H v Nursing and Midwifery Board of Australia
[2014] WASC 325
•16 SEPTEMBER 2014
H -v- NURSING AND MIDWIFERY BOARD OF AUSTRALIA [2014] WASC 325
| SUPREME COURT OF WESTERN AUSTRALIA | Citation No: | [2014] WASC 325 | |
| Case No: | GDA:20/2013 | 20 MAY 2014 | |
| Coram: | CORBOY J | 16/09/14 | |
| 28 | Judgment Part: | 1 of 1 | |
| Result: | Leave to appeal out of time refused Appeal dismissed | ||
| B | |||
| PDF Version |
| Parties: | H NURSING AND MIDWIFERY BOARD OF AUSTRALIA ROYAL PERTH HOSPITAL |
Catchwords: | Appeal State Administrative Tribunal Application for leave to appeal out of time from order suspending registration as a nurse Whether the Tribunal erred in finding that the appellant suffered from a psychiatric disorder No new principles |
Legislation: | Nurses and Midwives Act 2006 (WA), s 50(b), s 82 State Administrative Tribunal Act 2004 (WA), s 90(1) |
Case References: | Nil |
JURISDICTION : SUPREME COURT OF WESTERN AUSTRALIA
- IN CIVIL
- Appellant
AND
NURSING AND MIDWIFERY BOARD OF AUSTRALIA
First Respondent
ROYAL PERTH HOSPITAL
Second Respondent
ON APPEAL FROM:
Jurisdiction : STATE ADMINISTRATIVE TRIBUNAL OF WESTERN AUSTRALIA
Coram : MR M SPILLANE (SENIOR MEMBER)
- MS E PAVLOS (SENIOR SESSIONAL MEMBER)
MS F CHILD (MEMBER)
File No : VR 23 of 2011
Catchwords:
Appeal - State Administrative Tribunal - Application for leave to appeal out of time from order suspending registration as a nurse - Whether the Tribunal erred in finding that the appellant suffered from a psychiatric disorder - No new principles
Legislation:
Nurses and Midwives Act 2006 (WA), s 50(b), s 82
State Administrative Tribunal Act 2004 (WA), s 90(1)
Result:
Leave to appeal out of time refused
Appeal dismissed
Category: B
Representation:
Counsel:
Appellant : In person
First Respondent : Ms G McGrath
Second Respondent : Mr I Repper
Solicitors:
Appellant : In person
First Respondent : Panetta McGrath Lawyers
Second Respondent : State Solicitor for Western Australia
Case(s) referred to in judgment(s):
Nil
- CORBOY J:
The history of the proceedings
The appellant's psychiatric assessments
1 The appellant commenced employment at Royal Perth Hospital (RPH) as a registered nurse in early 2007.
2 Staff members at the hospital expressed concerns about her mental health from late 2008. In June 2010, the acting area manager, human resource services, South Metropolitan Area Health Service, wrote to an industrial health physician, Dr Blake, requesting an assessment of the appellant's fitness to work and ability to safely perform her duties as a registered nurse. Dr Blake's report noted that the appellant gave a history of conflict with staff at the hospital and that she had complained of bullying. Dr Blake also noted that the appellant had previously seen a psychiatrist and recommended that she 'return to her psychiatrist in an endeavour to address what may well be an emergent paranoid state of mind' (letter dated 30 June 2010, exhibit 1, pages 25 - 27).
3 Dr Blake referred the appellant to a psychiatrist, Dr Boon Loke. He provided a report, dated 14 July 2010, in which he concluded that the appellant had 'well systematised persecutory delusions'; that she lacked insight into her symptoms and that she had a long history of delusional disorder, persecutory type. She had not received adequate anti-psychotic therapy due to her lack of insight (exhibit 1, pages 9 - 10).
4 The appellant refused permission for Dr Loke to provide a copy of his report to Dr Blake and RPH. Consequently, he sent a copy of his report to the appellant accompanied by a letter in which he recommended that she receive outpatient treatment from a psychiatrist and that atypical anti-psychotic medication be prescribed (exhibit 1, page 8). The appellant responded with a letter to Dr Loke in which she alleged that there had been factual errors in his report regarding her history. She also stated in her letter that she had consulted Dr Manners in 2009 for a psychiatric assessment and that he had advised her that she was 'all right' after three sessions (letter dated 19 July 2010, exhibit 1, pages 31 - 32).
5 In August 2010, the appellant's general practitioner referred her to Dr Atartis for a further psychiatric assessment (letter dated 20 August 2010, exhibit 5). Dr Atartis agreed with Dr Loke that the appellant was most likely suffering from a 'delusional disorder, persecutory type, long-standing with poor insight'. He also considered that the appellant had secondary depressive symptoms (report dated 24 August 2010, exhibit 5).
6 The appellant did not agree with Dr Atartis' diagnosis and advised him that she was unwilling to accept his recommendations for treatment. Dr Atartis considered that the appellant was unfit for work given her reluctance to accept his diagnosis and treatment plan.
7 The South Metropolitan Area Health Service referred the appellant to Dr Spear for a further psychiatric assessment in October 2010. He diagnosed her as suffering from a delusional disorder and a major depressive disorder. He identified some paranoid personality traits. He considered that psychotherapy would assist and that a low-dose anti-psychotic medication might help 'reduce [the appellant's] distress and reduce her abnormal beliefs' (report dated 4 October 2010, exhibit 1, pages 11 - 17).
8 Dr Spear concluded that the appellant's delusional disorder affected her ability to work effectively as a member of a nursing team. However, he also considered that she was capable of returning to work as a registered nurse if she followed his recommended treatment plan. He thought that, with treatment, the appellant would be able to return to her full-time normal duties in about three months. That view was consistent with the opinion that had been expressed by Dr Atartis.
