Health Ombudsman v Yasin[2023] QCAT 243

[2023] QCAT 243

QUEENSLAND CIVIL AND ADMINISTRATIVE TRIBUNAL

JONES, Judicial Member

Assisted by:

DR CAVANAGH

DR WALDEN

MS HARROP

No OCR 228 of 2020

No OCR 037 of 2022

HEALTH OMBUDSMANApplicant

v

YASIN, Shafiq GhulamRespondent

BRISBANE

WEDNESDAY, 17 MAY 2023

JUDGMENT

1. [1]
   This proceeding is concerned with an application by the director of proceedings on behalf of the Health Ombudsman (Applicant) against Shafiq Ghulam Yasin (Respondent).  The relief sought against the Respondent is as follows:

1. (i)
   Pursuant to section 107(2)(b)(iii) of the Health Ombudsman Act 2013, the Respondent has engaged in professional misconduct.
2. (ii)
   Pursuant to section 107(3)(a) of the Health Ombudsman Act 2013, the Respondent is reprimanded.
3. (iii)
   Pursuant to section 107(4)(a) of the Health Ombudsman Act 2013, the Respondent is disqualified from applying for registration indefinitely.

And finally:

4. (iv)
   That there be no orders as to costs.

For the reasons set out below, it is the decision of the Tribunal that those findings and orders ought be made.

Antecedents of the Respondent

2. [2]
   At all relevant times, the Respondent was a registered health practitioner as defined by Schedule 1 of the relevant legislation and section 5 of the National Law.  On 9 October 2007, the Respondent was registered in Australia as a medical practitioner with the Medical Board of Australia.  In 2008, the Respondent obtained specialist registration as a psychiatrist through the Royal Australian and New Zealand College of Psychiatrists.  The Respondent no longer holds registration as a medical practitioner.  

3. [3]
   The Respondent was born on 26 March 1969 in Pakistan and was aged between 47 and 49 years of age when the alleged conduct occurred.  He holds a Bachelor of Medicine, Bachelor of Surgery from the University of Karachi in Pakistan.  That would appear to have been obtained in 1997.  He was first registered as a medical practitioner in Australia on 9 October 2007.  As already alluded to, the Respondent is no longer a registered health practitioner following his failure to renew his registration on or before 30 September 2019.

4. [4]
   Before proceeding further, it is noted that the Respondent has declined to participate in any meaningful way with the Applicant or indeed with this Tribunal  Notwithstanding numerous attempts to keep him informed of the pending proceedings.  On 12 July 2018, the Respondent sent an email to the Health Ombudsman advising:

I acknowledge receiving your email.  I would like to confirm that my flight for overseas trip was due only six hours after the representative from the Health Ombudsman delivered the notice of immediate action.  Since 9 pm on 2^nd July  2018, I am overseas looking after my sick mother suffering from stage three cancer.  I will try to send any documents as per Health Ombudsman monitoring requirements ASAP.  I would like to confirm that I haven’t seen any female or male patients since 2^nd of July nor am I planning to see any patient in the near future.  I will be in touch soon.  Also I have engaged MIGA (my medical indemnity) to support me in this process.  Regards, Shafiq.

5. [5]
   As at July 2018, the Respondent was legally represented.  However, on 28 March 2019, his then legal advisors advised the Health Ombudsman that they no longer acted for the Respondent.  That the Respondent has failed to engage in any way with the Health Ombudsman or otherwise is of itself a concerning factor.  The Respondent has been the subject of previous proceedings in this Tribunal involving an admitted patient boundary violation incident. 

6. [6]
   In 2010, the Respondent was referred to the Tribunal involving allegations that he had maintained an inappropriate and sexual relationship with a female whom he had treated for bipolar disorder.  The matter was dealt with in the matter of the Medical Board of Australia v Yasin [2011] QCAT 300.  The contact between the Respondent and the patient on that occasion was a consensual one.  A number of particular features could be summarised as follows:

• Sometime in February 2008 during the Respondent’s first consultation with the patient, his leg came into contact with the patient and he provided her with his mobile number.  Shortly afterwards, the pair commenced a series of telephone calls over an extended period of in the order of eight months.  These calls went well beyond the involvement of therapeutic matters.  
• In March 2008, at the patient’s request, the Respondent provided her with a letter advising her medical condition was improving which he sought to use in support of her securing a study scholarship.  That situation involved the Respondent meeting the patient in person where they engaged in consensual hugging and kissing.  
• A similar level of intimacy occurred on two or three other occasions over the next four months.  The relationship developed further in that on one occasion the Respondent travelled to Sydney where he met the patient and they engaged in consensual sexual intercourse.  On that occasion, the Tribunal found that the conduct fell substantially below the conduct expected of a health practitioner and the Tribunal suspended the Respondent’s registration for a period of two years to be suspended after 12 months with an operational period of three years.
• In addition, he was ordered to complete a course in ethical decision-making and boundary violations for health professionals and to complete a minimum of 12 months professional supervision with an approved psychologist or psychiatrist focusing on boundary violations.  

