Health Ombudsman v APR[2025] QCAT 103

QUEENSLAND CIVIL AND ADMINISTRATIVE TRIBUNAL

REASONS FOR DECISION

What is the referral about?

1. [1]
   On 30 May 2024 the Director of Proceedings on behalf of the Health Ombudsman (‘Director’) filed a referral alleging the respondent had been convicted on 15 December 2023 in the District Court of Queensland at Southport of six criminal offences.  The offences, which are all domestic violence offences, were committed in a single course of conduct in the evening of one day.  There is a non-publication order in place.

Is it appropriate to determine this matter on the papers?

2. [2]
   In response to the Health Ombudsman’s show cause notice as to taking immediate action, the respondent replied, by email on 28 May 2022, that “… I see no point in attempting to reply back with any submissions. I can see no positive outcome with regard to my nursing career at this point in time or if any in the future …”.^[1]
3. [3]
   The referral and brief of evidence were personally served on the respondent on 20 August 2024.^[2]  Despite numerous emails from the Director, or those acting for the Director, to the respondent and material being confirmed as delivered by tracked post, consistent with the sentiments she expressed on 28 May 2022, the respondent has not acknowledged the referral or responded to the Director or the Tribunal in any way. 
4. [4]
   In those circumstances, the Tribunal proceeds to determine the matter on the papers in accordance with s 32(2) of the Queensland Civil and Administrative Tribunal Act 2009 (‘QCAT Act’).

What law applies to the referral?

5. [5]
   The referral proceeds before the Tribunal pursuant to ss 103(1)(a) and 104 of the Health Ombudsman Act 2013 (‘HO Act’).
6. [6]
   The Tribunal is exercising original jurisdiction.^[3]  The Director has the burden of proof of the allegation.  Because of the potential consequences to the respondent of adverse findings, the Tribunal may only find that the respondent engaged in the alleged conduct and that it should be characterised as professional misconduct or unprofessional conduct if it is satisfied of these matters according to the standard of proof articulated in Briginshaw v Briginshaw.^[4]
7. [7]
   There is no obligation on the respondent to provide any evidence, either by giving evidence or calling evidence.  As noted earlier in these reasons, the respondent has not participated in the proceeding.
8. [8]
   The Tribunal must observe the rules of natural justice,^[5] is not bound by the rules of evidence^[6] and may inform itself in any way it considers appropriate.^[7]

What facts does the Tribunal find the referral proceeds on?

9. [9]
   The respondent pleaded guilty to the criminal offences which form the particulars for the referral to the Tribunal.^[8]  The material before the Tribunal includes a verdict and judgment record confirming the offences and the pleas of guilty.^[9]  The respondent has not disputed any of the facts put forward before the criminal court on which the sentence for the six offences proceeded.
10. [10]
    In those circumstances, the Tribunal proceeds on the basis that the respondent is taken to have committed the acts which at law constitute the offences.^[10]  Thereby the Tribunal finds the allegation in the referral is established.
11. [11]
    The respondent was convicted of:

    1. two counts of common assault – domestic violence offence pursuant to ss 335 and 564(3A) of the Criminal Code Act 1899 (Qld) (‘Criminal Code’);
    2. two counts of assault occasioning bodily harm whilst armed/in company – domestic violence offence pursuant to ss 339(1), (3) and 564(3A) of the Criminal Code;
    3. one count of wounding – domestic violence offence pursuant to ss 323(1) and 564(3A) of the Criminal Code; and
    4. one count of assault occasioning bodily harm – domestic violence offence pursuant to ss 339(1) and 564(3A) of the Criminal Code.
12. [12]
    There was a Statement of Facts which set out the facts which founded the convictions and on which the sentence proceeded.^[11]
13. [13]
    The background to the offending, which is relevant to context only, was that the respondent was 53, the complainant was her husband who was 54, they had been married for 32 years and shared three adult children.  The two of them and one of their children lived together on acreage.  They had been experiencing marital difficulties, and about one week prior to the offending had begun sleeping in separate rooms.  The husband slept in a detached granny flat whilst the wife slept in the main house.
14. [14]
    The events which preceded the offending, which is also relevant to context only, were that they had had an argument the day of the offending.  In the evening, the respondent had walked into the husband’s bedroom on a few occasions and made disparaging remarks, trying to initiate an argument.  He ignored her and went to bed.  After an hour or so the husband awoke and heard a hissing noise.  He switched on the lights to find that the respondent had placed a gas bottle in the walk-in robe behind his bed and opened the gas tap.  He switched it off, placed it outside his bedroom and went back to sleep.  He was later awoken again to the sounds of a gas bottle hissing.  This time the bottle was leaning on the bedroom door outside the bedroom.  He switched off the bottle and threw it into the bushes outside.  As he was getting back into bed, the respondent came into the bedroom and went into the bathroom saying nothing.  After she left, he went into the bathroom and found she had put dog poo on the bathroom wall, door, the sink, and on his phone and car keys.^[12]  Not wanting to confront the respondent, he returned to bed and lay down again, eventually falling asleep.
15. [15]
    The circumstances of the offences themselves were that:

    1. The husband awoke to the respondent entering his bedroom.  She began punching him in the chest, neck, and head areas (count 1 – common assault (domestic violence order (‘DVO’)).  He fended her off and she punched him again in the neck area, which to him felt different to the earlier punches.  That was because she had been holding a knife and had stabbed him with it causing a 1 cm puncture wound on the upper left side of his neck (count 3 – wounding (DVO)).  The husband, at this stage unaware that the respondent had a knife, pushed her off him and out of the room.  As he did so, she swiped at him causing a laceration to the top of his left hand (count 2 – Assault occasioning bodily harm whilst armed – (DVO));
    2. When the respondent came at the husband again, he saw that she was holding a knife.  It was a steak knife from the kitchen in the main house.  They struggled as he attempted to disarm her, and she pushed and kicked him (count 4 – common assault (DVO)).  They were slipping on the husband’s blood.  The husband managed to take the knife from the respondent which he threw away in the direction of the laundry.  She then grabbed his scrotum and held on.  Her long nails caused a laceration and he had to pry her hands away to release her grip (count 5 – assault occasioning bodily harm (DVO)).
    3. The husband pushed the respondent out of his bedroom, and she landed on the floor and screamed.  She tried to grab his scrotum again and he pushed her away hard and she screamed again.  He retreated to the bathroom where he noticed that he was bleeding from his hand and the wound on his neck.  A large volume of blood was dripping on the floor.  The respondent came into the bathroom.  She picked up a ceramic moisturiser pump bottle and threw it at the husband.  It stuck him in the head and smashed, causing lacerations to his scalp (count 6 – assault occasioning bodily harm whilst armed (DVO)).
16. [16]
    The husband got away and called triple zero.  When the police arrived at the house they saw the respondent standing out the front, crying and covered in blood.  The husband was also covered in blood and bleeding form his neck wound.
17. [17]
    The next day, in an interview with police, the respondent told the police they had had an argument, the husband had been ignoring her, so she placed the gas cylinder in his room to get him to talk to her.  The respondent told the police that they had had an argument in the bedroom and she got a knife and was threatening to self-harm, and the husband had told her to ‘stab him’, then he had grabbed the knife and forced it into his own neck.  The Crown did not accept this account.  She told the police she could not recall grabbing the husband’s scrotum.  In addition to some matters, I will refer to below, the respondent’s barrister submitted that she was very intoxicated at the time of the offences and that the psychologist who had provided a report on the sentence was guarded about abstinence post release without treatment and management in the community.^[13]
18. [18]
    The respondent was sentenced to two and a half years imprisonment on 15 December 2023, with release on parole after serving 4 months in custody, with some time in pre-sentence custody declared as time served under the sentence.  The Court structuring the sentence to recognise the serious nature of the offences and the powerful and unusual factors in mitigation.^[14]  The respondent’s sentence should be completed around 15 June 2026.

What is relevant about the respondent?

19. [19]
    At the time of the incident giving rise to the offences, the respondent was working as a National Disability Insurance Scheme carer.  She was registered as an enrolled nurse^[15] and had previously been employed as a casual enrolled nurse at one of the local hospitals.
20. [20]
    On 30 May 2022, some 2 months after the incident giving rise to the charges and 18 months prior to the convictions, the Health Ombudsman took immediate registration action and suspended the respondent’s registration.
21. [21]
    There is nothing before the Tribunal to indicate the respondent has any prior disciplinary history.
22. [22]
    A forensic psychologist’s report was tendered on the respondent’s sentence.^[16]  The key points arising from it are:

    1. That the respondent self-reported an extensive pattern of coercive control and abuse of her by the husband, beginning in the respondent’s teenage years and persisting throughout the marriage.  That self-reporting was supported by material provided by the respondent’s mother and adult children;
    2. On testing, the respondent displayed symptoms of severe depression and anxiety, moderate symptoms of substance abuse and dependency, symptoms consistent with borderline personality disorder and some indicating schizotypal personality disorder were present. PTSD symptoms were present at a clinically significant level; 
    3. A psychologist who treated her after the offending and before the sentence reported that the respondent had acute mental health issues, had been diagnosed with PTSD, traits of borderline personality disorder, major depressive disorder with anxious distress and severe substance abuse disorder, required a long term, multidisciplinary approach to mental health care, intervention from a specialist substance abuse treatment service and that stability in mental health was necessary before the respondent could effectively participate in treatment for her violent behaviour; 
    4. The respondent was considered a low risk of future violent offending with the one scenario possible being a repeat of her past violence if she returned to the relationship with her husband, which was expressed as a moderate risk;
    5. The psychologist expressed the opinion that the respondent’s history and symptoms were indicative of what is commonly referred to as ‘battered woman syndrome’, a subcategory of post-traumatic stress disorder and while her intoxicated state at the time of the offending undoubtedly played a significant role in diminishing her inhibitions and impairing her decision making, the ultimate driving mechanisms responsible for her behaviour were deeply rooted in her extensive trauma history resulting from chronic intimate partner violence.
23. [23]
    The Crown did not contest the contents of the psychological report on the sentence and the Court accepted that there was a causal link between the respondent’s mental health issues and the offending, such that moral culpability is reduced and general and specific deterrence are moderated.^[17] 

How should the Tribunal characterise the respondent’s conduct?

24. [24]
    Unprofessional conduct is defined in s 5 of the Health Practitioner Regulation National Law (Queensland) (‘National Law’) as:^[18]

professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers, and includes

[…]

the conviction of the practitioner for an offence under another Act, the nature of which may affect the respondent’s suitability to continue to practise the profession.

25. [25]
    Section 5 of the National Law includes a definition of professional misconduct by a registered health practitioner as including:^[19]

unprofessional conduct by the practitioner which is conduct substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; and

more than one instance of unprofessional conduct that, when considered together, amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of raining or experience; and

conduct of the practitioner, whether occurring in connection with the practice of the health practitioner’s profession or not, that is inconsistent with the practitioner being a fit and proper person to hold registration in the profession.

26. [26]
    In deciding whether the respondent’s conduct should be characterised as ‘professional misconduct’ or ‘unprofessional conduct’, the Tribunal is required to make a judgment as to the degree of departure from the standard reasonably expected of the respondent by the public and/or her professional peers.^[20]  Some analysis of other cases involving practitioners committing criminal offences assists in making that judgment.
27. [27]
    On the facts in Health Ombudsman v Niem Quoc Tang,^[21] which involved 38 false declarations to obtain government benefits, by understating income, the Tribunal observed that the dishonest conduct was deliberate and protracted, involving 38 false declarations over 17 months, with a benefit derived of over $12,000 and cessation only because of detection by the authorities.^[22]  The Tribunal concluded it was a large and considerable departure from the standard expected of a registered health practitioner of his level of training and experience.
28. [28]
    In Health Care Complaints Commission v Haasbroek (‘Haasbroek’),^[23] the Tribunal identified three principles for consideration in making that determination:^[24]

    1. to first and foremost be designed to protect the health and safety of the public;
    2. to uphold the standards of members of the medical profession, to ensure that they continue to be held in high regard by their patients, the public generally and other professionals.  This means practitioners must act, both personally and professionally, with integrity and with respect for the law, in all aspects of their behaviour; and
    3. to have an element of deterrence, so that other practitioners are aware of the consequences of inappropriate behaviour in their professional and personal lives.
29. [29]
    In the context of cases involving convictions for domestic violence offences:

    1. In Haasbroek, the Tribunal determined that the practitioner was guilty of unsatisfactory professional conduct, but not that he was ‘otherwise not a suitable person to hold registration’ and the appropriate protective order was a reprimand.^[25]  The practitioner, a general practitioner for over 15 years at the time of the Tribunal hearing, was first convicted of a charge of assault occasioning bodily harm after trial by a Magistrate.  The violence was that during a family dispute, he punched a relative by marriage with a closed fist.^[26] He appealed unsuccessfully against that conviction.^[27]  The next course of conduct involved interactions with his then wife.  There was a police record of violence where the wife was recorded as the aggressor.^[28]  Some years later, following an altercation between the practitioner and his wife, police were called to the family home and an AVO for the protection of the wife and two eldest children was made.^[29]  The practitioner moved out of the family home but came back to it to spend time with the children, a dispute between him and his wife ensued and he pushed her onto the bed and swore at her.^[30]  Arising from this incident he was convicted of common assault, breach of an AVO and intimidation in the relevant Local Court.  His appeal against those convictions was dismissed.^[31]  He was convicted of further breaches of an AVO, in sending two text messages to his wife on his plea of guilty.  The evidence before the Tribunal was that whilst they divorced, they had managed to develop and maintain a respectful and courteous relationship and he continued to financially support the children and maintained contact with them.^[32]  The convictions were for offences committed over a course of about 5 years, but where all the offending against his wife occurred over about a 15-month period.  The Tribunal observed that the factual circumstances of events which ground a criminal conviction or finding may, depending on their gravity, if established to the requisite standard, constitute a separate and distinct complaint and the circumstances, of themselves, may otherwise render a practitioner unsuitable for registration^[33] but that they did not do so in this case;^[34]
    2. In Health Ombudsman v Field,^[35] the practitioner was a registered nurse.  He was convicted of offences under the Explosives Act 1999 (Qld), the Weapons Act 1990 (Qld) and the Criminal Code, arising from a domestic dispute between the practitioner and his wife which led to a consensual search of the practitioner’s house by the Queensland police, which was the first charge in the referral.  The second was that he failed to notify of the charges, action taken by his employer, the convictions and the termination of his employment by his employer in accordance with s 130 of the National Law.  The practitioner did not participate in the proceeding.  He was 55 years old and had no criminal history.  The offending occurred in a single incident at his home, after he had been drinking heavily.  His wife had also been drinking and they got into a verbal argument which escalated and he grabbed his replica firearm to scare his wife, which he pointed at her, saying it was the one she knew doesn’t work.  The argument continued, with his wife raising the topic of his homemade firearm and saying it would be non-operational because he had made it which caused him to put a bullet in its chamber, point it outside towards the ground and pull the trigger to discover, to his surprise, that it did work.  Police attended in response to the wife’s call and located the firearms and ammunition.  He made full admissions to police.  The Health Ombudsman suspended his registration.  The Tribunal observed that there could be no doubt that the conduct was incompatible with the characteristics, attributes and ethical standards required in the profession, where it involved violence in a domestic setting, the making and use of a hand made gun, the firing of a sawn-off rifle and the possession of ammunition in the context of an admitted drinking problem.  This was plainly “professional misconduct”.^[36]  The Tribunal observed that the appropriate sanction was to be determined on the basis of whether the practitioner was a fit and proper person to hold registration as at the date of the hearing.^[37]  The Tribunal observed that there was limited evidence before it of any reformation of character, no evidence of any steps taken to address his underling drinking problem and his unwillingness to engage in the referral process demonstrated a lack of understanding of the responsibilities of professionals and the roles played by professional bodies in upholding professional standards.^[38]  It determined that, on the evidence of the offending conduct and the very limited evidence of insight and remorse, the practitioner was not a fit and proper person to hold registration.  Consequently, the Tribunal ordered that his registration be cancelled and imposed a disqualification period of one year in circumstances where his registration had been suspended for three years at the date of the Tribunal’s determination;
    3. In Health Ombudsman v JTM,^[39] the practitioner, a 44-year-old enrolled nurse, was convicted on his own plea of guilty of one count of assault occasioning bodily harm whilst armed (domestic violence offence).  The matter proceeded on agreed facts and agreed sanction but was disputed as to characterisation.  Whilst the practitioner was registered at the time of the relevant events, he had not worked for some years as a registered nurse due to a back injury he suffered at work.  After he was charged, the QPS made a mandatory notification and the Health Ombudsman suspended his registration for two years before revoking the suspension.  The Board had determined, having referred him for a health assessment, that conditions were appropriate as he suffered from mental health conditions which were stable at the time of assessment and being appropriately treated.  The conduct giving rise to the offending occurred after the practitioner had consumed a significant amount of alcohol.  He got involved in an argument with his partner and stepdaughter in the presence of the two younger children.  In the course of the argument, he armed himself with a kitchen knife and grabbed his partner around the throat from behind with his left hand and held the knife in his right hand.  She attempted to break his grip by biting at his hand.  He held the knife above her head and made stabbing motions towards the top of her head and, at one stage, she could actually feel the tip of the knife on the top of her head.  