9 Yet another psychiatrist, Dr Edward-Smith, assessed the appellant in September 2011. She made a provisional diagnosis of paranoid delusional disorder with a differential diagnosis of chronic paranoid schizophrenia and a co-morbid major depressive episode (report dated 13 September 2011). She considered that the appellant required urgent psychiatric treatment; that she was unfit to work to as a registered nurse; that consideration should be given to involuntary inpatient treatment if the appellant continued to refuse voluntary outpatient treatment and that it was difficult to anticipate when the appellant might be able to return to work as a registered nurse.
The application to SAT
10 The director of nursing and patient support services at RPH wrote to the respondent by letter dated 1 October 2010 expressing concern over the appellant's wellbeing and her fitness to practise as a registered nurse (exhibit 1, page 7). The director advised that the appellant had been placed off-duty until a psychiatric assessment had been completed and the appellant was deemed fit to resume her normal nursing duties.
11 The impairment review committee of the respondent recommended that the appellant undergo a further psychiatric assessment by Dr Spear in January 2011. An appointment was made for the appellant to be examined by Dr Spear. However, the appellant did not consent to the examination and she did not attend the appointment (affidavit of Kay Hyde, forming part of exhibit 1).
12 The respondent commenced proceedings in the State Administrative Tribunal by an application dated 8 February 2011. The respondent sought an order under s 90(1) of the State Administrative Tribunal Act 2004 (WA) (SAT Act) for an interim injunction restraining the appellant from working as a nurse until the respondent's application was determined. It also sought orders under s 82 of the Nurses and Midwives Act 2006 (WA) (the Nurses Act). The orders sought under that Act were that:
(a) the appellant comply with such conditions as SAT may impose on her registration;
(b) the appellant seek and undergo medical treatment or counselling as specified by SAT;
(c) the appellant's registration be suspended either generally or in relation to any specific circumstances or service, for a period of time, not exceeding 2 years, as specified by SAT.
13 The application stated that the orders were sought under s 50(b) of the Nurses Act as the appellant suffered from an impairment to such an extent that her ability to practise as a nurse was or was likely to be affected. The impairment was identified as a delusional disorder and a major depressive disorder.
The proceedings in SAT
14 The respondent's application was before SAT for several hearings:
(a) Directions hearing held on 15 February 2011 - Chaney J (President) granted the interim injunction sought by the respondent. The appellant stated in the hearing that she had voluntarily attended a psychiatrist, Dr Manners, in May 2009. He had advised her that she was not unwell. However, he had subsequently issued a report that was different to the advice that he had given her in consultation. The appellant's counsel sought an order under s 61(4)(d) of the SAT Act suppressing publication of the appellant's name and the evidence that had been presented in support of its application to avoid endangering the appellant's mental health or safety. Chaney J was not satisfied that the evidence that had been received by SAT established that an order should be made under s 61(4)(d) SAT Act. However, he was satisfied that there were grounds for making an order under s 61(4)(h) SAT Act.
(b) Directions hearing held on 23 March 2011 - Chaney J made directions for a substantive hearing of the respondent's application.
(c) Directions hearing held on 12 April 2011 - The appellant sought an adjournment of the proceedings as she was no longer represented.
(d) Directions hearing held on 2 June 2011 - The hearing was convened for the return of various summonses that had been issued for the production of documents. RPH objected to the parties inspecting some of the documents that it had produced on the ground that they contained information that was confidential to third parties. The appellant was given leave to inspect those documents that had been produced by the hospital that referred to her.
(e) Directions hearing held on 14 June 2011 - The appellant sought access to all documents produced by RPH. Chaney J indicated that a representative from the hospital had attended SAT and had further identified documents in respect of which a freedom of information exclusion had been applied by the hospital. The documents were said to concern interviews that had been conducted by the hospital with various staff members.
(f) Directions hearing held on 20 June 2011 - Chaney J and two members of SAT presided. The parties were granted access to all documents produced by RPH on condition that the documents were only to be used for the purpose of the proceedings in SAT.
(g) Hearing on 28 July 2011 – substantive hearing of the respondent's application before Senior Member Spillane and two members of SAT.
(h) Hearing on 17 August 2011 – continuation of the hearing of the respondent's application.
(i) Hearing on 21 September 2011 – continuation of the hearing of the respondent's application. The hearing was adjourned as the appellant was an involuntary patient at Graylands Hospital at that time. The appellant was not present at the hearing. However, she represented by a solicitor from the Mental Health Law Centre.
(j) Hearing on 26 October 2011 – continuation of the hearing of the respondent's application at which the Tribunal delivered its decision and the reasons for its decision.
The evidence
15 The respondent called Dr Spear, Dr Manners, Dr Atartis and Ms Kovac to give evidence at the hearing of its application. The Tribunal also received evidence from Dr Heaysman and Mr Hwee and it agreed to a request by the appellant that she be assessed by another psychiatrist. Dr Edward-Smith examined the appellant in September 2011.
16 Dr Spear prepared a statement of his evidence that was received by the Tribunal as an exhibit (exhibit 2). He recounted the history that had been provided by the appellant. Dr Spear stated that the appellant had informed him that:
(a) The appellant had experienced a fear of going onto the streets and a desire to run from strangers. That fear had commenced in about 1990 (exhibit 2, par 12).
(b) Between 1999 and 2001, the appellant had believed that doctors were stalking her and hiring people to follow her (exhibit 2, par 13; it was apparent from other evidence that she had held this belief while working as a nurse in Singapore).
(c) The appellant believed that the same people were following her, breaking into her car and moving objects since she had moved to Western Australia in 2005 (exhibit 2, par 13).
(d) The appellant had sometimes heard colleagues talking about very intimate details of her life (exhibit 2, par 16). Dr Spear also noted that, '[h]owever, she did express some doubt about whether she had actually overheard these conversations and therefore it was unclear to me, at the time of my assessment, as to whether she may also be experiencing auditory hallucinations'.