7. [7]
   In that case, the Tribunal noted that a matter that worked in favour of the Respondent was the extent of his cooperation in the investigation and the subsequent proceedings.  The Tribunal also noted that the Respondent had accepted the responsibility of his conduct and fully recognised that the conduct was entirely inappropriate.

8. [8]
   These features are not present in this proceeding in that, as has already been identified, the Respondent has in no way cooperated with either the investigation or these proceedings and it must follow then that there was no evidence before the Tribunal, which understands that he is now ashamed and remorseful for his conduct.

9. [9]
   It is also of concern that notwithstanding those earlier proceedings and the consequences that flowed from those proceedings, the Respondent nonetheless continued to engage in what could only be described as predatory conduct involving four other women who were clearly vulnerable.  This is a case where there was a significant balance of power in favour of the Respondent and it was a situation where those four women would have placed enormous trust in the Respondent.  Their mental health issues, which will be discussed in more detail in a moment, also made them particularly vulnerable at the time.

The Appropriate Test

10. [10]
    It is uncontroversial that the onus rests with the Applicant to satisfy the Tribunal that the relief sought ought to be granted.  It is also uncontroversial that given the seriousness of the allegations and the potential consequences for the Respondent, the burden of proof is to be determined according to the principles prescribed in the well-known case of Briginshaw v Briginshaw (1938) 60 CLR 336.  That said, a number of other important factors need to be kept in mind in a proceeding such as this.   

11. [11]
    The conduct of a proceeding in this Tribunal is governed by section 28 of the Queensland Civil and Administrative Tribunal Act 2009.  By virtue of the operation of section 28(3) of the Act this Tribunal is not bound by the rules of evidence other than to the extent it adopts them, it may inform itself in any way it considers appropriate, and must act with as little formality and technicality as is permitted under the relevant legislation.  Drawing from the rules of evidence, section 92 of the Evidence Act 1977 provides for the admissibility of documentary evidence as to facts in issue.  This provision relevantly provides:

1. (1)
   In any proceeding (not being a criminal proceeding) where direct oral evidence of a fact would be admissible, any statement contained in a document and tending to establish that fact shall, subject to this part, be admissible as evidence of that fact if—

   1. the maker of the statement had personal knowledge of the matters dealt with by the statement, and is called as a witness in the proceeding; or
2. (2)
   The condition in subsection (1) that the maker of the statement or the person who supplied the information, as the case may be, be called as a witness need not be satisfied where—

   1. the maker or supplier is dead, or unfit by reason of bodily or mental condition to attend as a witness; or

3. (c)
   the maker or supplier can not with reasonable diligence be found or identified; or

5. (e)
   no party to the proceeding who would have the right to cross-examine the maker or supplier requires the maker or supplier being called as a witness; or
6. (f)
   at any stage of the proceeding it appears to the court that, having regard to all the circumstances of the case, undue delay or expense would be caused by calling the maker or supplier as a witness. 

12. [12]
    In this case, as will be discussed below, one of the patients who was a victim of the Respondent is no longer alive.  Also, there can be little doubt that each of the other three women who provided statements in various forms had serious mental health issues.  It is also the situation that at no time had the Respondent given any indication that he required any of the witnesses to be present to be cross-examined.  In Re Pochi v Minister for Immigration and Ethnic Affairs (1979) 36 FLR 482, Justice Brennan observed:

As the New South Wales Law Reform Commission has pointed out in its report on the rule against hearsay, hearsay, “has a wide scale of reliability”, and there is no reason why logically probative hearsay should not be given credence.  However, the logical weakness of hearsay evidence may make it too insubstantial, in some cases, to persuade the Tribunal as to truth of serious allegations.

