Health Ombudsman v JKR[2022] QCAT 29

QUEENSLAND CIVIL AND ADMINISTRATIVE TRIBUNAL

REASONS FOR DECISION

1. [1]
   By application filed on 18 December 2020, the Director of Proceedings on behalf of the Health Ombudsman (the applicant) referred disciplinary proceedings involving the respondent pursuant to sections 103 and 104 of the Health Ombudsman Act 2013 (The HO Act) to the Tribunal.
2. [2]
   The referral contains one allegation against the respondent who was, at all relevant times, a registered nurse. On 19 August 2020, the respondent pleaded guilty to one count of forgery and one count of uttering, both committed on 7 March 2019. He was fined $600, and the Magistrate did not record a conviction.

Background

3. [3]
   The applicant who has represented himself before the Tribunal, was born in the Philippines on 19 August 1985. He was 33 at the time of the offences and is 36 now.
4. [4]
   He obtained a Diploma in Nursing from Barrier Reef Institute of TAFE in 2012 and a Bachelor of Medicine from the University of Queensland in 2015.
5. [5]
   He was first registered as a nurse on 13 August 2012.
6. [6]
   On 26 April 2018, the Nursing and Midwifery Board of Australia (the Board) imposed conditions on his registration to the effect that he was not to practise in any role requiring direct or indirect patient conduct.
7. [7]
   On or shortly after 5 November 2019, the Health Ombudsman imposed an interim prohibition order on the respondent’s registration, prohibiting him from providing any health service, paid or otherwise, in a clinical or non-clinical capacity.
8. [8]
   He has not practised as a registered nurse since the imposition of the conditions on his registration by the Board in 2018. He is presently working in a business not associated with healthcare. His registration is current, subject to those conditions, until 31 May 2022.

The Relevant Conduct

9. [9]
   The background to the respondent’s offending is important. He has a significant history of mental health issues, dating back many years. He suffers from temporal lobe epilepsy and a quite severe bipolar affective disorder (type 1).^[1] He has had issues in the past with noncompliance with medication,^[2] but at the present time, and for some period of time, he has been compliant, and is attending a private psychiatrist, and a psychiatrist in a public hospital system, together with a case manager.
10. [10]
    The allegation in the referral is particularised, and those particulars are mirrored in the SOAF filed by the parties.^[3]
11. [11]
    It is agreed between the parties that the Board had become aware of a decline in the mental health of the respondent in early 2016. As a consequence, he was required to attend specialist appointments at the direction of the Australian Health Practitioner Regulation Agency (Ahpra).
12. [12]
    On 7 March 2019, the respondent attended an appointment with a consultant psychiatrist, Dr Matthews, at The Toowong Specialist Clinic. This appointment was for the purposes of a health assessment by an independent health assessor at the direction of Ahpra.
13. [13]
    During the health assessment, the respondent handed two documents to Dr  Matthews. Both were purportedly letters from his then treating psychiatrist, Dr Colleen Hendry, both dated 7 February 2019.
14. [14]
    One of them is genuine, while the other was a forgery.
15. [15]
    The forged letter purported to request that Dr Matthews advise Ahpra that the respondent be cleared to return to work as a registered nurse. The forged letter claimed that (inter alia):

“(The respondent) is now in full remission of his medical condition, and it is my opinion that (he) is fit and has capacity to return to work as a registered nurse”

“The only way for (him) to return to work as a registered nurse is for you to advise Ahpra that he has clearance to return to work as a registered nurse so that the conditions on (his) Ahpra registration can be removed.”

“(He) has already been cleared by his neurologist, Dr Stephen Read, cleared by his GP, Dr Ethan Salleh, and cleared by me, Dr Colleen Hendry, consultant psychiatrist.”

