatment order for six months and was required to take anti-psychotic medication. After that time he ceased taking the medication and did not have any follow-up treatment. 11. Mr Hudson reported experiencing considerable stress as a result of his workplace culture during 2015 and 2016. 12. In January 2017, following use of cannabis and magic mushrooms, Mr Hudson was admitted to hospital for just over two weeks. On that occasion his diagnosis was bipolar, and he was again prescribed anti-psychotic medication upon discharge. For about six months prior to that admission, Mr Hudson had been smoking approximately 10 cones of cannabis per day. 13. Mr Hudson made a statement to another health practitioner about his relationship with Patient A during the course of that hospital admission. As a result a mandatory notification was made to AHPRA. 14. Following his discharge, Mr Hudson self notified to AHPRA concerning his mental health condition and past hospital admissions. 15. In February 2017 s 150 proceedings were held and the NMC imposed the condition that Mr Hudson not work as a registered nurse. Mr Hudson admitted the improper relationship. 16. In August 2018 Mr Hudson was admitted to hospital for two weeks, at first as an involuntary patient. Unlike the other three admissions, Mr Hudson stated that he had not taken cannabis prior to experiencing psychosis. Mr Hudson had ceased taking anti-depressant medication prescribed by his GP approximately three months prior. On discharge the diagnosis was acute exacerbation of chronic schizophrenia, and further anti-psychotic medication was prescribed. 17. The last depot admission of anti-psychotic medication recorded in Mr Hudson's clinical notes is 10 October 2018. 18. Mr Hudson is currently a full time caregiver for a close relative who is terminally ill. Hearing and Evidence 1. Mr Hudson attended the hearing and represented himself. 2. Although there was a complaint of impairment based on mental impairment, disability or condition, it was uncontested that the nature of the illness Mr Hudson experiences is intermittent. Mr Hudson was focused and cogent in his dealings with the Tribunal and we were satisfied that he was competent to participate in the proceedings. 3. The HCCC submitted reports of the hospital investigation into the relationship, the s 150 proceedings, including an assessment of Mr Hudson by consultant psychiatrist Dr Parsonage dated 25 August 2017 undertaken as part of that process, voluminous medical records concerning Mr Hudson's hospital admissions, and a peer expert report by Ms Marabong. 4. The peer expert Ms Marabong was very strongly critical of the practitioner's conduct, which she opined was significantly below the standard reasonably expected of a RN with an equivalent level of training or experience. 5. Ms Marabong noted that when Mr Hudson was first approached by Patient A he should have declined to exchange phone numbers and explained the need for professional boundaries. Ms Marabong also stated that it would have been appropriate for Mr Hudson to have informed his manager and sought guidance. She notes that: RN Hudson's rather impulsive act to date [Patient A] immediately following her discharge displays poor judgement and serious concerns about impropriety and exploitation naturally arise. 1. The peer expert notes that while there are 'no clear guidelines or protocols of an acceptable timeframe for the development of a personal relationship following a professional one' the NMB Code of Conduct states that sexual relationships between nurses and former patients are 'inappropriate in most circumstances'. This is because such relationships 'raise questions of integrity in relation to nurses exploiting the vulnerability of persons who are or who have been in their care', because of the questionable nature of consent in such circumstances, and the very real potential for harm. 2. Ms Marabong was strongly critical of the practitioner on that basis that he knew of Patient A's long term mental health and social problems and 'had the responsibility to be more conscious of her vulnerabilities and avoid a situation which may foreseeably be harmful to her.' 3. The peer expert also expressed strong criticism concerning the use with, and provision of, cannabis to Patient A. As a mental health professional, RN Hudson would undoubtedly be aware of the adverse effect illicit substances can have on one's mental state, making it lamentable that he would encourage a person with a mental illness to use cannabis. RN Hudson have to have been aware of the potential for [Patient A] to become unwell following his supply of cannabis to her, showing an errant disregard for her safety. 1. Mr Hudson submitted a brief written statement and three professional references from fellow registered nurses. In relation to his current treatment he submitted a brief letter from Kristie Meldrum, a nurse member of the follow up team from his most recent hospital admission, and a recent letter by psychologist Gary Grant. 