13. [13]
    In the context of this proceeding, the observations made by the court in the Health Care Complaints Commission v Wingate [2007] NSWCA 326 are pertinent.  There, the Court of Appeal observed:

In Bowen-James [Bowen-James v Walton, NSWCA, 5 August 1991, unreported], after referring to passages in Edelsten and passages to similar effect in Ibrahim v Walton (NSWCA, 23 April 1991, unreported), the Court continued:

In our opinion, there is no right to silence or any privilege against self-incrimination upon which a medical practitioner, answering a complaint before the Tribunal is entitled to rely.  Indeed, we would endorse the observations made by Hope AJA in Ibrahim.  There is a public interest in the proper discharge by medical practitioners of the privilege which the community accords them and in the due accounting for the exercise of the influence which the nature of the occupation permits them, and indeed requires them, to exert over their patients.  They are not, of course, officers of the Supreme Court and, accordingly, the precise force of the decision in Re Veron; Ex parte Law Society of New South Wales (1966) 84 WN(NSW) (Pt 1) 136, particularly of what was said at 141-2 cannot apply.  Nevertheless, we are of the opinion that if a medical practitioner fails to answer by giving his or her account of the matters charged, there can be no complaint if the Tribunal draws the unfavourable evidentiary inference which absence from the witness box commonly attracts. 

14. [14]
    In the case of Health Care Complaints Commission v Kingston [2018] NSWCATOD 28, there the Tribunal observed:

1. [4]
   But the above comments in Bowen-James may need to be followed with caution in the light of Rich v Australian Securities and Investment Commission [2004] HCA 42. The Tribunal as a matter of law may draw adverse inferences as a result of the Respondent’s failure to give evidence as to explanations to his conduct.

1. [5]
   A specialist Tribunal is not obliged to draw an adverse inference in the absence of an explanation from the respondent. Such an obligation would be inconsistent with the entitlement of the Tribunal to take into account the circumstances in which the failure to offer an explanation arose, including the importance of the matter in the proceedings and the potential adverse consequences for the practitioner of failing to proffer an available explanation.

The complaints 

15. [15]
    The allegations against the Respondent involve four females who were, at various times, patients of the Respondent.  They shall be referred to as patients A, B, C and D.  Initially, proceedings were commenced in respect of only one of those patients (patient A).  However, following further complaints and investigations, proceedings were brought and prosecuted in respect of the other three patients.  It was determined that all the complaints should be dealt with in the one proceeding.  In respect of patient A, the violating conduct of the Respondent can be summarised as follows.  At the relevant time, patient A was 23 to 24 years of age.  In early 2017, she was referred to the Respondent.  She continued to see the Respondent for approximately six weeks.  Overall, between 17 February 2017 and 27 March 2018, patient A had 12 consultations with the Respondent.  The Respondent had not made any notes of these consultations with patient A.  

16. [16]
    At the time, she had been diagnosed with attention deficit hyperactivity disorder and was prescribed the medication commonly referred to as Ritalin.  On regular occasions during consultations, the Respondent asked about her sexual and romantic history, including how many sexual partners she had had, and why she had not had sex, and whether she would have sex in the future.  These conversations bore little, if any, relevance to her clinical care.  On regular occasions, notwithstanding the fact that patient A had told the Respondent that she did not like to be touched by people outside her family unit, the Respondent nonetheless touched the patient on her hands and shoulders, squeezed her arm, hand or neck, and put his hand down the back of her shirt on one occasion, and raised her shirt up to prod at her spine.  

17. [17]
    Also, over the course of some seven or eight consultations with this patient, the Respondent had touched her breasts inside of her bra with his fingers.  At no time did patient A consent to the Respondent touching her, and on about 13 June 2018, she attended Capalaba Police Station and provided information about the Respondent’s conduct.  However, she did not make any formal complaint.  She did, however, make a complaint to the Health Ombudsman.  She was interviewed by the Health Ombudsman investigators and, on 15 January 2019, she signed a written statement. Notwithstanding being advised that the Respondent’s conduct might constitute sexual assault, she indicated that she did not wish to pursue the matter. 