(e) The appellant believed that staff members at RPH were monitoring her and bugging her conversations (exhibit 2, par 18).
17 Dr Spear noted that he had stated in his report of 4 October 2010 that the appellant appeared capable of delivering competent nursing care. However, he added:
[F]rom my assessment of [the appellant] and in considering her ability to return to work as a Registered Nurse, it is my view that it would be premature for [the appellant] to return to work as a Registered Nurse without having commenced treatment for her condition. I have formed this opinion on the basis that, due to her delusional disorder, she misinterprets events occurring around her and she assumed that people around her are or will be hostile to her and she responds to those people in a negative way. As part of her condition she makes assumptions about people and attributes negative things to them (exhibit 2, par 20).
18 Dr Spear then explained in further detail how the appellant's delusional disorder and her lack of insight into her illness would, in his opinion, adversely affect her ability to discharge many of the 'key' responsibilities of a registered nurse (exhibit 2, par 22). He stated in his oral evidence to the Tribunal that he considered that the appellant's medical condition could be treated and that, with treatment, she could commence a graduated return to work program after approximately three months and resume normal duties after six months.
19 The appellant's cross-examination of Dr Spear reflected two concerns that were central to her approach to the respondent's application and to her submissions in this appeal.
20 First, the appellant claimed that aspects of her history had been either incorrectly recorded or not properly considered and investigated. For example, she put to Dr Spear that he had raised the possibility of a neurological examination to exclude epilepsy. The examination had not occurred and it was suggested that Dr Spear's diagnosis was doubtful for that reason (28 July 2011, ts 31). Dr Spear replied that he had thought that it was unlikely that the appellant suffered from epilepsy. Further, the appellant had subsequently disputed the suggestion that she had suffered episodes of 'blanking out' - that was the symptom that had led him to raise the possibility of epilepsy (see, for example, at ts 32).
21 Second, the appellant suggested to Dr Spear that a delusional disorder involved bizarre beliefs that were untrue and that she could not be suffering from such a disorder if, as she alleged, she had been bullied in her workplace. The appellant contended in the Tribunal and in this appeal that staff members at RPH had fabricated complaints against her; that those complaints had been used as evidence to suggest that she was unwell; and that her denials and allegations that the complaints were false had been used to diagnose her as suffering from a delusional disorder of a persecutory nature.
22 The following exchange occurred in the course of cross-examination on that issue (ts 39):
[The appellant]: If there [is] enough evidence to show that there really organised bullying happening in the Royal Perth Hospital against me, what do you think? Are you going to change your diagnosis?
Dr Spear: Well, exactly. If there was evidence that you had been treated inappropriately, bullied and harassed, then obviously that may change my views of things, but it wouldn't necessarily change my diagnosis, because I believe that your beliefs have gone back to a much earlier period, as early as 2000 from what you told me - - -
[The appellant]: Yes, 2000?
Dr Spear: - - - with your belief that various people have been following you and there being some kind of conspiracy involved in that, which seems difficult to make sense of to me.
23 Dr Spear was then asked further questions on this aspect of his evidence in re-examination (ts 41):
Ms McGrath: Just to confirm, Dr Spear, from the information provided to you at the time of your assessment of [the appellant], she provided a history of these events from about 2000?
Dr Spear: Yes.
Ms McGrath: And I think you stated at paragraph 14 of your statement that you formed the opinion that she suffered from long standing issues which were not related to her current workplace?
Dr Spear: That's correct. I believe these pre-dated her employment in Royal Perth Hospital.
Ms McGrath: Right. So on the basis of that, if you were then provided with the emails to which [the appellant] referred which referred to a grievance that she had, do you think that the other evidence that you were also with - that would influence your diagnosis?
Dr Spear: It wouldn't change my diagnosis, no.
- (The appellant returned to this issue and Dr Spear's evidence later in the hearing at ts 91 and following.)
24 The appellant's general practitioner, Dr Heaysman, referred the appellant to Dr Manners in April 2009. Dr Manners stated in a report to Dr Heaysman dated 29 May 2009 that, '[i]t is difficult know what is happening with [the appellant]' but she appeared to have 'significant anxiety symptoms associated with ideas of reference and some possible paranoid ideation' (exhibit 3).
25 Dr Manners recounted the history that had been provided by the appellant. That included a belief that she had been stalked since 2000 by a Singaporean doctor. She had informed Dr Manners that she believed that the doctor had hired people in Australia to stalk her and she claimed that 'outside people "noticed strange things happening around me"'. Dr Manners concluded his report by advising that he could not exclude a delusional disorder or a paranoid personality disorder. However, he had not offered any treatment until further assessment as he was 'unclear as to what I am dealing with'.
26 Dr Manners' notes were produced to the Tribunal. They recorded that he had seen the appellant on 18 May, 22 June and 13 July 2009. His note of the consultation on 22 June stated that, 'there is a mild degree of paranoia, but overall seems to be functioning'. However, his note of the consultation on 13 July 2009 recorded:
The appellant came in today. She is still showing strong paranoid ideation believing she is being tracked and also misinterpreting. She generally has good personality, but is most likely suffering from delusional disorder, possibility of paranoid personality disorder. She does not want to see me any more as I am not willing to accept the veracity of what she is telling me about people following her which was being organised by a doctor in Singapore. Will see again only if requested.
27 Dr Manners confirmed the matters stated in his report and clinical notes in his oral evidence. The gist of the appellant's cross-examination of Dr Manners was to criticise him for failing to follow up by making appointments for her continuing assessment.