16. [16]
    Dr Matthews noted that the two letters were remarkably different in terms and font, appearance and writing style. He inquired with Dr Hendry, who confirmed that she had not written one of the letters, despite the fact that it was on her letterhead and that her signature had been copied. Dr Matthews reported the matter to Ahpra
17. [17]
    On 20 August 2019, police from the Indooroopilly CIB attended the respondent’s residence and spoke with him. Under caution and warning, he agreed to attend the police station to speak with police. He told them that he had copies of the forged letter that he wished to give to them.
18. [18]
    He then handed over copies of the two letters he had presented to Dr Matthews, with handwritten notations identifying how and why he had forged the letter. One of those notes stated that he had forged the letter in an attempt to re-obtain his registration, which was otherwise taking too long due to his not obtaining the full support of Dr Hendry.
19. [19]
    Upon attending the police station, the respondent contacted a lawyer. The lawyer asked for further time to provide legal advice to his client. Police agreed to meet with the respondent at a later date.
20. [20]
    On 3 September 2019, the respondent attended the Indooroopilly Police Station. He declined to participate in an interview with police.
21. [21]
    Police then issued him with a notice to appear and on 19 August 2020, he appeared legally represented before Magistrate Nunan of the Brisbane Magistrates Court and pleaded guilty to one charge of forgery and uttering in contravention of section 488(1) of the Criminal Code and one charge of utter a forged document in contravention of section 488(1)(b) of the Criminal Code. As noted earlier, he was convicted and fined $600, and convictions were not recorded. He otherwise has no criminal history or regulatory history. He is otherwise a man of impeccable good character.

Characterisation of the Conduct

22. [22]
    The applicant has the onus of proving that the admitted conduct constitutes professional misconduct or, alternatively, unprofessional conduct. The applicant submits that the proved conduct falls squarely within the definition of professional misconduct, as defined in section 5(a) of the Health Practitioner Regulation National Law (Queensland) (National Law):

1. (a)
   unprofessional conduct by the practitioner that amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience;…

23. [23]
    In the applicant’s submission, the relevant features of the approved and admitted conduct of the respondent demonstrating that it does fall within this definition are set out in Mr Price’s submission at paragraph 34:

34. The relevant features of the respondent’s conduct demonstrating it being substantially below the respected standard, including:

1. (a)
   The serious nature of the criminal conduct;

2. (b)
   The dishonest nature of that offending;

3. (c)
   The respondent’s conduct breaches his duty of good faith, candour, and comprehensive disclosure. He did so not through omission, but by positively misrepresenting Dr Hendry;

4. (d)
   It was a deliberate and calculated course of conduct, which can be ascertained from the following:

1. (i)
   The use of Dr Hendry’s letterhead;

2. (ii)
   The drafting of a three-paragraph letter addressed to Dr Bradley Matthews;

3. (iii)
   The forging of Dr Hendry’s signature; and

4. (iv)
   Attending his health assessment appointment with  Dr Matthews and providing him with the forged letter;

5. (e)
   The forged letter purported to be a medical document, the inviolability of which ought to have been fundamental to the respondent in the practice of his profession;

6. (f)
   The respondent’s conduct strikes at the heart of the regulatory system and medical practice, as he sought to subvert the Board’s health assessment process;

7. (g)
   The consequences of the respondent’s conduct were potentially significant. The interim advantage sought by him through his conduct was Dr Matthews providing a positive report to the Board effectively clearing the way for his return to work as a registered nurse. The ultimate advantage sought by the respondent was the Board removing conditions from his registration that prevented him from working. Had the respondent been successful, the Board may have allowed him to return to work without conditions sufficiently adapted to safeguarding the public and the profession against the risk the respondent actually represented.

24. [24]
    The respondent’s submission ^[4] is that at the time he committed the offence on 7 March 2019, he “was undergoing an acute mental health crisis and was in a poor psychological state.”
25. [25]
    As I understand the submission, he argues that because of an acute mental crisis at the time he committed the offence, his moral culpability is thus reduced, taking what was objectively serious conduct outside of the descriptor of professional misconduct. Over recent days, he sent a number of documents and certificates and submissions to the Tribunal, with copies going, as well, to Mr Price. The Tribunal has considered all of that material, much of which was uncontentious, and in the Hearing Brief in any event.
26. [26]
    The evidence in support of that submission, I infer, comes from the material filed in these proceedings, both by the applicant and the respondent^[5], supplemented by the new largely repetitive material that was sent recently. Much of that evidence does not address the issue or is not relevant to it. For example, his previous psychiatrist, Dr Hendry, whose report was the subject of the forgery given to Dr Matthews on the 7^th March, has provided many reports “To Whom It May Concern”; from 13 November 2017^[6] to 7 February 2019^[7], in which she described the respondent’s mental state as stable and him being compliant with his medication. She did not make any assessment of his mental state at or around 7 March 2019.
27. [27]
    After the episode of forgery and for ethical and therapeutic reasons, Dr Hendry no longer treated the respondent, and his care was transferred to consultant psychiatrist Dr Ben McDarmont.
28. [28]
    In a report dated 9 March 2020,^[8] Dr McDarmont states that he took over the respondent’s care on 3 July 2019 in relation to his bipolar disorder. He said that the respondent described retrospectively to me that in the period of February to March 2019 his mood was not stable. He has expressed his belief that his mood instability and lack of sleep, had impacted on judgment, particularly in relation to the forged letter. He has voiced his belief that at the time he did not have insight in the appropriateness of his behaviour, and he has voiced his belief that he felt detached from reality during that period.
29. [29]
    Clearly, Dr McDarmont is reporting what the respondent was saying, not expressing an expert opinion.
30. [30]
    There is another relevant document which was brought to the Tribunal’s attention by Mr Price, which is a medical report under the hand of Dr Hugh Wall, a general practitioner at SmartClinics, dated 16 December 2019.^[9] In that report, Dr Wall refers to an attached report, and there is no attached report. He states that that report says:

"...during the period, 1 February 2019 to 31 March 2019, (the respondent) had been mentally incapacitated and was cognitively impaired for work and study. During this period, (he) had symptoms of depression, insomnia and agitation, which caused alterations in his cognitive thought processes.”

31. [31]
    Dr Wall as a general practitioner is not purporting to express an expert opinion, rather he is referring to a report which is not produced, and which, in any event, would be contrary to the available evidence.
32. [32]
    I do not accept the respondent’s submission that when he forged the letter and then gave it to Dr Matthews on 7 March 2019, his moral culpability was reduced because of an extant decline in his mental health.
33. [33]
    That is not what was said on his behalf by his lawyer before the Magistrate on 19 August 2020. Although a report referring to his mental health impairment was handed to the Magistrate, the solicitor appearing for the respondent, who was present during the proceedings, did not rely on the report or other material relating to his client’s mental impairment as evidence of reduced moral culpability. Rather, he relied upon it as reflecting remorse and insight into his behaviour.
34. [34]
    When both Dr Hendry and Dr Matthews notified Ahpra of the suspected forgery, the regulator sought the respondent’s response, which was received on or about 2 May 2019.^[10] In the criminal proceedings, if it was part of this response, that the respondent’s solicitor focused on as demonstrating remorse. He read from the letter without tendering it. He said:

“To make me feel at ease, calm, relaxed, and composed to Dr Bradley Matthews, independent health assessment, I wrote a referral letter myself to Dr Bradley Matthews, to be the best of my ability without sounding over-confident or arrogant.”

35. [35]
    The solicitor quotes other parts of the response, said to have come from the respondent’s medical insurer, but not all of it. The relevant parts of that letter form part of the agreed facts, namely:

“To make me feel at ease, calm, relaxed, and composed to Dr Bradley Matthews’ independent health assessment, I wrote a referral letter myself to Dr Bradley Matthews, to the best of my ability without sounding over-confident and arrogant, which I’ve cut and pasted on to Dr Colleen Hendry’s letterhead and handed it to Dr Bradley Matthews. I plagiarised Dr Colleen Hendry’s statements, of full remission and capacity to return to work as a registered nurse, which she has clearly written on her Aprha monthly reports…

I sincerely regret my actions in falsifying a letter from Dr Hendry. I realise that it was a bad choice and it will never happen again. I had asked for Dr Hendry to provide me with a letter of support to give to Dr Matthews. However, Dr Hendry was not willing to provide a letter. I then chose to write the letter myself, because what I wrote in the letter is what wanted (sic) Dr Matthews to know about me without sounding overconfident.”

36. [36]
    In other words, he was then admitting on 2 May 2019 that his motivation for doing what he did was not due to any acute mental health crisis, but entirely due to self-interest.
37. [37]
    The last report of Dr Hendry, which is in the hearing brief, relates to examination of the respondent on 2 February 2019^[11] in which she describes him as stable and actively engaged in treatment.
38. [38]
    When Dr Matthews examined him on the day of the offending, there is no suggestion from the doctor that during the 90-minute clinical assessment conducted that afternoon, that the respondent was suffering from an acute mental health crisis; indeed, the relevant parts of the report are to the contrary. Under the heading of Clinical Presentation, Dr Matthews wrote:

“(The respondent) denied any depressed mood, stating that took eight hours sleep per night which was restful and had an intact appetite. He felt that his energy and motivation was similarly unaffected, and he had no subjective impairment of concentration. He denied any syndromal anxiety and denied any psychotic symptoms, either now or in the past, on direct questioning. He stated that he had never been suicidal. “

39. [39]
    Further on in the report under the heading Mental State Examination, Dr Matthews wrote:

“(The respondent) presented as a … male of Filipino decent. He was well groomed and dressed appropriately. He was earnest and engaging, and highly enthusiastic to indicate his stability of mental state and his subjective level of insight into his condition. There was an anxious prolixity to his speech, but no other abnormality to this regard. His mood presented as euthymic and his affect was reactive. His thought content reflected an enthusiasm to assert  a good level of mental health, and thought stream, form and possession were intact. There was no evidence of perceptual disturbance, I was, however, concerned from the history that he provided me that his insight into his mental issues were only partial, insofar as he was willing to identify a vulnerability to a depressed mood, but viewed what may have been significant affective episodes as possibly been secondary to having drinks “spiked”. He possibly minimised the extent of his episodes of ill health.”

40. [40]
    It is common ground that the respondent did suffer what could be described as an acute mental health episode in May 2019 which may have contributed to the contents of the letter dated 2 May 2019 to Ahpra. This led to his admission to the high dependency unit at the Princess Alexandra Hospital from 7 May 2019 to 14 May 2019.
41. [41]
    That admission is referred to in a report to Ahpra dated 19 June 2019^[12], from Dr Matthews, and even then, by reference to the material supplied to the doctor from the PAHt, the respondent was characterising his admission as a result of his seizure disorder, when clearly, by reference to the discharge summary from the Princess Alexandra Hospital,^[13] he was admitted on 7 May 2019 as a result of “mania with psychotic symptoms”, clearly related to his bipolar affective disorder and not his epilepsy.
42. [42]
    It follows that I do not accept that the respondent’s moral culpability in planning and executing the criminal acts on 7 March 2019 is reduced in any meaningful way. Having said that, a comparison of the forged report of Dr Hendry^[14] and her real report^[15], which was also handed to Dr Matthews by the respondent that day, does not suggest any sophistication or detailed planning. It perhaps reflects a sense of desperation and frustration. He provided both reports to Dr Matthews on 7 March 2019. Not only is the style inconsistent, but also the contents, the real one urging a process of returning to work as a registered nurse, and the false one stating unequivocally that he was fit and had capacity for him to return to work as a registered nurse.
43. [43]
    It is little wonder that Dr Matthews was immediately suspicious and I infer, after the consultation, contacted Dr Hendry and confirmed that she did not write the forged report. I accept the characterisation of the conduct as set out in paragraph 34 of Mr Price’s submission.
44. [44]
    The forging of his long term psychiatrist’s signature and the deliberate attempt, albeit quite unsophisticated, designed to undermine the proper assessment of his health, are serious features of his conduct, bearing in mind the paramount principle.
45. [45]
    Section 41 of the National Law makes evidence of relevant codes, guidelines and standards applicable to nurses admissible in proceedings such as this, as evidence of what constitutes appropriate professional conduct. The Board’s code of conduct for nurses unsurprisingly emphasises the importance of honesty and integrity. 1.2 of the Code states, “Nurses practice honestly and ethically and should not engage in unlawful behaviours, as it may…damage the reputation of the profession.”
46. [46]
    Although none of the comparable cases referred to in the applicant’s submission involved a similar factual scenario, each involved a professional engaging in dishonesty by attempting to mislead the peak body in relation to academic results or qualifications. In Medical Board of Australia v Anwar^[16], the practitioner created and relied upon a number of false documents; in an attempt to mislead the regulators and also to mislead the Australian Medical Council in attempts to obtain employment and/or registration in Australia by falsely representing that he had a particular qualification from the University of Malaysia. His conduct was clearly professional misconduct.
47. [47]
    Nursing and Midwifery Board of Australia v Brocklehurst [2011] QCAT 71 involved a nurse falsifying an academic record, but is of little assistance, as it was decided under a pre-existing scheme. In Health Ombudsman v Park [2021] QCAT 309, the respondent was a pharmacy intern. She was required to complete a certain number of hours in training as an intern to qualify for general registration. She falsified the record of the hours, forged the signature of her supervisor, and submitted a false declaration to the Board in her application for general registration, which was granted. Her misconduct was discovered soon after, and her registration was cancelled. That conduct was held to be professional misconduct.
48. [48]
    The cases relied upon by the respondent in his written submission, namely, Health Ombudsman v Wrede [2019] QCAT 356, Health Ombudsman v Mullins [2019] QCAT 339, and Health Ombudsman v Cassingham [2019] QCAT 358, involved health professionals engaging in dishonesty and/or forgery, but none involved any element of attempting to mislead the regulator. The cases are of limited value in this aspect of the proceedings because the parties had agreed that the admitted conduct was professional misconduct.
49. [49]
    I am satisfied to the requisite standard that the proved conduct relating to the criminal matters is professional misconduct as defined in section 5(c) of the National Law.
50. [50]
    On the evidence here, the proved conduct has to be viewed in the background of a constant theme in reports obtained by Ahpra from psychiatrists over the years to assess the state of the respondent’s mental health.  In a report dated 1 May 2019, that is, after the offending, Dr Matthews (who then had a number of assessment reports of consultant psychiatrist Dr Bill Redding from 2016 to 2017 before him) wrote:

I note Dr Reddan’s comments reflecting a similar experience to my own in assessing (the respondent) in that his history “lacked the necessary candour”, that it was clear that “(the respondent) had considerably edited the history”, and that “to get any sort of history from (the respondent) is difficult.”

Sanction

51. [51]
    Proceedings of this nature are protective in nature and not punitive. Contrary to what the respondent might think, this Tribunal in these proceedings does not have power to revoke the interim protection order made on or after 1 November 2019 or to make any orders that will affect the conditions presently imposed on his registration by the Board.
52. [52]
    The conduct is serious for the reasons set out above. It was apt to undermine the regulatory process designed to protect the health and safety of the public. It also has to be taken into account that it was unsophisticated conduct and that his misconduct would be readily detected as it was.
53. [53]
    General deterrence is important to emphasise that such conduct will not be tolerated, as in addition to its potential corrosive effect on the regulatory system, it is conduct that is apt to undermine public confidence in what is a profession that operates at the very heart of our health system.
54. [54]
    I accept without question that the respondent is remorseful. I think it is highly unlikely that he will reoffend. He has no other criminal convictions or a regulatory notices in his history.
55. [55]
    The latest report from Dr McDarmont in the hearing brief^[17] continues a theme that he is capable of maintaining his medication regime and stabilising his mental health.
56. [56]
    He cooperated with the criminal proceedings and he has fully engaged in these proceedings and co-operated in a respectful and professional manner. His health status is for others, but on all the evidence before the Tribunal, I conclude that the respondent’s insight into the seriousness of the impugned conduct is still somewhat limited. His medical condition may explain this, so I do not think that specific deterrence has much relevance in this case.
57. [57]
    Occupational Therapy Board of Australia v Cornelio (Review and Regulation) [2019] VCAT 20 involved an overseas trained occupational therapist who forged his supervisor’s signature on two documents provided to the Board. He was not charged or convicted of any offence. The forgeries were detected almost immediately, and he admitted his wrongdoing. He co-operated with the disciplinary process and admitted that his conduct amounted to professional misconduct. The Tribunal was satisfied that the defendant was sorry for his actions and understood that he acted entirely inappropriately. He had allowed his registration to lapse, so by the time of the orders he had been out of practice for nine months. He was reprimanded and disqualified from applying for registration for three months, which effectively meant a 12-month period of being unable to practise.
58. [58]
    Relevantly in this case, the respondent has not been able to practise since the Board-imposed conditions in 2018. As Mr Price submits correctly, those conditions and his inability, therefore, to gain employment in his chosen profession relate to his health impairment and not to the conduct the subject of this referral.
59. [59]
    The interim prohibition order imposed by the Health Ombudsman on 5 November 2019 was also relevant to his health impairment but also took into account his conduct, although by then, he had not been convicted. It follows that it’s difficult for the Tribunal to conclude that as a direct result of his conduct, he has been prevented engaging in his chosen profession. As a matter of fairness, and bearing in mind the purposes of sanction, some allowance should be made which cannot be calculated in mathematical terms.
60. [60]
    The sanction aspect of the proceedings relating to Dr Anwar were conducted separately.^[18] As I noted earlier, his conduct involved multiple forgeries and utterings to obtain Australian medical registration and in an attempt to obtain employment and mislead the Australian Medical Council. He initially engaged in the proceedings but then withdrew. He had not practised in Australia for almost four years and the Tribunal, contrary to the submission made by the applicant, disqualified him for another eight years. The report does not refer to any criminal proceedings as a result of this particular dishonesty. It is clearly a much more serious case.
61. [61]
    Park involved a very young intern. Nevertheless, she engaged in serious dishonesty, including pleading guilty to a number of offences of dishonesty. She didn’t suffer from any health impairments. She had undertaken postgraduate studies and had not been able to practise in her chosen profession for over two and a-half years at the time of the Tribunal proceedings. As well as a reprimand, she was disqualified from applying for registration for a period of six months from the date of the order.
62. [62]