18. [18]
    In respect of patient B, she was aged between 26 and 27 at the time.  She was referred to the Respondent in or around November 2009.  She was only 19 years of age at that time and had an unfortunate history of substance abuse, suicide attempts, and childhood trauma whilst in foster care.  There would also appear to have been evidence of emotional and physical abuse, all of which the Respondent was aware.  The Respondent’s first consultation with patient B occurred on 4 December 2009.  The consultation with patient B ended some time in 2010 or 2011.  However, on 2 June 2016, patient B was referred to the Respondent by another medical practitioner.  Records indicate that patient B had 13 consultation with the Respondent between 20 January 2017 and 27 March 2018.  On three occasions during consultations, the Respondent massaged her neck after she had complained to the Respondent of suffering a migraine.  Notwithstanding advising the Respondent of suffering from a migraine, at no time did she consent to the Respondent massaging her neck.  On another occasion, patient B told the Respondent that she was looking for work to help support her to look after her young son.  The Respondent advised her that he needed his house to be cleaned as he did not have time to do it himself.  An arrangement was reached whereby patient B was to clean the Respondent’s house in exchange for money.  At approximately 3 pm on the same day as that arrangement was made, the Respondent left with patient B, driving to his home at Wellington Point.  

19. [19]
    On arriving at the Respondent’s home, patient B observed that the house did not need cleaning, which she later described in her statement as being in a spotless condition.  Once inside the house, the Respondent took her to the main bedroom of his home and asked her to provide him with a massage.  The Respondent changed into a robe, leaving on his underwear.  He then removed his robe and lay face down on the bed, wearing only his underwear.  Patient B then straddled the Respondent and massaged his back for about two minutes.  The Respondent then offered to massage patient B, but she declined.  The Respondent then paid patient B a cash payment of $40 and drove her back to the clinic.  It should be observed that there is no suggestion that any of that conduct was anything other than consensual.  Nonetheless, is it clearly a flagrant breach of the doctor and patient relationship.  It is a clear case, as is the other – as was the case involving patient A – a clear case of boundary violation.  

20. [20]
    On 10 July 2018, patient B made a formal complaint and the Health Ombudsman commenced investigations.  Unlike the situation involving patient A, patient B did not sign each page of her statement.  Indeed, she only signed the first page.  That situation continued, notwithstanding a number of attempts made to have her complete the signing process.  
21. [21]
    Turning then to patient C.  She was 53 years of age at the time.  She had a history of depression, anxiety, and schizophrenia.  There was also – in her case – a history of at least three previous suicide attempts.  She had experienced periods of psychosis and delusional beliefs, dating back to at least 2012.  Between March 2017 and April 2017, the Respondent had five consultations with patient C.  On 27 March 2017, at or about 5 pm, patient C attended the clinic for an appointment with the Respondent. 

22. [22]
    During that consultation, she had told the Respondent that she had had problems with sex in the past.  The Respondent then stood, got out of his chair, walked behind patient C, where she sat in her chair, and said words to the effect, “Oh yes, I have had problems with sex in the past too.”  And he then massaged her shoulders, making a groaning-type noise.  At the end of the consultation, the Respondent asked her to stay and continued to talk.  She agreed.  The Respondent told his receptionist at that time that she could go home for the day.

23. [23]
    The Respondent and patient C remained in the clinic on their own for a period of two hours and engaged in what she described as friendly chit-chat.  They also spoke about a number of matters completely unrelated to her clinical care.  The patient invited the Respondent to her home for dinner, in what she described as a gesture of friendship.  They then exchanged phone numbers.  About a week later, the Respondent, in fact, contacted patient C by phone and asked if he could visit her at her house.  He arrived at about 7 pm and stayed for a period of three hours.  On this occasion, the Respondent told patient C that she could trust him as he would not do anything wrong.  

24. [24]
    The Respondent and the patient then talked for a period of time about matters, none of which had anything to do with her clinical care.  On 14 April 2017, the Respondent attended patient C’s house at or around 9 pm.  The Respondent told her that he had to move house and this was causing him stress and that he may have been beginning to have a nervous breakdown.  The Respondent and patient C then went into her bedroom where they lay on the bed until between 4.30 am to 5.30 am on the following day.  The Respondent had patient C sign a Medicare billing form and then left the house.

25. [25]
    Following that event, on 17 April 2018, patient C disclosed to one Dr Douglas, a psychiatric registrar, that she had previously been treated by the Respondent and that the therapeutic relationship had ceased as she believed, to use her words, the Respondent was “hitting on me and we nearly had intercourse”.  On 19 June 2018, patient C had a further consultation with Dr Douglas where she disclosed a number of matters which were materially consistent with the conduct which has been summarised above.  Of particular significance, she told Dr Douglas that they did not have intercourse notwithstanding laying on the bed for a number of hours.