2. The three references from nurses who have worked with Mr Hudson describe him as good natured, hard-working, honest and reliable. They note his past and on-going efforts to manage his own mental health issues, and his 'immense shame' and remorse concerning the improper relationship. 3. In his written statement Mr Hudson stated, 'I feel that my actions leading to this investigation…were and remain morally and professionally indefensible.' 4. Mr Hudson presented as genuinely and deeply ashamed of his conduct, and as earnest in his desire to undertake treatment in order to restore and maintain his mental health. We accept him as a witness of truth. 5. Mr Hudson stated that he was committed to returning to nursing. He had thought he was well suited to mental health nursing because he could empathise with patients, but now he feels that is not an asset, and would rather return to another setting such as aged care. 6. In his oral evidence, Mr Hudson stated that his relationship with Patient A was a very serious lapse in judgement, but one which was a spontaneous and ill-considered response to a chance meeting, not a planned or predatory effort to exploit the patient. 7. At the commencement of the relationship in October 2016, Patient A had been under Mr Hudson's direct care some 11 months previously. However Mr Hudson stated that he believed at that time (and for some time subsequently), that a much longer period, of two or three years, had elapsed. He understood from Patient A that she had been discharged from the outpatient service (that day) and was in good health. He did not regard her at the time as vulnerable, particularly as he himself had been an inpatient on previous occasions, although he now accepts that Patient A was indeed very vulnerable. 8. Mr Hudson's consistent position was that he had not been under the influence of drugs while he was working, and that he had not used cannabis or taken any other drugs since his discharge from hospital in 2017. While we accept the evidence that Mr Hudson is no longer using cannabis, we find that on his account of consuming 10 cones per day outside of work hours through much of 2016, his professional skill and judgment must have suffered during that time. 9. The Tribunal was required to make a determination concerning the impairment complaint in the context of multiple competing and overlapping diagnoses, and without a current independent expert assessment of Mr Hudson's health. 10. In these circumstances, leave was given for Dr Taylor, the psychiatrist leading the team concerning Mr Hudson's most recent hospital admission, to give oral evidence despite there being no statement from him in evidence. Leave was also given to the HCCC to call Dr Parsonage to give oral evidence, although he had not seen Mr Hudson since August 2017. 11. Mr Hudson's treating practitioners comprised Ms Meldrum, a community mental health nurse, Mr Grant, a clinical psychologist, and Dr Taylor, a consultant psychiatrist. All of them appeared by phone. 12. Mr Hudson had not seen his GP for several months, and there was no evidence from the GP. 13. Ms Meldrum engaged with Mr Hudson on a weekly basis, mostly by phone, since his most recent discharge from hospital some five months earlier. 14. Ms Meldrum characterised Mr Hudson as 'mentally stable' and stated that he has attended all follow up appointments and been compliant with medication. She noted Mr Hudson's mental health support following his anticipated discharge from the service would be his GP and psychologist, and expressed herself as comfortable with that level of support. 15. Dr Taylor first saw Mr Hudson in November 2018 and has seen him on four occasions in total. Dr Taylor reported that he was happy with Mr Hudson's progress, and viewed him as stable and compliant. Dr Taylor was proposing to discharge Mr Hudson from the outpatient service the next day, i.e. following the hearing, on the basis that the service was an acute service and he was confident that Mr Hudson 'won't need us anymore'. 16. Dr Taylor was of the opinion that Mr Hudson does not have schizophrenia, and as there was no evidence of psychosis, he had ceased prescribing an anti-psychotic in recent months. He thought Mr Hudson would benefit from some on-going counselling but not necessarily with a clinical psychologist. 17. Mr Grant is currently seeing Mr Hudson under a mental health plan based on a referral from Mr Hudson's GP. The GP's diagnosis in that referral was reported by Mr Grant as based on anxiety and depression. 18. Mr Grant first saw Mr Hudson in September 2018 and had seen him on six occasions by the time of the hearing, with a further four subsidised consultations available on that plan. Mr Hudson's evidence was that he could not afford to undertake unsubsidised sessions. 