28 Dr Atartis stated in his oral evidence that the appellant had provided him with a copy of Dr Loke's letter of 14 July 2010. He had questioned the appellant about the matters referred to in the letter. It was apparent the appellant still held beliefs about being followed by the Singaporean doctor. Further, Dr Atartis stated that:
… I did satisfy myself at the end of the assessment that she did in fact suffer from a delusional disorder, and I also thought that she was depressed clinically as well, with all the stress she was having in the workplace, and I offered to treat her for both of those. When I confirmed my diagnosis that it was in keeping with Boon Loke's previous diagnosis, I remember [the appellant] was not very happy with my assessment … (ts 54 - 55).
29 Dr Atartis stated that the appellant had twice presented at his rooms without an appointment in the days following his assessment. The appellant expressed some hostility towards Dr Atartis which indicated that she did not accept his diagnosis (ts 56). He considered that she was not fit to work without treatment.
30 The appellant maintained, through her cross-examination of Dr Atartis, that he had 'provoked' and upset her by including a reference to schizophrenia in his diagnosis. Dr Atartis explained that the reference had been included to ensure that the medication that he had prescribed was made available under the Pharmaceutical Benefits Scheme (ts 58). The appellant then challenged an aspect of her history as it had been recorded by Dr Atartis (where she had worked on one previous occasion as a nurse). Finally, the appellant apparently sought to have Dr Atartis confirm a diagnosis of delusional disorder for the purpose of facilitating a claim under an income protection insurance policy (ts 66-67).
31 Ms Kovac was the nursing director, Division of Cancer and Neurosciences, RPH. She provided a statement of her evidence that was received by the Tribunal as an exhibit (exhibit 6).
32 Ms Kovac stated that she had been requested to attend a meeting held on 30 December 2008 between the appellant, a clinical nurse specialist and an acting nurse manager. The purpose of the meeting was to discuss concerns that had been expressed about the appellant's behaviour. Subsequently, the appellant's then general practitioner, Dr Heaysman, and a clinical psychologist, Mr Hwee, had provided reports to Ms Kovac. Mr Hwee's reports had noted that the appellant was experiencing difficulty in her workplace but it was not suggested that she was unable to fulfil her duties as a nurse.
33 Ms Kovac described various incidents involving the appellant that had culminated in about March/April 2009 in a request that she undergo psychological assessment. According to Ms Kovac, there were further incidents after that time and she wrote to the appellant in November 2009 explaining the standards of behaviour that were required by the hospital (exhibit 6, par 28). Ms Kovac sent another letter in May 2010 following further complaints by staff members. As has already been noted, the appellant was eventually placed on paid leave and referred to Dr Blake for assessment.
34 Ms Kovac was cross-examined about the arrangements that had been made in early 2009 for supervision of the appellant's work after it had been decided that her performance should be managed for a period. There was a difference between the appellant and Ms Kovac over the extent to which feedback had been provided during the management period (ts 76). The appellant also challenged the extent to which, if at all, she had been supervised and managed during this period. It was apparent from her cross-examination that the appellant regarded the steps that were taken during the performance management period as instances of bullying (see at ts 84 - 85).
35 Finally, the appellant was keen to explore with Ms Kovac the complaints that had been made against her by other staff members at RPH. The apparent purpose of the appellant's questioning was to challenge the veracity of the complaints and whether Ms Kovac's response to the complaints had been appropriate.
36 The Tribunal discussed with the appellant what evidence she wished to adduce on completion of the respondent's case. The Tribunal agreed to request Dr Heaysman and Mr Hwee to attend the hearing as a result of that discussion. However, it declined a request by the appellant that a number of staff members from RPH be called so that they could be questioned about her allegations of bullying.
37 It was necessary for the Tribunal to adjourn the hearing to enable Dr Heaysman and Mr Hwee to attend to give evidence. The appellant did not appear at the resumed hearing on 17 August 2011. Rather, she sent a letter to the Tribunal requesting that it appoint another psychiatrist for the purpose of conducting a further psychiatric assessment. A message was sent to the appellant advising that her request would be dealt with at the resumed hearing and that Dr Heaysman and Mr Hwee would attend to give evidence at that time. The Tribunal determined that it would receive evidence from Dr Heaysman and Mr Hwee at the resumed hearing, notwithstanding that the appellant was absent, as the appellant had been advised of the hearing (17 August 2011, ts 4-5).
38 Dr Heaysman stated that the appellant had first consulted him in November 2008. He had seen her on approximately 14 occasions during 2009. He had referred the appellant to Mr Hwee in early 2009 for anger management counselling. He had then referred the appellant to Dr Manners in April 2009 (ts 9).
39 Dr Heaysman stated that the appellant had given a history of being stalked for approximately six months and that she had experienced nightmares. He had subsequently certified her as being totally unfit for work on the grounds that she had been bullied and was suffering from depression, anxiety and insomnia (ts 10). He had issued a certificate indicating that she was unfit for work between 21 January and 21 April 2011. He had not seen her since that time.
40 The following exchange occurred during Dr Heaysman's evidence (the question was asked by the Tribunal's senior member):
I suppose what I'm trying to get to, Dr Heaysman, is that [the appellant], I think, believes that - and you may not have made a diagnosis and I'm trying to be careful with the question, but I think she believes that you didn't believe that she had a delusional disorder of any type or any psychiatric condition, but her problem was depression due to bullying at work?---Yes. Basically that was the main reason, yes, but I think in the background there is that effect that she couldn't cope with what was happening in her mind [indistinct] she was obviously delusional and I think she had been hearing things, noticing people - footsteps, and she couldn't, sort of, quite, sort of - and I think that had been coming on for many years, that stalking sort of personality (ts 12 - 13).