26. [26]
    On 11 July 2018, patient C was interviewed by a Health Ombudsman investigator.  During one of those interviews, patient C alleged, notwithstanding her assertion to Dr Douglas that sexual intercourse had not occurred, she on this occasion said that the Respondent had coerced her into her bedroom and had penetrated her vagina with his fingers and pushed his erect penis against her vagina.  For various reasons which will be addressed in a moment, the Applicant does not press the Tribunal to proceed on the basis that that conduct had occurred.

27. [27]
    Nonetheless, it was submitted on behalf of the Applicant that the balance of her evidence concerning boundary violations ought to be accepted.  Sadly, patient C was found deceased in her home in May 2019.  The inference being that she had committed suicide.  Turning then to patient D, she was aged between 23 and 24 years at the relevant time.  At the relevant time, she had been employed as a case manager at a drug and rehabilitation facility known as “Breaking Through Transitional Services”.  That service provided services to male patients who had been released on bail or parole into the facility.

28. [28]
    The Respondent had attended Breaking Through to see patients in his capacity as a psychiatrist.  It was there that he met patient D.  In 2017, patient D stated that she was experiencing depression and anxiety and it was recommended that she seek treatment from the Respondent.  Between sometime in January 2017 and June 2018, patient D was a patient of the Respondent and had attended appointments with the Respondent either at the Breaking Through premises or at the Respondent’s clinic on approximately 25 occasions.  Between January 2017 and November 2017, on occasions the Respondent would massage patient D’s shoulders, collarbone, and also around her chest area.

29. [29]
    He also, on one occasion, placed his hands inside her shirt and massaged her breasts and nipples whilst she was seated.  Also, the Respondent employed patient D in an administrative role at his clinic for a period of approximately two weeks.  Whilst employed at the clinic, the Respondent invited her to his house after work to collect a script which he had prepared for her.  On that occasion he directed patient D into his bedroom and procured her to lay on his bed where he lay beside her for a period of time.  On another occasion, between 1 August 2017 and 1 October 2017, whilst employed at the Respondent’s clinic, the Respondent had asked her how her back was feeling.  

30. [30]
    He then massaged her shoulders, chest, and back area, undid the clip of her bra, placed his hands on her buttocks, procured her to unzip her pants and pull them down to her hips and then to lay down beside him on the floor, where he continued to massage her back and bottom, rocking his body back and forth and thrusting his pelvis against the patient.  The following day patient D resigned her job; however, she continued to see the Respondent when he came to Breaking Through.  Eventually she disclosed to another medical practitioner some of the conduct perpetrated by the Respondent and, in July 2018, the Health Ombudsman commenced investigations.  Following those investigations on 24 May 2022, this patient, patient D, provided a sworn affidavit as to the conduct of the Respondent.

What Evidence Ought Be Accepted

31. [31]
    On behalf of the Applicant, the following submission was made:  

The Applicant submits that patients A, B and C’s evidence ought be received into evidence by reference to section 92 of the Evidence Act for the following reasons:  

1. (a)
   direct oral evidence of the matters detailed in the statement would be admissible;
2. (b)
   the patient statements were signed or initialled by them;
3. (c)
   the maker of the statement – the patients – had personal knowledge of the matters dealt with by the statement;
4. (d)
   the condition in subsection (1) that the maker of the statement be called as a witness need not be satisfied because:

1. (i)
   in respect of patient C the witness is deceased;
2. (ii)
   in respect of patients A and B they are unfit by reason of mental conditions to attend as witnesses, or, alternatively;
3. (iii)
   the Respondent has not (at least presently) required (or indicated an intention to require) the patients to be called as a witness.

32. [32]
    The Tribunal notes though, in respect of patients A and B, whilst there is clearly evidence that both of these women suffer serious mental health issues, there is no evidence to suggest that their mental condition was such as to make it impossible for them to attend as a witness.  That said, though, as already has been referred to, none of the evidence of those patients has been challenged, and there has not been any requirement on the part of the Respondent that they be present for cross-examination.  