    Wrede, involved a medical doctor who was also a specialist paediatrician. She had a long history of health-related issues relating to personal circumstances and working in multiple workplaces, which led her to self-medicating using stimulant drugs to help her to stay awake and to treat her anxiety. She forged four prescriptions for drugs of that nature in the names of two or three child patients. She was ultimately exposed and was charged with forgery and uttering, to which she later pleaded guilty. She immediately notified her workplace and was stood down from all duties. As at the date of hearing, she had not worked as a doctor since 2017.
63. [63]
    The matter of her health impairment was dealt with by Ahpra and ultimately, she was granted non-practising registration. Both parties were legally represented and had agreed both on characterisation and sanction, namely, a reprimand without any suspension. In exercising its independent discretion and notwithstanding the agreement of the parties, the then Deputy President of QCAT, his Honour Judge Allen QC, referred to her significant level of insight, a period of almost two years that she was not able to practise and her commitment to further treatment as factors relevant to his decision not to order any period of suspension.
64. [64]
    Mullins involved a registered nurse. She was a young person but had been registered for nine years. She too had long-term health problems, including physical problems and depression. As a result of fracturing her wrist, she was prescribed oxycodone and became dependent on opioids. This led to her stealing a number of pre-authorised prescription sheets from her employer hospital, which she then used to obtain opioids for her own self-treatment.
65. [65]
    She was ultimately convicted on her own plea of guilty to stealing, fraud, forgery and uttering. As in the earlier case, her health impairment was handled by Ahpra, and at the time of the hearing, her registration was subject to conditions preventing her from practising without approval of the Board, and subject to screening and testing conditions to ensure that she was no longer abusing schedule 8 drugs. She had been out of practice for three years at the time of the hearing. As in Wrede, the applicant in this case submitted that a short period of suspension was not necessary, having regard to the conditions currently attaching to her registration. She was found to have shown real insight into her conduct and had taken significant steps to address her underlying health issues.
66. [66]
    Cassingham involved a pharmacist who committed criminal offences to obtain schedule 8 drugs for himself. He committed a number of offences over a number of days in September 2015. Not unlike the respondent in Mullins, his opioid dependence stemmed originally from being prescribed opioid medication for pain relief following a severe fracture. In that case, again, it was held that he had significant insight. He had been out of practice for four years, had shown appropriate remorse, and the parties, both of whom were legally represented, had agreed that the sanction be a reprimand.
67. [67]
    It has often been said a reprimand in itself is a serious sanction. It reflects public denouncement of the respondent’s conduct. Having regard to all these matters set out in these reasons, and having considered all the submissions, I have concluded that it is not necessary in the particular circumstances of this case, to reflect matters of general deterrence and public denunciation and protection of the reputation of the profession by the imposition of what would be, in any event, a short period of suspension on the respondent. The respondent has also applied for an order under section 66 of the Queensland Civil and Administrative Act 2019 (the QCAT Act).
68. [68]
    The application is not accompanied by any material or relevant evidence, but evidence can be gleaned from some of the material already in the hearing brief. I am very grateful to Mr Price for drawing my attention to this material. I do not intend to revisit the details of that material, but I am satisfied that, although it is unusual for the Tribunal to exercise its discretion pursuant to section 66 of the QCAT Act to de-identify the respondent, it is appropriate in this case.
69. [69]
    I am satisfied that it is appropriate in this case, to make such an order which is unopposed to avoid endangering the physical and mental health of the respondent, and otherwise in the particular circumstances of this case, given this man’s long struggle with a serious health impairment, it is in the interests of justice. Accordingly, I order as follows:

1. Pursuant to section 107(2)(b)(iii) of the Health Ombudsman Act 2013, the Tribunal decides that the respondent has behaved in a way that constitutes professional misconduct;

2. Pursuant to section 107(3)(a) of the Health Ombudsman Act 2013, the respondent is reprimanded;
3. Pursuant to section 66 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld), publication of;
   1. the contents of a document or thing being produced at the Tribunal;
   2. evidence given before the Tribunal; and
   3. any order made or reasons given by the Tribunal

is prohibited to the extent that it could identify or rear to the identification of the Respondent in these proceedings, save as is necessary for the parties to engage in this proceeding or any appeal therefrom, or for the applicant to advise the Australian Health Practitioners Regulatory Authority of the outcome of this proceeding.

4. No order as to costs.