41 Mr Hwee stated that he had seen the appellant on 10 to 12 occasions. The first consultation was in January 2009 and the last appointment had been in January 2011. He stated that over several sessions the appellant 'was willing to disclose this concern she had regarding this doctor that she had worked with previously overseas and this belief that this doctor was monitoring her activities currently and had been doing so for some time' (ts 19). He had become concerned over time that the difficulties described by the appellant were more than just personality or conflict related problems in her workplace and that there was a 'deeper' or 'more serious' psychological or psychiatric explanation. He had also been concerned about whether the appellant's health problems were affecting her ability to work as a nurse. Accordingly, he had contacted the respondent as he 'wanted to get information from the Nurses Board as to what process I would need to follow if I did start to develop more serious concerns about her ability to practice and operate professionally and safely as a nurse' (ts 20). However, he had not had access to the appellant's psychiatric assessments.
The Tribunal's reasons
42 The Tribunal delivered its reasons orally at the hearing held on 26 October 2011. As mentioned earlier, the appellant had been an involuntary patient at Graylands Hospital in September 2011.
43 The Tribunal noted in its reasons that the appellant had written to it by a letter received on 20 September 2011. The letter referred to the assessment that had been undertaken by Dr Edward-Smith. The appellant stated that if she was diagnosed by Dr Edward-Smith as suffering from a delusional disorder or if she was forced to take any anti-psychotic medication, she would accept the diagnosis and treatment in order to be discharged from Graylands Hospital. She stated further that, '[i]t is the end of my nursing career. I'm not willing or going to do any nursing-related jobs in the future' (26 October 2011, ts 5).
44 The Tribunal also noted in its reasons that Dr Edward-Smith had concluded that the appellant was presently unfit to work as a registered nurse due to the severity of her chronic paranoid delusional disorder and that her condition was long standing, having been present for 10 to 20 years (ts 6). The Tribunal concluded that:
Based on the evidence of the various psychiatrists, and in particular Dr Spear, Dr Atartis and Dr Edwards-Smith, not to mention the fact that [the appellant] has unfortunately become an involuntary patient at Graylands Hospital, the Tribunal is satisfied that [the appellant] does suffer from an impairment which is or is likely to affect her ability to practise as a nurse pursuant to s 50 of the Nurses and Midwives Act 2006 (ts 7).
45 The Tribunal further considered that it was appropriate to make orders pursuant to s 82(1) of the Nurses Act for the well-being of the appellant and the protection of the public. The Tribunal accepted the opinion of Dr Edward-Smith that it was difficult to state when the appellant would be able to return to work and that it was necessary to suspend her registration for a period to allow her to be treated.
The Tribunal's orders
46 The Tribunal made orders pursuant to s 82(1) of the Nurses Act that:
(1) the appellant's registration to work as a registered nurse be suspended for a period of six months;
(2) at the completion of the period of suspension, the following conditions be imposed on the respondent's registration as a registered nurse:
(a) the appellant refrain from working in any capacity, either paid or unpaid, which required registration with the respondent until she has been certified as fit to work as a nurse by her lead treating psychiatrist;
(b) prior to working in any capacity, whether paid or unpaid, which required registration with the respondent, the appellant undergo formal psychiatric evaluation by a psychiatrist appointed by the respondent for the purpose of the appellant obtaining a report regarding her fitness to work as a nurse;
(c) the appellant must undergo formal psychiatric review every three months by a psychiatrist appointed by the respondent, with the frequency of such reviews to be reassessed by the respondent after twelve months;
(d) prior to working in any capacity, whether paid or unpaid, which required registration with the respondent, the appellant:
(i) must give to the respondent the name and practice address of the appellant's treating psychiatrist;
(ii) consult with her treating psychiatrist at least once every three months and more frequently if recommended by the psychiatrist;
(iii) provide the respondent once every three months with a report written by the treating psychiatrist in a format agreed by the respondent;
(e) prior to working in any capacity, whether paid or unpaid, which required registration with the respondent, the appellant must obtain approval from the respondent to undertake such work;
(f) prior to working in any capacity, whether paid or unpaid, which requires registration with the respondent, the appellant must give to the respondent the contact details of any employer or contracting body for whom she is intending to work and allow the respondent to exchange information with any such employer or contracting body.
47 The appellant's appeal notice proposed the following grounds of appeal:
1. I am not a mentally sick person according to the international standards.
2. Unlike criminal evidence, the mental illness does not present/go away because my medical evidence is illegally recorded.
3. There are 5% of the delusional disorder patients telling the true stories. If I can prove the close monitoring is true, I am not
4. a psychiatric person.
48 The appellant made an affidavit that was filed with her appeal notice. She stated in her affidavit that 'I was forced to see psychiatrists in order to obtain my nursing registration back in 2012, but Nursing and Midwifery Board of Australia made obstacles to prevent me from back to nursing career' (affidavit made on 20 December 2013, par 4).
49 The appellant subsequently filed a further document entitled 'Appellant's grounds of appeal'. The appellant alleged in that document that the Tribunal had erred as, among other things, it had:
(a) refused to issue summonses for the documents and witnesses that the appellant had requested to prove that she had been 'distantly close monitored in detail 24/7 hours' (par 1);
(b) ignored the 'science of psychiatry' and relied on 'forged medical reports' (par 2);
(c) determined the presence of psychosis on 'illegal' evidence provided by psychiatrists rather than according to 'international psychiatric diagnostic standards' (par 3);
(d) considered an irrelevant matter - that the appellant had been admitted to Graylands Hospital.
50 In addition, the appellant claimed that Dr Spear had failed to arrange for her to be neurologically assessed and that she had not been diagnosed as a 'psychiatric patient' while she was a patient at Graylands Hospital.
51 The appellant referred in her written submissions (appellant's submissions dated 17 April 2014) to a number of occasions on which she had requested that RPH produce further documents – the occasions to which the appellant referred included instances after the Tribunal had delivered its reasons. The submissions appeared to assume that the appellant had been diagnosed as a paranoid schizophrenic and contained the following statements that were relevant to the issues determined by the Tribunal:
10. Page 8, the medical reports are contradictory and inconsistent. The Discharge Summary on 19 th October, 2011 showed the principal diagnosis delusional disorder was responsible for admission.