19. In his letter dated 6 February 2019 Mr Grant stated that he does not perceive Mr Hudson to be suffering from psychotic or bipolar disorder and gave the opinion that Mr Hudson is 'cognitively healthy', articulate and insightful, but experiencing 'reactional depression.' He noted that Mr Hudson is aware that mental health nursing may not be 'the best fit' for him. Mr Grant stated that he has not seen any evidence that Mr Hudson is using drugs or alcohol. 20. Mr Grant did not accept that Mr Hudson had schizophrenia or schizo-affective disorder, and he believed that his drug induced psychosis had 'cleared up'. 21. In oral evidence Mr Grant stated that he had not communicated with the acute care team, but stated that he was satisfied that his consultations with Mr Hudson 'every two or three weeks' would be 'quite adequate' for Mr Hudson's ongoing care, on the basis that Mr Hudson was very compliant. 22. In his August 2017 report Dr Parsonage gave the opinion that Mr Hudson was impaired both by reason of his mental health and his substance abuse. Dr Parsonage met with Mr Hudson at that time and examined records relating to the three hospital admissions. Dr Parsonage stated, The exact diagnosis of those problems remains somewhat unclear. The use of cannabis and at times other drugs before the onset of the psychotic experiences raises the possibility of a substance induced psychotic disorder and this appears to be reinforced by an absence of other episodes or psychosis or mood disturbance suggestive of Bipolar Disorder. On the other hand Mr Hudson has exhibited symptoms of mania and his admissions to hospital have ranged [from] more than two weeks to two months, which raises the possibility that his substance use may have triggered episodes of a recurrent condition such as Schizoaffective Disorder. 1. In that report Dr Parsonage also noted that Mr Hudson's mental health was being managed only by his GP at that time. He expressed the view that this level of management was 'manifestly inadequate'. 2. The HCCC provided Dr Parsonage with a copy of the records in evidence concerning Mr Hudson's most recent hospital admission. He appeared by phone and was asked to give an updated opinion as to his diagnosis based on this information. Dr Parsonage was careful to note that he had not made a recent assessment of Mr Hudson. 3. Dr Parsonage stated that based on Mr Hudson's account of abstinence over the preceding 12 months it was not clear that there was a current cannabis use disorder. However the fact of the most recent psychotic episode in the absence of a cannabis trigger made a diagnosis of schizo-affective disorder more likely. 4. Dr Parsonage characterised schizo-affective disorder as falling between schizophrenia and bipolar disorder, and stated that it may involve little or no impairment in between acute episodes which could occur months or years apart. Dr Parsonage noted that during previous episodes Mr Hudson had sometimes exhibited mania but at other times, including the most recent episode, had suffered delusions with no mood disorder, making a diagnosis of bipolar less likely. 5. The fact that Mr Hudson had recurrent episodes of psychosis, and the last episode was not triggered by drugs, meant in Dr Parsonage's view that there was a very high chance of relapse without any medication. Given that depot medication is long lasting and the last admission of depot anti-psychotic medication was less than six months previously, it would still be active in Mr Hudson's system. A further three to six months monitoring would be necessary to ensure that he was stable and well. 6. It was Dr Parsonage's opinion that Mr Hudson required much more effective and substantial on-going care under the direction of a psychiatrist. This should involve 'optimising' and close monitoring of medication. 7. A management plan for Mr Hudson's on-going care should also involve the assistance of both a GP and psychologist to provide supportive counselling and to react to early signs of a relapse. Dr Parsonage stressed that a proper regime of treatment and management should ensure continued review of Mr Hudson even when he appeared well, in order to ensure that he stays well. 8. In Dr Parsonage's opinion, Mr Hudson would also benefit from undertaking some form of organised social activity or voluntary work prior to returning to the workforce. He supported a gradual return to work under close supervision, and suggested that Mr Hudson would also benefit from undertaking an ethical training course in boundary violation. Findings and Reasons 1. The issues facing the Tribunal were: 1. Whether the conduct amounted to misconduct 2. The nature and extent of the practitioner's impairment; 3. Appropriate protective orders; Misconduct 1. The Tribunal is independently satisfied that the particulars of complaint 1 were proved to the standard in Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336. 2. Although Patient A was not under the practitioner's direct care at the time of the relationship, he was well aware of the seriousness of her multiple health conditions and he should have been aware of, and responsive to, her on-going vulnerability. 