Hampshire v Health Care Complaints Commission [2021] NSWCA 283
19 November 2021 - Meagher and Gleeson JJA, Hulme J
In sum: The Court of Appeal dismissed the appeal of a health practitioner from a decision of the Tribunal to cancel his registration. The Court determined that the Tribunal addressed the correct questions and provided adequate reasons for its decision.
Facts: The appellant was a psychiatrist on whose registration practice conditions were imposed in May 2010, including limiting his alcohol consumption, requiring that he abstain from taking sedative medications and requiring him to gain Medical Council approval prior to changing the nature or place of his practice ([7]).
The respondent (the HCCC) alleged the appellant was guilty of unsatisfactory professional conduct and professional misconduct in relation to sexually inappropriate text and voice messages sent by the appellant to a former patient (Patient A) and breaches of the practice conditions. The HCCC also alleged the appellant suffered an impairment and was not competent to practise ([14]-[18]).
At the hearing in November 2020, the appellant’s treating psychiatrist (Dr Apel) agreed that the appellant fulfilled the criteria for the diagnosis of an alcohol use disorder. The diagnosis had not previously been made. The alcohol use disorder was added as a particular of the complaints of impairment and not competent to practise and the proceedings were adjourned to permit further evidence to be adduced. The appellant relied on Dr Apel’s expert opinion that the appellant’s alcohol use disorder could be managed with conditions; Dr Apel acknowledged that the appellant had not yet commenced a period of abstinence and that three years of abstinence would have to be demonstrated before the disorder could be said to be in remission ([21]).
In July 2021 the Tribunal found the appellant guilty of two complaints of unsatisfactory professional conduct as defined in s 139B(1) of the Health Practitioner Regulation National Law (NSW) (the National Law) and one complaint of professional misconduct pursuant to s 139E, and determined that he was impaired because his alcohol use disorder could grossly impair his judgement and clinical ability, and that for that reason he was not competent to practise. The Tribunal cancelled the appellant’s registration and imposed a three-year non-review period ([3], [30]-[34]).
The appellant appealed against: (i) the finding of professional misconduct; (ii) the finding that he is not competent to practise; and (iii) the protective orders as being excessive; or, in the alternative, that the Tribunal’s reasons for rejecting the evidence of Dr Apel were inadequate ([42]).
Held (dismissing the appeal):
Issue 1 – challenge to the finding of professional misconduct
(i) The appellant’s challenge to the Tribunal’s finding of professional misconduct did not raise any question of law and mischaracterised the nature of the Tribunal’s finding of professional misconduct. Whilst the finding did involve an evaluative judgment by the Tribunal, it was not a discretionary decision to which error in the House v The King sense would apply (i.e. it was not plainly unjust and no wrong principle was applied) ([51]-[52]).
(ii) The Tribunal’s finding that the appellant’s conduct in relation to Patient A was both “significant” and “serious” was not only open but hardly surprising, given the Tribunal’s findings as to: the escalating sexual undertones in the appellant’s interactions with Patient A; the appellant’s knowledge of Patient A’s vulnerability and much younger age; the power imbalance between the appellant and Patient A; and the fact that the conduct was not fleeting, went on for several hours, was overtly sexualised and unwanted, and the appellant’s persistence and conduct appeared to have a tone of harassment ([55]-[56]).
(iii) The Tribunal did not fail to consider the evidence attributing the appellant’s conduct in relation to Patient A to his alcohol use disorder. The weight to be given to that evidence in assessing the serious nature of the conduct was a matter for the Tribunal ([57]).
Issue 2 – challenge to the finding of non-competence to practise medicine
(iv) The Tribunal’s decision that the appellant was not competent to practise is not a discretionary decision to which the principles in House v The King apply. No question of law was raised by this challenge ([75]).
(v) The Tribunal did not fail to consider the effect of the appellant’s addiction to alcohol on his conduct; rather, it was only after considering the effect of his addiction, including the evidence of Dr Apel, that the Tribunal came to the conclusion that the appellant is not competent to practise. The Tribunal’s finding was well open to the Tribunal on the evidence ([81]-[83]).
Issue 3 – challenge to protective orders
(vi) The challenge to the exercise of a discretionary power by the Tribunal to cancel the appellant’s registration and order a three-year non-review period raised a question of law insofar as it was demonstrated that there was error in the House v The King sense ([76]).
(vii) The appellant’s conduct in relation to Patient A was the result of the consumption of alcohol and sedative medication in breach of the conditions of his registration on a single day. The Tribunal addressed the risk that similar conduct could occur at any time during the remission phase of his alcohol use disorder, having regard to the paramount consideration of public health and safety pursuant to s 3A of the National Law. The Tribunal did not address the wrong question or fail to address the question at all ([85]-[86]).
(viii) Whether there was no appropriate alternative to cancellation of registration was a matter of judgement for the Tribunal. The Tribunal had regard to the relevant evidence, including Dr Apel’s opinion; it was not required to accept his opinion that monitoring and supervision was appropriate. It was well-open to the Tribunal to find that the proposed conditions did not address the risk to the health and safety of the public ([90]-[92]).
(ix) The Tribunal gave adequate reasons for rejecting Dr Apel’s opinion that the appellant’s impairment because of his alcohol use disorder could be addressed by imposing conditions on his practice. The appeal was dismissed ([98]).
Read the decision on the NSW Caselaw website.