33. [33]
    No mention is made in those submissions in respect of patient D.  That is unsurprising, given that her evidence was recorded in a sworn affidavit, the contents of which remain entirely unchallenged.  While patient A’s version of events was not reduced to affidavit form after being interviewed, she signed her witness statement.  That statement was made only some six months after the last violation incident on the part of the Respondent.  It is a cogent document in its form, and, of course, the contents of it are unchallenged.  The versions provided by patients B and C, however, are more troublesome.  Patient B only signed the first sheet of her statement and did not sign the important acknowledgement component of her statement.  That said, her statement was concise, detailed, and lacked any obvious attempt to gild the lily.  Those matters – together with the fact that her evidence is unchallenged and bears a number of features consistent with the evidence provided by the other patients – having regard to all of those matters, on balance the Tribunal also accepts the evidence of patient B.  
34. [34]
    Turning, then, to the evidence of patient C.  This woman was clearly a very troubled person.  She had been variously treated for anxiety, depression and schizophrenia and had three suicide attempts before sadly taking her own life in May of 2019.  The difficulty for the Applicant in respect of this patient is that while not pressing that the Tribunal act on her evidence concerning a serious sexual assault, the Applicant nonetheless presses that the Tribunal ought to accept the balance of her evidence.  The Applicant says that it is not pressing that part of her evidence concerning the sexual assault for a number of reasons, including, in particular, her serious mental health issues at the time and a number of inconsistencies in her evidence, in particular her failure to refer to any such conduct when making the more contemporaneous complaint to Dr Douglas.  To put it shortly, the Applicant is saying the Tribunal ought not accept her evidence concerning the sexual assault but, nonetheless, could comfortably accept her evidence on the other matters.

35. [35]
    On balance, the Tribunal has reached the conclusion that patient C’s evidence, insofar as it is relevant to this proceeding, ought be accepted.  That evidence remains unchallenged but, more significantly in the Tribunal’s view, is that it evidences conduct on the part of the Respondent which has a number of significant similarities with the conduct reported by the other patients.  

36. [36]
    Overall, there is no room for doubt that the Respondent in this case has deliberately involved himself in a predatory course of conduct involving clearly troubled and vulnerable women, in circumstances where he had already been dealt with for patient boundary violations. To put it bluntly, he was given an opportunity to address his issues and continue his profession but, instead, chose to adopt a course of further predatory conduct with these four patients.  

37. [37]
    In Medical Board of Australia v Yasin [2011] QCAT 300, the matter already referred to above, the Tribunal correctly observed that boundary violations involving psychiatrists were particularly egregious.  That was so because of the patient’s vulnerability and the heightened potential for them to develop a dependency on the practitioner.  In this context, the observations made in Psychology Board of Australia v Garcia [2015] VCAT 128, at paragraph 46, are also pertinent.  There, the Tribunal observed:

General deterrence is a more important factor in the case.  Psychologists treat vulnerable people.  There is an inherent imbalance in the professional relationship.  If this is allowed to transfer into a personal relationship, the potential exists for damage to the client.  This is why there are rules designed to prevent such occurrences.  These rules are fundamental to the regulation of the psychologist/client relationship.  The disposition must reflect the Tribunal’s support of this regulation and the requirement to illustrate that failing to meet the standard has disciplinary consequences.

38. [38]
    The fact that those observations were made in respect of a psychologist rather than a psychiatrist is of no consequence.

39. [39]
    The Respondent’s conduct was predatory and involved the taking advantage of multiple vulnerable patients.  Such conduct significantly erodes public confidence in the medical profession and, overall, the totality of the Respondent’s conduct reveals a gross defect in his character, and the Tribunal has no difficulty in concluding that he is not a fit and proper person to hold registration as a medical practitioner.  As already mentioned in this regard, the Respondent’s failure to engage in either the investigation process or in these proceedings generally is also a matter that the Tribunal considers needs to be taken into account.  

40. [40]
    This is a case where any sanction imposed requires a significant message of general deterrence.  The findings and orders of the Tribunal need to not only maintain the public confidence in the profession, but also – in the Tribunal’s view, in this case – to protect other potential vulnerable victims being taken advantage of by the Respondent.  For the reasons given, then, the finding of the Tribunal is that:

1. Pursuant to section 107(2)(b)(iii) of the Health Ombudsman Act 2013, the Respondent has engaged in professional misconduct in respect of all four patients named.
2. Pursuant to section 107(3)(a) of the Health Ombudsman Act 2013, the Respondent is reprimanded. 
3. Pursuant to section 107(4)(a) of the Health Ombudsman Act 2013, the Respondent is disqualified from applying for registration indefinitely. 
4. There be no order as to costs.