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- Health Ombudsman v Theodoros[2024] QCAT 378
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Health Ombudsman v Theodoros[2024] QCAT 378
Health Ombudsman v Theodoros[2024] QCAT 378
QUEENSLAND CIVIL AND ADMINISTRATIVE TRIBUNAL
CITATION: | Health Ombudsman v Theodoros [2024] QCAT 378 |
PARTIES: | health ombudsman (applicant) v stellios theo theOdoros (respondent) |
APPLICATION NO/S: | OCR185-21 |
MATTER TYPE: | Occupational regulation matters |
DELIVERED ON: | 16 October 2024 |
HEARING DATE: | 29 September 2023 |
HEARD AT: | Brisbane |
DECISION OF: | Judicial Member Reid |
ORDERS: |
|
CATCHWORDS: | ADMINISTRATIVE LAW – ADMINISTRATIVE TRIBUNALS – QUEENSLAND CIVIL AND ADMINISTRATIVE TRIBUNAL – where the Health Ombudsman has brought disciplinary proceedings against the respondent – where the respondent applies for the whole of the proceeding to be struck out – whether the discretion to strike out the proceeding ought be exercised – whole of the proceeding not struck out PROFESSIONS AND TRADES – HEALTH CARE PROFESSIONALS – MEDICAL PRACTITIONERS – DISCIPLINARY PROCEEDINGS – PROCEEDINGS BEFORE BOARDS, TRIBUNALS, ETC – where the respondent says the proceedings are brought for punitive rather than protective purpose – where that would be antithetical to the purpose of disciplinary proceedings – where the respondent says this is in part due to the unlikelihood of the respondent ever returning to practice – whether the proceedings are an abuse of process – whether in the alternative to being struck out, the proceedings ought be stayed PROCEDURE – CIVIL PROCEEDINGS IN STATE AND TERRITORY COURTS – PLEADINGS – STRIKING OUT – FRIVOLOUS OR VEXATIOUS PLEADING – where the respondent alleges that in the alternative to the whole of the proceeding being struck out, certain paragraphs ought to be struck out as frivolous or vexatious – whether the allegations in the impugned paragraphs are frivolous or vexatious PROCEDURE – CIVIL PROCEEDINGS IN STATE AND TERRITORY COURTS – PLEADINGS – STRIKING OUT – OTHERWISE ABUSE OF PROCESS – where the respondent alleges that in the alternative to the whole of the proceeding being struck out, certain paragraphs ought to be struck out as otherwise being an abuse of process – whether the allegations in the impugned paragraphs are an abuse of process Queensland Civil and Administrative Tribunal Act 2009 (Qld), s 47 Board of Professional Engineers of Queensland v Lennox [2010] QCAT 702; cited |
APPEARANCES & REPRESENTATION: | |
Applicant: | S J Keim SC instructed by the Office of the Health Ombudsman |
Respondent: | J R Hunter KC instructed by Ashurst |
REASONS FOR DECISION
Introduction
- [1]The Director of Proceedings on behalf of the Health Ombudsman (OHO) filed its referral of disciplinary proceedings on 28 June 2021, containing 25 allegations of professional misconduct against the respondent, who was at all relevant times, a general practitioner (GP).
- [2]The allegations involve seven patients as follows:
Patient | Allegation number |
Patient A | 1-5 |
Patient B | 6-9 |
Patient C | 10-14 |
Patient D | 15-18 |
Patient E | 19-21 |
Patient F | 22-23 |
Patient G | 24-25 |
- [3]When the respondent provided his Form 30 —Response on 28 October 2021, he also wrote to the applicant detailing concerns about the way the allegations were framed and seeking particulars of a number of matters.
- [4]In October 2022, the applicant filed an application to amend the referral. Both parties have filed submissions in that matter in November 2022, but it has not yet been determined.