…
12. The staff at the Graylands Hospital forged the records by putting the onset time to 2009, and kept on writing 'Perceive an evil Singapore doctor following'; it should be seemed as a non bizarre delusion, all my documents and reports showed the onset time was year of 2000.
52 The reference in the above extract from the appellant's submissions to 'page 8' was to a bundle of documents that the appellant filed in these proceedings. Pages 8 and 9 of the bundle comprised a discharge summary provided by Graylands Hospital. It stated that the appellant had been admitted to the Hospital on 17 September 2011 and discharged on 19 October 2011. It appears that the summary was not provided to the Tribunal. However, it stated, among other things, that the appellant had a 'long history of delusional disorder with over 20 years of well-systemised persecutory delusions based around a doctor in Singapore stalking her'.
53 The appellant raised other matters in a document entitled 'Amendment 1 for my submissions to the Supreme Court, WA', nearly all of which went beyond the proposed grounds of appeal alleged in the appeal notice. The appellant also made an affidavit on 8 April 2014 that contained her explanation for why she had not commenced her appeal within the time limit specified by the SAT Act (she also briefly dealt with this and other matters in an affidavit made on 11 March 2014).
The SAT Act and the appellant's appeal
54 Section 105(1) of the SAT Act provides that a party may only appeal from a decision of SAT if leave to appeal is given. Section 105(2) provides that the appeal can only be brought on a question of law. However, that section is qualified by s 105(13) which provides that if a decision by the Tribunal is made under a 'relevant Act' and the decision has the effect of depriving a person of the person's capacity to lawfully pursue a vocation, an appeal may be brought on any ground whether it involves a question of law, a question of fact or a question of mixed law and fact. It was accepted by the respondent that the Nurses Act was a relevant Act for the purpose of s 105(13) at the time that SAT made its decision and that the appellant was not confined to an appeal on a question of law.
55 Section 105(5) provides that an application for leave to appeal has to be made in accordance with the rules of the Supreme Court and within a period of 28 days after the day on which the Tribunal's decision was given. Section 105(6) provides that, if leave is granted, the appeal has to be instituted in accordance with the rules of the Supreme Court and within the period of 21 days after the day on which leave is granted. Section 105(7) provides that the court to which the appeal lies may extend the time limits fixed by s 105 and an extension may be given even though a time limit has passed.
56 Obviously, the appellant's application for leave to appeal was made long after the period specified by s 105(5). The effluxion of time raises two considerations that are specific to this matter, in addition to the discretionary concerns that would ordinarily apply where an application for leave to appeal is made so long after the challenged decision.
57 First, the primary order made by the Tribunal was to suspend the appellant's registration as a nurse for a period of 6 months. Obviously, that order has expired according to its terms. Consequently, an issue going to the court's discretion to grant leave is whether there is utility in the proposed appeal.
58 The second matter that has occurred since the decision of SAT is that the appellant surrendered her registration as a nurse in February 2013. Accordingly, it would be necessary for her to apply under s 77 of the Health Practitioner Regulation National Law (WA) Act 2010 (the National Law) if she wished to resume working as a registered nurse. Section 80(1)(e) of the National Law provides that a national board, such as the respondent, may require the applicant for registration to undergo a health assessment within a reasonable time and at a reasonable place. It was submitted on behalf of the respondent that the appellant was susceptible to a requirement that she undergo a health assessment if she wished to resume work as a registered nurse regardless of the effect of the orders made by SAT and the outcome of her appeal from those orders. That possibility also raised an issue concerning the utility of the proposed appeal.
59 It will be necessary to return to each of those matters later in these reasons when the question of whether leave to appeal should be granted is considered. However, it is appropriate to first examine the merits of the appeal on the grounds proposed by the appellant.
The Tribunal's decision
60 The medical evidence presented to the Tribunal was consistently to the effect that the appellant was suffering from a delusional disorder. Further, Dr Atartis, Dr Spear and Dr Edwards-Smith agreed that the appellant was unfit to work as a registered nurse at the time that they conducted their assessments due to the nature of the appellant's medical condition and her failure to seek treatment. Dr Heaysman issued medical certificates in early 2011 and Mr Hwee made inquiries of the respondent regarding the procedure to be followed if he determined that the appellant could not work 'professionally and safely' as a nurse. It is sad to note that both Dr Atartis and Dr Spear considered that the appellant would have been capable of returning to work on a graduated basis within a relatively short time if she had co-operated in the treatment of her condition. It is apparent that the Tribunal accepted that evidence in fixing the period of suspension and in making its ancillary orders.
61 A further aspect of the medical evidence that is significant having regard to the appellant's proposed grounds of appeal is that Dr Loke, Dr Atartis, Dr Spear and Dr Heaysman considered that the appellant's delusional disorder was long standing. That was based on the history that she had given to her examining psychiatrists; in particular, that she believed that she had been stalked and followed while working as a nurse in Singapore (the appellant gave the same history to Dr Manners). She had held that belief since about 1999 or 2000. Consequently, the appellant's belief that a doctor in Singapore had stalked her and that he had hired people to follow her in Singapore and in Perth had pre-dated her employment at RPH.
62 The appellant's examining psychiatrists had not based their diagnoses solely on the complaints and allegations that the appellant had made about her treatment at RPH. It followed that she could not necessarily establish that she did not suffer from a delusional disorder by merely demonstrating that she had, in fact, been bullied while working at the hospital. The point was made in the evidence given by Dr Spear reproduced earlier in these reasons.
63 The appellant put to Dr Spear and Dr Atartis that they had incorrectly recorded aspects of her history. The matters identified by the appellant were minor and did not affect their opinions. She also criticised the doctors who had examined her in various ways but the matters to which she referred were either explained (Dr Spear) or were not directly relevant to the issues to be determined by SAT.