3. The fact that the practitioner's judgment was clouded by his chronic substance abuse and incipient mental ill health is relevant to an assessment of the seriousness of the conduct in context, but it does not prevent a finding of misconduct. 4. Evidence of the hospital investigation into Mr Hudson's relationship with Patient A demonstrates that Patient A's initial response was to lie about the sexual relationship in order to protect Mr Hudson's position, although she later acknowledged that the relationship had occurred. This had the effect of damaging Patient A's relationship with the caseworker upon whom she relied for support. 5. While every case must be judged on its own facts, it would be a rare instance where this Tribunal found that a sexual relationship between a mental health practitioner and a current or former mental health patient did not amount to misconduct, by reason of the extreme power imbalance in such a relationship and the inherent vulnerability of such patients. See e.g. Health Care Complaints Commission v Hollis [2019] NSWCATOD 6; Health Care Complaints Commission v Nelson [2019] NSWCATOD 22; Health Care Complaints Commission v Firth [2015] NSWCATOD 118 and [2015] NSWCATOD 84. 6. It bears repeating that the vulnerability of a mental health patient, and in particular someone who has been so acutely unwell as to be an inpatient of a mental health service, does not instantly disappear upon discharge, but may persist for months or even years depending upon the severity of their health condition and their life circumstances. 7. Even if a former mental health patient subsequently presents as well, or is perceived by themselves or others to be fully recovered, all of the health practitioners who treated that patient maintain a very substantial power imbalance in their interaction with the patient. This is by virtue of the treating relationship, including but not limited to the practitioner's experience of that person when they were acutely unwell, and their access to that person's therapeutic disclosures and clinical records. 8. The Tribunal is independently satisfied that the conduct amounts to professional misconduct by reason of its inherent seriousness. Complaint 2 is made out. Impairment 1. The issue of the practitioner's current state of health was a difficult one. Mr Hudson has been the subject of a number of diagnoses at different times, and he has not had the benefit of a consistent treating relationship with a psychiatrist over the course of his intermittently acute ill health. 2. The Tribunal is not required to be satisfied as to the correct diagnosis of the practitioner's impairment, but must be satisfied that he does currently suffer from an impairment: Grant v Health Care Complaints Commission [2003] NSWCA 73 [11]-[12]. 3. We accept Mr Hudson's evidence that he is no longer using cannabis or other drugs. The last hospital admission, unlike the previous admissions, was not precipitated by substance use. This indicates that Mr Hudson suffers from some underlying psychiatric condition that may recur in the absence of substance use. 4. Having weighed and considered the conflicting evidence, we conclude that Mr Hudson does suffer a current impairment in the form of a recurrent psychotic condition and that it is likely to detrimentally affect his capacity to practise nursing. 5. Ms Meldrum, Dr Taylor and Mr Grant all expressed the view that Mr Hudson is currently well and were sanguine about his current treatment and management which will involve at most, consultations with Mr Grant every three weeks. 6. Dr Parsonage's evidence stood in direct contradiction to that of Mr Hudson's treating practitioners. Even allowing for the fact that Dr Parsonage had not recently assessed Mr Hudson, the Tribunal, applying its own specialist knowledge, preferred the evidence of Dr Parsonage. 7. Mr Hudson has had four serious and prolonged psychotic episodes in just over 10 years. He is not currently taking any anti-psychotic medication, is not under the regular care of a medical practitioner, and has only four subsided sessions with a psychologist remaining under his current mental health plan made with a GP with whom he is not in regular contact. We find that Mr Hudson's condition is not appropriately managed in these circumstances, and that there is an on-going risk of recurrence. As such Mr Hudson's impairment poses a very serious risk to his clinical judgment and abilities for the foreseeable future. 8. In oral submissions Mr Hudson expressed his distress and frustration that he has done everything he was told to do, and tried to get well, only to hear Dr Parsonage's opinion that this was insufficient. He stated, I just want to know what I need to do to get from A to B. I don't want to challenge anything. I just want to comply. If there's a glimmer of hope that I can work again [as a nurse] I'll cling to that and do whatever I need to do. 1. The Tribunal accepts that this frustration and distress is understandable, but the weight of the evidence supports the conclusion that Mr Hudson is not currently fit to practise. Further we find that Mr Hudson's own long-term health, and the safety of the public, require that he actively pursue a different course of treatment. 