- [5]The applicant filed further and better particulars, apparently in response to the respondent’s concerns of 28 October 2021, on 2 August 2023. In response the respondent filed the application to strike out the referral on 10 August 2023. It is that application I am to determine.
Background
- [6]In order to understand the basis of the application, it is necessary to understand something of the history of the matter.
- [7]The allegations relate to alleged misconduct during the period from 2002 to 2015.
- [8]The respondent was born on 13 November 1951 and was first registered as a doctor in February 1977. He remained so registered until February 2022. At all relevant times, he was a GP at Weller’s Hill Medical Centre (WHMC). He resigned from the practice in December 2021 and then surrendered his registration.
- [9]The OHO first received notification from a fellow practitioner at WHMC in December 2015, concerning allegations of inappropriate conduct involving, in particular, the respondent performing an excessive number of pap smears.
- [10]The OHO referred the matter to the Australian Health Practitioner Regulation Agency (Ahpra) which investigated it and took immediate registration action on 14 April 2016. The Medical Board of Australia (Board) imposed a condition on the respondent’s registration that the respondent not have contact with any female patients without the presence of an approved chaperone, and was in any case not to undertake any gynaecological procedures. He had by that time in any case, voluntarily ceased treating female patients. He abided by those conditions thereafter until his retirement.
- [11]Principally the respondent seeks, pursuant to s 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld) (QCAT Act), to strike out the referral and further particulars of 2 August 2023 in whole, on the basis of an abuse of process.
- [12]In the alternative, he seeks to strike out paragraphs five and seven to 12 of the referral which relate to background matters, professional standards and codes of conduct and definitions on grounds of disciplinary action.
- [13]Alternative to striking out those paragraphs in whole, he seeks to strike out some of the particulars relating to those paragraphs.
- [14]In addition, in the event the whole of the referral is not struck out, he seeks orders striking out some of the particulars relating to allegations three, four, eight, nine, 11, 12, 16, 17 and 20.
- [15]Appendix 1 to these reasons is a reproduction of “Annexure A” to the application, which sets out in detail the various alternative grounds sought.
- [16]Chronologically, the first complaint to the OHO by a patient was by Patient A on 5 July 2017. She then provided a detailed written complaint on 23 July. Patient B provided a written complaint also on 23 July of that year.
- [17]The OHO determined to investigate matters and in December 2017 asked the Medical Board of Australia to transfer the matter to it for investigation. This was done pursuant to s 193A(4) of the Health Practitioner Regulation National Law (Queensland) (National Law).
- [18]The OHO referred the matter to the Director of Proceedings early on, but it was referred back to the OHO for further investigation. Patient C provided a written complaint on 29 July 2020, and subsequently other complaints were made by a number of former patients.
- [19]Ultimately, the matters were all referred to the Director of Proceedings on 26 May 2021 and in turn the Director of Proceedings referred the matter to the Tribunal on 28 June 2021.
- [20]The respondent provided his response to the referral on 28 October 2021 and as I have said raised a number of objections to the form of the complaints.
Strike out
- [21]The principal relief the respondent seeks is to strike out the referral pursuant to s 47 of the QCAT Act as an abuse of process. Section 47 of the QCAT Act provides relevantly as follows:
- This section applies if the tribunal considers a proceeding or a part of a proceeding is—
- frivolous, vexatious or misconceived; or
- lacking in substance; or
- otherwise an abuse of process.
- The tribunal may—
- if the party who brought the proceeding or part before the tribunal is the applicant for the proceeding, order the proceeding or part be dismissed or struck out; or
- for a part of a proceeding brought before the tribunal by a party other than the applicant for the proceeding—
- make its final decision in the proceeding in the applicant’s favour; or
- order that the party who brought the part before the tribunal be removed from the proceeding.
- [22]It appears to me that, in the circumstances of this case, the applicant for the proceeding, namely the OHO, is not the party who bought the proceeding or part of the proceeding before the Tribunal. It is the respondent who has done so. Consequently, s 47(2)(a) is not applicable.