64 It was apparent that the appellant's allegations that the doctors called by the respondent had 'forged' medical reports and provided 'illegal' evidence substantially rested on a combination of the matters that were put by the appellant during the hearing in the Tribunal and her view that she did not suffer from any disorder (but see the comments in the next paragraph of these reasons). As to the allegation that the psychiatrists who had examined the appellant had not assessed her according to the appropriate medical standards, there was no evidence presented to the Tribunal to that effect, nor was there any suggestion in the hearing that the appellant contended that any of the doctors had applied an erroneous standard in formulating their diagnoses and opinions.
65 It should also be noted that it was not always easy to identify the appellant's attitude towards the diagnosis that she was suffering from a delusional disorder. Reference has already been made to the fact that she apparently sought confirmation from Dr Atartis that she was suffering from a delusional disorder for the purposes of making a compensation claim. The ambiguity in her position was captured in a letter dated 5 July 2011 that she wrote to Chaney J and in which she stated (the letter was handed up at a directions hearing held in these proceedings on 28 April 2014):
I am fully aware of that the symptoms of delusional disorder might be with me the rest of my life as stated in Dr Spear's report. It also prevents me from fulfilling any of my nursing duties under any condition in the future.
I still disagree with the diagnosis of Dr Boon Loke, Dr George Atartis and Dr Jonathan Spear. The different diagnoses between my GP Dr Heaysman and the three consultant psychiatrists have caused lots of trouble, but the psychiatrists' reports can override a general practitioner's opinion at any circumstances.
I need my GP Dr Heaysman to fill up my private insurance report in order to make a compensation claim; unfortunately, I even could not make an appointment in his clinic. A complaint has been lodged with the Health Consumer's Council …
66 As has been seen, Dr Heaysman accepted and agreed with the diagnosis that the appellant had for some considerable time suffered from a delusional disorder. (The letter of 5 July 2011 was also referred to by the Tribunal at the hearing held on 28 July 2011, ts 7.)
67 In my view, the appellant has not demonstrated that the Tribunal erred in making its findings and orders on any of the grounds proposed in her notice of appeal.
The application for leave to appeal out of time
The approach to the application
68 The proceedings in the Tribunal did not concern a dispute over the private interests of the parties; it concerned the appellant's capacity to work as a registered nurse and the public interest in ensuring that registered nurses are capable of properly performing their professional duties. There were no 'fruits' of a judgment that had been enjoyed by one party or a status quo established by the Tribunal's decision that had become entrenched and which it would be unjust to now disturb. Consequently, in my view the appellant's application for leave to appeal out of time should be largely determined according to the merits of her proposed appeal. That is not to dismiss as irrelevant the inordinate delay in commencing the appeal. There is always a public interest in finality. However, that interest must be balanced against the effect, if any, that the Tribunal's decision has on the appellant's right to pursue her profession. It is for that reason that I have first considered the merits of the appellant's proposed appeal.
Leave to appeal should be refused
69 The appellant's application for leave to appeal out of time will be refused having regard to the merits of the proposed appeal. As has been explained, I do not consider that the appellant has demonstrated that the Tribunal erred in its findings or in the orders that it made.
70 Accordingly, it is not necessary to consider the other matters that were raised by the parties and which might have been relevant to the application for leave. However, I will comment on the appellant's explanation for the delay in commencing her appeal and on the respondent's contention regarding the utility of the appeal in deference to the submissions that were made by the parties about those matters.
The explanation for the delay in commencing the appeal
71 The appellant made an affidavit on 8 April 2014 stating the reasons why she had not commenced her appeal in the 28 day period stipulated by s 105(5) SAT Act. She repeated her allegations and complaints concerning the conduct of the appellant's examining psychiatrists; the behaviour of nursing staff at RPH and the refusal by the Tribunal to issue witness summonses directed to members of the staff of RPH. She stated that there had been no alternative but to 'pretend' that she had accepted that she was ill in order to obtain a discharge from Graylands Hospital (she had been discharged prior to the Tribunal's decision). She had travelled to China immediately following her discharge and had attempted to commence an appeal while there, including by faxing an 'application letter'.
72 The appellant had decided in 2012 to comply with the orders made by the Tribunal in order to 'get my nursing licence back, just to make a living for survival' (par 20). Accordingly, she was 'forced' to see psychiatrists but 'the Nursing and Midwifery Board of Australia and the Osborne Park Clinic made obstacles to prevent [her] from back to nursing career' (par 21).
73 Finally, the appellant stated that had she suffered from sleep deprivation as a result of the monitoring and harassment to which she was subjected and that a combination of all of the matters to which she referred in her affidavit had contributed to the delay.
74 The appellant had apparently accepted the Tribunal's decision by some time in 2012. However, it seems that she was unable to obtain a medical certificate that she was fit to resume her employment as a registered nurse as required by the Tribunal's orders. Further, she complains that she continues to be monitored and harassed and so it is not apparent why she was unable to commence her appeal much earlier but she has been able to now institute her appeal.
75 In my view, the appellant has not satisfactorily explained the inordinate delay in commencing her appeal. Her failure to do so, together with her apparent acceptance of the Tribunal's orders in 2012, count against granting leave to appeal so far out of time.
The respondent's submissions on the utility of the appeal
76 The Tribunal's orders assumed that the appellant would maintain her registration as a nurse. The primary order made by the Tribunal suspended her registration for 6 months. The Tribunal's ancillary orders expressed conditions to be imposed on her registration - conditions that were principally directed to her working as a registered nurse.
77 As has been noted, the appellant surrendered her registration in 2013. It would appear that the Tribunal's orders no longer have any effect in those circumstances. There is no registration that is conditioned by the orders; that is, there is nothing on which the orders can take effect. The appellant cannot work as a registered nurse because she is not registered rather than because she cannot satisfy the requirements specified by the Tribunal. It will be necessary for the appellant to satisfy the requirements of the National Law rather than the orders of the Tribunal if she wishes to resume working as a registered nurse.