2. We concur with Dr Parsonage's recommendations as sensible and proactive steps that would assist in managing Mr Hudson's condition, remediating risk to patient safety, and preparing Mr Hudson for any future application for reinstatement as a registered nurse. 3. We encourage Mr Hudson to seek out a treating psychiatrist who can assess and monitor his medication needs over time. In conjunction with that specialist oversight, a supportive treating team including a counsellor and GP who are seen regularly, and are all in communication with each other, will assist in providing continuity of care and hopefully preventing a further episode, or at least reacting in a timely and effective way to the onset of any further episode. Protective Orders 1. The finding of misconduct, in combination with impairment, mean that deregistration is the only appropriate order in order to protect the health and safety of the public in this case. 2. We find that, based on the practitioner's genuine remorse and frank admissions, the risk of him engaging in sexual misconduct in the future is very low. The deterrence effect of these orders is therefore much more directed to the profession at large than the practitioner in particular. 3. The Tribunal is concerned that Mr Hudson's illness remains poorly understood by those who have treated him in the past, and that he is currently not receiving adequate treatment, medication management or psychological support. His condition, although intermittent, is extremely serious. 4. In these circumstances, the Tribunal finds that the higher threshold of a substantial risk to the health and safety of the public is met, and a prohibition order preventing Mr Hudson from undertaking other forms of health services apart from registered nursing, is also required. 5. We stress that this order is not intended to be punitive and should not impede Mr Hudson from pursuing voluntary work or outside activities of the kind suggested by Dr Parsonage. 6. For the sake of clarity we also note that the terms of the prohibition order do not prevent Mr Hudson from providing caregiving services to the relative whom he is currently caring for. Costs 1. Ordinarily costs in this jurisdiction follow the event unless there are reasons to conclude otherwise: Qasim v Health Care Complaints Commission [2015] NSWCA 282 [85]; Health Care Complaints Commission v Philipiah [2013] NSWCA 342 [42]-[44]. 2. The HCCC was successful in its case and conducted the hearing properly and efficiently in the public interest. 3. The case was, however, somewhat hampered by the lack of a current independent assessment of the practitioner's mental health. This resulted in the taking of additional oral evidence in an attempt to piece together evidence on the complaint of impairment. 4. In circumstances in which the practitioner made complete and early admissions concerning the misconduct, and the duration of the hearing was substantially taken up with the question of impairment by reason of mental health, a partial reduction of costs is justified. Orders 1. Pursuant to findings of unsatisfactory professional conduct and professional misconduct, under s149C(4)(a) of the National Law if the practitioner was still registered as a nurse the Tribunal would have cancelled his registration; 2. Pursuant to s149C(4)(b) of the National Law the practitioner is disqualified from being registered as a nurse for a period of 1 year from the date of this decision; 3. Pursuant to s149C(4)(c) of the National Law, the Tribunal requires the Nursing and Midwifery Board to record the fact that had he been registered the Tribunal would have cancelled Mr Hudson's registration for a period of 1 year from the date of this decision; 4. Pursuant to s 149C(5A) of the National Law, the practitioner is prohibited from providing health services as defined by s 4 of the Health Care Complaints Act 1993 (NSW) for a period of 1 year from the date of this decision; 5. The Respondent to pay 80 per cent of the Applicant's costs of these proceedings pursuant to cl 13(1) of Sch 5D of the National Law as agreed or as assessed under the Legal Profession Uniform Law Application Act 2014 (NSW); 6. A non-publication order under s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the name of Patient A listed in the schedule to the complaint and any other patient named in evidence. ********** I hereby certify that this is a true and accurate record of the reasons for decision of the New South Wales Civil and Administrative Tribunal. Registrar 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 March 2019