- [23]Instead, if I consider the terms of s 47(1) of the QCAT act have been met, then I should act under s 47(2)(b) and make the final decision in the proceeding in the respondent’s (that is, the applicant before me) favour.
- [24]Little turns on that. If I conclude the proceedings are an abuse, they will end.
- [25]The respondent notes in paragraph 13 of his counsel’s submissions, the principles involved in considering when an abuse of process has arisen. They relate to considerations of oppression and unfairness, and they are usefully summarised by Member Fantin (as her Honour then was), in Board of Professional Engineers of Queensland v Lennox.[1]
- [26]In this case the applicant, it seems to me, relies on the following to justify a finding of such an abuse:
- proceedings of this kind are to protect the health and safety of the public, and in circumstances where the respondent is no longer registered as a doctor, there is no real risk of that kind;
- the allegations concern events between 2002 and 2015, so long ago;
- some allegations made by patients are not the subject of referral but were made by patients known or may have been, by the current complainants;
- the OHO has been slow or dilatory in the investigation and prosecution of the matter; and
- the OHO has ongoing difficulties in particularising complaints. The further and better particulars filed 2 August 2023 only addressed two of the paragraphs of the referral (paragraphs 24.7 and 24.8) and include further and better particulars of allegations in an amended referral which the OHO is yet to be given leave to file.
- [27]The respondent alleges the significant lapse in time between the subject events, and any hearing of the matter will be such that his ability to respond properly has been unfairly impacted. His memory, and those of the complainant’s, will have been impaired by the passage of time.
- [28]Further, it is said he must incur significant costs in defending the allegations in circumstances where some substantial admissions were made by the respondent, which could have led to a satisfactory resolution of the matter.
- [29]The respondent relies also on the fact that allowing the proceedings to continue may “[exacerbate] the emotional toll on the complainants by the unnecessary protraction of the proceedings”. He does not, however, address the possible impact on the complainants if the proceedings were to end without resolution of these complaints, even at this stage.
- [30]It is submitted to be open to me to conclude that, in circumstances where there is no risk to the health and safety of the public, the OHO persisting with the referral is deliberate and for a purpose other than the protection of the health and safety of the public.
- [31]I do not so conclude. Whilst the respondent will no doubt not ever again practice and so is himself no direct danger to the health and safety of the public, the detection and punishment of doctors who engage in misconduct does have the effect of promoting the safe and competent conduct of all practitioners. There is in my view, nothing to support a finding that the prosecution of the referral is for any ulterior purpose.
- [32]The applicant submitted, and I accept, that if practitioners were to avoid accountability by ceasing to practice, the general deterrence of the complaints system would be reduced.[2] I do not, of course, suggest that the respondent’s counsel submitted otherwise, but his submission was that the respondent’s retirement was just one of the myriad of factors which together would justify a finding that the proceeding was an abuse of process. The applicant’s counsel, in his submissions, refers to cases which supported the view that summary dismissal of a referral because of abuse of process should be justified only in the clearest of cases, where the was no real prospect of success and should be undertaken with caution.[3]
- [33]I have earlier set out something of the timeline of the matter.
- [34]It is in my view a matter of concern such proceedings have taken so long. I myself am not aware of all that is involved in such a process so do not wish to be unduly critical, but such delays can and do result in difficulties in the prosecution of such matters. Whatever the cause of such delays, and I can think of many potential causes, efforts must be made to progress such matters far more quickly. When I identify the weighing process referred to in Lennox,[4] I do not conclude that this is a case in which I should exercise my discretion to strike out the whole of the proceedings as an abuse of process. This is particularly so in circumstances where the respondent does not point to particular loss of evidence of a critical nature which loss would prejudice the conduct of his defence.