When the stepdaughter screamed at him to let her mother go, he eventually did but then struck her in the face with an open palm causing her lips to swell, her glasses to be dislodged and her note to bleed.  She and the children then barricaded themselves in a room, he managed to get the door open at some point and was still armed with the knife and insisted he would exchange the knife for his daughter.  This occurred, the situation calmed down and they walked outside waiting for the police to arrive.  As the practitioner insisted he was not intoxicated at the time of the offending, the Tribunal proceeded on the basis he was not, observing, as had the sentencing judge, that acting in such a way whilst sober is equally as bad if not worse than when intoxicated.  The practitioner had no previous history, pleaded guilty at an early stage, expressed remorse and placed material before the sentencing judge demonstrating his efforts to address the causes of his offending behaviour through counselling and treatment.  The Tribunal accepted that as a general proposition misconduct in the course of performing professional duties, particularly by the commission of criminal offences, is regarded more seriously in disciplinary proceedings than misconduct committed outside those duties.^[40]  The Tribunal went on to observe, amongst other things, that the admitted conduct was very serious, involving the use of a knife in a highly emotionally charged situation, and actual violence committed on the respondent’s female partner which caused a number of injuries to her face.^[41]  It found that the conduct was professional misconduct within both (a) and (c) of the definition in the National Law.^[42]  The Tribunal imposed the agreed sanction, which was a reprimand, noting that the practitioner’s registration status was unknown and he had had an effective twenty-four month suspension of his registration and the usual principles concerning agreed sanctions;
    4. In Health Ombudsman v HCG,^[43] the characterisation, which was not disputed by the practitioner, was professional misconduct being conduct ‘inconsistent with the practitioner being a fit and proper person to hold registration in the profession’.^[44]  The practitioner was a trainee general practitioner with a significant history of psychiatric issues for which his registration had been subject to an undertaking and a condition for which he had been subject to comprehensive monitoring.  He was the respondent to a DVO in favour of the complainant.  They had been in a relationship for about two years.  Whilst the DVO was in force, there was an altercation between them at their residence, during the course of which he headbutted the complainant causing a laceration over her eyebrow.  When she called the police he took her phone and smashed it.  He notified of charges and then of convictions for two indictable offences and a summary offence.  There was evidence the practitioner was remorseful, had paid compensation and was continuing to receive psychiatric treatment.  His treating psychiatrist said the practitioner displayed good insight and willingness to address his concerns.  His treating psychologist said he was very unlikely to reoffend;
    5. In Nursing and Midwifery Board of Australia v LYS,^[45] a registered nurse was convicted of four offences in the Magistrates Court.  LYS admitted the facts of those offences and the conclusion that they constituted professional misconduct.  Two were domestic violence offences – one of common assault and one of wilful damage.  The other offences were driving under the influence and enter a dwelling without consent.  While intoxicated, LYS drove to the residence currently occupied by her ex-partner and his two children, then aged 18 and 17.  She had previously lived there too but was not permitted to enter and did not have a key.  LYS entered the residence by removing a screen panel and the wilful damage charge resulted from damage to the panel and a screen door.  No compensation order was sought for the damage, due to the low cost of repair.  LYS then went upstairs to her former partner’s bedroom and when he woke up there was a verbal altercation.  He removed her from the residence and locked the door behind her.  She re-entered the residence and he saw her in the dining room with a knife.  LYS held the knife in a threatening manner and said words to the effect “I will fucking stab you”.  He disarmed LYS and forced her out of the house and into the garage.  He called 000 and when police attended, they located LYS in the garage – she approached police and identified herself.  After analysing the statutory regime and other authorities, the Judicial Member accepted that the convictions for family violence can be seen as a type of conduct coming within subparagraph (c) of the definition of “unprofessional conduct”^[46] and that each of paragraphs (a) and (b) of the definition of professional misconduct were engaged.^[47]  The Tribunal was not persuaded that subparagraph (c) of the definition of professional misconduct was engaged in the particular circumstances.^[48]  In refusing to impose any period of suspension of registration, the Tribunal noted, amongst other things, that there was no evidence that LYS presented any risk to the public from practising; she was an exemplary nurse; whilst she was affected by alcohol on the night of the incident, there was no suggestion of alcohol problems which may cause concern for repetition of behaviour and LYS was subjected to conduct that met the description of family violence by her former partner during mediation proceedings to try to resolve the breakdown of the relationship, all of which reinforced that the conduct was out of character in the particular case.
30. [30]
    The Director submits there is sufficient evidence before the Tribunal to find that the respondent’s conduct the subject of the allegation constitutes professional misconduct.
31. [31]
    The Tribunal agrees with this submission noting the level of violence used, including the use of a knife and the protracted nature of the conduct, albeit conduct occurring on one occasion.  The Tribunal finds it is conduct which comes within the definition of subsection (a) of the National Law.
32. [32]
    The Tribunal also finds it is conduct which comes within the definition of (c) of the National Law at the time of the hearing, noting that on the evidence before it, the respondent is a very unwell person, and someone who has not yet undertaken steps to address her underlying conditions or develop insight or understanding into what has occurred.