Paragraph 5 and 7 to 12
- [35]Paragraph 5 of the annexure to the application relates to an allegation that the respondent was, between 2002 and 2010, subject to approved registration standard codes and guidelines “including” two particularised guidelines and standards, being the:
- Good medical practice: a code of conduct for doctors in Australia, 2005 (2005 Code of Conduct); and
- Statement of Sexualised Relationships, February 2005 (2005 Sexual Boundary Statement).
- [36]Because they came into being only in 2005, it is said that they necessarily could not define practice standards prior to then. It seems to me that is logically correct.
- [37]In paragraphs 7 to 12 the applicant pleads certain definitions in the policies and guidelines set out therein, but respondent complains the definitions are inaccurately pleaded because they are incomplete and/or taken out of context. In that circumstance an allegation that is made that the definition was breached is said to be misconceived. It is submitted that the pleading should accurately reflect the definitions in the guidelines and standards.
- [38]The applicant submits, in relation to paragraph 5 of the referral that in his response the respondent admits to being subject to professional standards listed in paragraphs 5 to 7 and also those in paragraphs 10 to 12 of the referral.
- [39]It submits that there is no basis for striking out the pleaded paragraphs.
- [40]I see some difficulty in the way the allegation in paragraph 5 is pleaded. The respondent simply could not, between 2002 and the time the 2005 Code of Conduct and 2005 Sexual Boundary Statement were promulgated, be subject to them.
- [41]In my view it is appropriate to order that paragraph 5 be struck out, but the applicant be given leave to replead. In my view, this should not take long and I will order that this occur within a period of 14 days from delivery of this judgement.
- [42]In relation to the respondent’s criticism of the way paragraph 7 of the referral is pleaded, it is my view that the reference to particular enumerated paragraphs of the Code of Conduct of both 2010 and 2014 obviates any risk of misapprehension or unfairness in such allegation.
- [43]In my view, the allegation in paragraph 9 of the definition sexual misconduct should also particularise the relevant provisions of the Sexual Boundaries Guideline. I strike out paragraph 9 of the referral, with leave to replead within the same time as I earlier set out.
- [44]Paragraphs 10 to 12 are properly pleaded by referring to particular enumerated paragraphs of the Sexual Misconduct Guidelines and the application to strike them out is dismissed.
Paragraphs 1, 6, 10, 15, 19, 22 and 24 of the allegations
- [45]The respondent submits each of these paragraphs of the referral should be struck out as being frivolous, vexatious or misconceived, lacking in substance or an abuse of process.
- [46]The seven different paragraphs concern similar allegations regarding the seven different complainants.
- [47]In each paragraph it is said the alleged treatment was “excessive in the circumstances” and not reasonably required for the well-being of the patient. Particulars of the allegations are then set out in each case.
- [48]In such circumstances, the “circumstances” are, in my view, those circumstances pleaded in the numbered paragraphs (for example, 1.1 to 1.7 with respect to allegation 1).
- [49]The respondent’s submission that the applicant has not pleaded the circumstances fails. I accept the submission of the applicant’s counsel at paragraph 39 to 53 of the written submissions.
- [50]In that circumstance, the submission that the applicant has not adequately responded to the respondent’s request for proper particularisation and so the pleading ought be struck out as an abuse of process also fails.
Paragraphs 1.6, 6.5, 10.4–10.7, 15.6, 19.4–19.6, 22.6 and 24.3–24.6 of the allegations
- [51]These paragraphs relate to allegations of unnecessary breast examinations, pap smears, vaginal swabs, skin and mole checks, and pelvic examinations.
- [52]The way the applicant frames the allegations is to assert that examinations were carried out on particular dates and then to allege that a number of such examinations were unnecessary, without alleging which examination was unnecessary.
- [53]My understanding, for example, is that the allegation in 1.6 is that three breast examinations identified in the paragraph were performed on patient Patient A, but the two were conducted outside the guidelines, that is, that only one was ever required in accordance with the guidelines.
- [54]The subparagraph is inelegantly pleaded. It would have, in my view, been better to allege that in circumstances where a breast examination was conducted without abnormality on 19 February 2015, such examination did not require repeat examinations within the immediate future and so examinations in July and October 2015 were unnecessarily conducted.
- [55]I do not accept that the failure of the applicant to replead in such a way following the respondent’s objection in October 2021 to the subparagraph as pleaded, constitutes an abuse of process which justifies those paragraphs being struck out absolutely.
- [56]In the circumstances, I will strike out these subparagraphs but give the applicant liberty to replead the in accordance with the same time frame I earlier set out.
Subparagraphs 3.1, 8.1, 12.1 and 16.1 of the allegations
- [57]These allegations concern text messages allegedly sent by the respondent to four of the complainant patients which are said to be unprofessional and inappropriate by reason of their context, frequency and persistency.
- [58]The respondent submits the particulars thereof are frivolous, vexatious and/or misconceived because the text messages are mischaracterised in the applicant’s pleading. He also alleges the texts do not support an allegation that there was an improper relationship or that professional boundaries were breached.
- [59]It can be seen that this aspect of the strike out application is an allegation that the alleged conduct, in engaging in the text exchanges, could not amount to a failure to maintain professional boundaries or amount to unprofessional conduct.
- [60]It is in my view, at least arguable that to have engaged in the text exchanges using first names, seeking information about symptoms in text messages and sending text messages unrelated to medical treatment, utilising the characters “x” or “xx” could constitute failures of the sort alleged.
- [61]I therefore decline to strike out the enumerated subparagraphs
Paragraphs 3.2, 8.2, 11.1(c), 12.2 and 20.1 of the referral programs 11.1(c) and 20 .1(a) of the particulars
- [62]These allegations concern alleged inappropriate physical contact — hugging and kissing complainants — or unnecessarily requiring a patient to undress and making inappropriate comments to them.
- [63]The respondent contends that the complaints are framed in such a way that the respondent has no indication of when the alleged conduct is said to have occurred. For example, in paragraph 11.1(c) it is alleged the conduct was “after a pap smear”, but no date or even approximate date is alleged. A similar complaint is made in respect of the other allegations.
- [64]The alleged conduct could therefore have occurred over a lengthy period of years.
- [65]It is said this effectively prevents the respondent from having the opportunity to vindicate himself and it is submitted the complaints should be properly particularised as to when alleged conduct occurred. Not to do so, it is said, is unfair or unjust.
- [66]The respondent in its submissions notes that apart from the allegation in 11.1(c) the respondent has not sought particulars of the allegations.
- [67]More importantly, it submits the respondent has effectively pleaded to the allegations in his response. The respondent has pleaded (in all cases other than in respect of paragraph 11.1(c)) that in circumstances where much time has elapsed since the alleged conduct, he cannot independently recall particular appointments but says they would have been conducted in accordance with his usual practice, and denies the allegations as being untrue.
- [68]In relation to paragraph 11.1(c) the respondent says that the allegation is that the alleged conduct was “following a pap smear test” is ambiguous. He further pleads, however, that such examinations were part of a well woman check. At such times, he alleges the patient would have been undressed, as this was necessary, but “he would provide her with a cover sheet for her to place appropriately”.
- [69]In my view, consideration of the pleadings in these matters, and the highly unusual nature of the alleged conduct mean the respondent is able to effectively deal with the allegation by way of denial, as he has, despite the vagueness of the time of the alleged conduct.
- [70]The failure to be able to particularise the timing more accurately does not in my view justify a strike out of the allegation. The vagueness of the complaint, at least in respect of time, is a matter the final determiner of the matter will no doubt take into account in assessing the reliability of the complainant’s evidence.
- [71]I decline to strike out these paragraphs of the referral.
Paragraphs at 4.2–4.3, 9.2–9.3 and 17.2–17.3 of the referral
- [72]The respondent alleges these allegations are misconceived. The allegations concern assertions that on particular days, the respondent made clinical notes which were misleading or untrue.