What orders are appropriate to address the conduct that has been established?

33. [33]
    The purpose of a sanction is to protect the public; it is not to punish the practitioner (although a practitioner may experience a protective action as a punishment, in the sense of negative consequences towards them). The Tribunal’s disciplinary jurisdiction is exercised for the paramount purpose of protecting the health and safety of the public^[49] and the protection of the reputation of the profession in the public mind. 
34. [34]
    There are well established considerations for the Tribunal on a disciplinary referral:^[50]

    1. preventing practitioners who are unfit to practice from practising;
    2. bringing home to the practitioner the seriousness of their conduct;
    3. deterring the practitioner from future departure from appropriate standards or others who might be minded to act in a similar way; and
    4. imposing restrictions on the practitioner’s right to practice to ensure public protection.
35. [35]
    An assessment of ongoing risk posed by the respondent is essential to any determination of sanction.  In performing that assessment, the degree to which the practitioner has acquired insight will be relevant.^[51]
36. [36]
    Having decided that the respondent has behaved in a way that constitutes professional misconduct, the Tribunal has a wide discretion to impose sanctions ranging from a caution or a reprimand of the respondent to cancellation of registration.^[52] 
37. [37]
    The Tribunal will consider a range of factors in a given case including the nature and seriousness of the alleged conduct, the extent to which the practitioner has shown contrition, insight or remorse for their conduct, the need for general or specific deterrence, evidence of rehabilitation and otherwise good character, including cooperation with the disciplinary process and the regulator and any mitigating factors which are personal to the practitioner. 
38. [38]
    The Director submits it is appropriate for the Tribunal to make the following orders:

    1. The respondent has engaged in professional misconduct within the meaning of section 5 of the National Law.
    2. The respondent is reprimanded.
    3. The respondent’s registration as a nurse is cancelled.
    4. The respondent is disqualified from applying for registration as a nurse for a period of twenty-four months from the date of this decision.
    5. No order as to costs.
39. [39]
    A reprimand is not a trivial penalty.^[53]  The Tribunal will impose a reprimand to mark the seriousness of the conduct.
40. [40]
    The gravity of professional misconduct is not to be measured by reference to the worst cases, but by the extent to which it departs from the proper standards.^[54]
41. [41]
    Even though the conduct was in the private sphere of the respondent’s life, the offending constituted a very substantial departure from proper standards.  The Tribunal’s assessment on the evidence is that the respondent does not present any risk to the public generally, however, the seriousness of her conduct and the level of her apparent health impairments indicate that there is a need to mark disapproval of what has occurred to uphold the standards of the profession.  Whilst reasons of general deterrence are often significant, in this case, because of the causal link between conditions the respondent suffers from and the offending, which the criminal court accepted, general deterrence assumes less relevance.
42. [42]
    Relevantly, as already noted, there is no evidence before the Tribunal to suggest the respondent has developed any insight into her actions.  That informs the importance of a sanction that enables this to develop before the respondent returns to practice as a nurse.
43. [43]
    The Tribunal accepts the submission that a disqualification period of in the order of two years would be consistent with the principles in Fleischmann.^[55]
44. [44]
    The Tribunal is satisfied that the sanction of cancellation of registration and the disqualification period the Director proposes is appropriate.  
45. [45]
    The Tribunal thanks the assessors for their thoughtful assistance in the determination of this referral.