- [73]In particular, it is said they are misleading and untrue because of the matters alleged in paragraphs 4.3, 9.3 and 17.3 respectively — namely, that the respondent had initiated the consultations by text messages which advised the patients of the purpose of the consultation and that he did not obtain informed consent.
- [74]The respondent in his pleaded response says the notes are a “true record” of the consultation. He admits however in respect of the allegations in 9.2 and 17.2 of the referral that his records were inadequate, but nevertheless submits there is no evidence to support the complaints of lack of informed consent.
- [75]The respondent submits that whether the nature of the text messages is such as to support a finding that the respondent has not obtain informed consent is a matter for the hearing.
- [76]In my view, it is important in resolving the matter to be able to carefully examine the texts and messages in the context of the oral evidence of the complainants and of any evidence of the respondent about the matter. That is, in my view, a matter best determined in the hearing of the matter when the credit of witnesses can be properly assessed.
- [77]I therefore decline to strike out these subparagraphs.
Orders
- [78]In the circumstances, I will order:
- Paragraph 5 of the referral be struck out, and the applicant given leave to replead.
- Paragraph 9 of the referral is struck out, with liberty to replead.
- Paragraphs 1.6, 6.5, 10.4–10.7, 15.6, 19.4–19.6, 22.6 and 24.3–24.6 of the referral be struck out, with liberty to replead.
- Such repleading is to be filed and served on or before 14 days after delivery of this judgment.
- The application is otherwise dismissed.
Appendix 1 — “Annexure A” to the application for miscellaneous matters filed 10 August 2023
- The Respondent applies for orders:
- Striking out the Applicant’s Referral filed 13 July 2021 (Referral) and further particulars filed 2 August 2023 (Further Particulars) in whole on the basis that it is an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or in the alternative
Paragraphs 1-18 (on pg. 1-5 of the Annexure to the Referral) as relate to background, registration and professional standards, definitions and grounds for disciplinary action
- Striking out:
- Paragraphs 5 and 7-12 (inclusive) of the Referral on the basis that they are:
- frivolous, vexatious or misconceived pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld);
Allegations 1-24 (on pg. 5-21 of the Annexure to the Referral) as relate to Patients [A], [B], [C], [D], [E], [F] and [G]
- allegations 1 (pg. 5-6), 6 (pg. 8-9), 10 (pg. 11-12), 15 (pg. 14-15), 19 (pg. 17), 22 (pg. 18-19) and 24 (pg. 20-21), including all particulars and sub-paragraphs, of the Referral and the associated Further Particulars on the basis that they are:
- frivolous, vexatious or misconceived pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- lacking in substance pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld);
- in the alternative to 1(b)(ii) above, particulars 1.6 (pg. 5-6), 6.5 (pg. 9), 10.4-10.7 (pg. 12), 15.6 (pg. 15), 19.4-19.6 (pg. 17), 22.6 (pg. 19), 24.3-24.6 (pg. 20-21) of the Referral and associated Further Particulars on the basis that they are:
- frivolous, vexatious or misconceived pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld);
- particulars 3.1 (pg. 7), 8.1 (pg. 10), 12.1 (pg. 13) and 16.1 (pg. 15), including all sub paragraphs, of the Referral and the associated Further Particulars on the basis that they are:
- frivolous, vexatious or misconceived pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- lacking in substance pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld); or alternatively
- an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld);
- particulars 3.2 (pg. 7), 8.2 (pg. 10), 11.l(c) (pg. 13), 12.2 (pg. 13) and 20.1 (pg. 18) of the Referral and paragraphs 11.l(c) and 20.l(a) of the Further Particulars on the basis that they are an abuse of process pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld);
- particulars 4.2-4.3 (pg. 7-8), 9.2-9.3 (pg. 11) and 17.2-17.3 (pg. 16), including all sub-paragraphs, of the Referral as misconceived pursuant to section 47 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld).
- Such other orders as the Tribunal deems necessary.