78 It is possible that the appellant retained a legitimate interest in pursuing her appeal despite the surrender of her registration given the subject matter of the proceedings in SAT - it may not be entirely accurate to characterise her proposed appeal in terms of its utility. However, it is not necessary to further consider that question given the conclusion that has been reached about the lack of merit in the proposed ground of appeal.
Other matters
The appellant's involuntary admission
79 The appellant complained in a document entitled 'Ground of appeal' that was filed sometime after the notice of appeal that the Tribunal had erred by taking account of the fact that she had been involuntarily admitted to Graylands Hospital (par 9). The Tribunal stated in its reasons that:
Based on the evidence of the various psychiatrists, and in particular Dr Spear, Dr Atartis, and Dr Edward-Smith, not to mention the fact that the respondent has unfortunately become an involuntary patient at Graylands Hospital, the Tribunal is satisfied that the respondent does suffer from an impairment which is or is likely to affect her ability to practice as a nurse (26 October 2011, ts 7).
80 That conclusion followed the Tribunal's reasoning on the evidence that had been presented in the application, including that given by Dr Heaysman and Mr Hwee. It is plain from its reasons that the Tribunal reached its ultimate conclusion substantially on the basis of the evidence that had been presented during the hearing of the respondent's application. However, the fact that the appellant had been involuntarily admitted to Graylands Hospital during the proceedings was a matter that was plainly relevant to her then capacity to work as a registered nurse. The Tribunal did not err in referring to that matter in its reasons.
The suppression order
81 The appellant requested in the course of these proceedings that the suppression order made by Chaney J be lifted. She claimed that the effect of the order was to deprive her of the opportunity to gain publicity for what she alleges occurred while she working at RPH and the steps that were taken by the hospital and the respondent to have her psychiatrically assessed.
82 As has been mentioned, Chaney J made the suppression order under s 61(4)(h) of the SAT Act. The order was expressed to be pending the further order of the Tribunal. Chaney J stated in the course of submissions about the order that he would suppress publication of the appellant's name and 'the evidence adduced to date' (15 February 2011, ts 10). However, the order that was pronounced was that 'pending further order of the tribunal, pursuant to s 61(4)(h) of the SAT Act, the name of the [appellant] and the evidence given in the proceeding is not to be published' (ts 11). His Honour stated that he would make the order given that the application concerned 'an impairment matter' and not a disciplinary complaint and having regard to the nature of the possible impairment that was then alleged to have been suffered by the appellant.
83 There is some ambiguity about the reach of the order as pronounced. However, in my view, the order was intended to prevent publication of all evidence adduced in the application unless and until a further order was made and not just the evidence that had been presented up to the date of the directions hearing before his Honour (comprising the evidence filed by the respondent in support of its application for interim orders).
84 As best as I have been able to ascertain from the Tribunal's record, the appellant never formally applied for a further order seeking to discharge or vary the suppression order made by Chaney J. However, as in these proceedings, the appellant appears to have been in the habit of communicating with the Tribunal by letter. The appellant handed up at the hearing in this appeal held on 28 April 2014 a letter that she had written to Chaney J, dated 3 May 2011. In that letter she claimed that a delusional disorder was characterised by non-bizarre delusions in the absence of mood or psychotic symptoms; that she did not suffer from hallucinations; that her sleep patterns had been severely disturbed by noise (which I infer from other material that was submitted by the appellant during these proceedings was a reference to electronic noise that the appellant claims has been deliberately transmitted by RPH or persons associated with RPH to harass her); that Dr Spear had not properly recorded her history and had not correctly diagnosed her; that she had made a complaint to the Crime and Corruption Commission and that 'under this situation, may I request the proceedings be published or let the media attend the hearing? The health system should be under supervision of public sentiment'. The appellant raised similar matters in her document entitled 'Amendment 1' (par 7).
85 The Tribunal also noted in its reasons that the appellant had written on 20 September 2011 inquiring as to why the suppression order had been made. The Tribunal did not treat the letter as a request to vary the order; it merely noted that the order 'was not before' the Tribunal.
86 The decision to suppression publication of the appellant's name and the evidence presented in the application did not, in itself, have the effect of depriving the appellant of her capacity to lawfully pursue her vocation (refer s 105(13)(b) SAT Act). Accordingly, it would be necessary for the appellant to demonstrate that there was a question of law involved in any appeal from the order made by Chaney J under s 61(4)(h) SAT Act. His Honour exercised a statutory discretion at an interlocutory stage of the proceedings. He properly took into account the nature of the respondent's application and its subject matter. I am unable to identify any possible error made by his Honour that would give rise to a question of law for the purpose of s 105 of the SAT Act.
Production of documents – summonses for witnesses to attend
87 As has been noted, the appellant complained in a document entitled 'Grounds of Appeal' that the Tribunal had erred as it had 'refused to summon the documents and witnesses I requested. I could prove I have been distantly close monitored in details 24/7 if all summons were granted' (par 1). The document further stated that 'the summons I requested were to prove the stories I told were true to fact, because the medical evidence I got, was illegal' (par 5).
88 The appellant did not identify in her 'Grounds of Appeal' document the witnesses and documents that she had requested be produced by summons. However, a review of SAT's files indicated that the appellant had filed summons for Dr Atartis, Dr Manners, Dr Loke, Dr Heaysman and Mr Hwee to attend to the hearing to give evidence. In addition, the appellant had filed summons for a number of RPH staff members to attend: a director of nursing, a clinical nursing specialist, two staff development nurses, two nurses, an ANF industrial officer, two human resources managers, an occupational health and safety manager and an area manager. The Tribunal declined to allow the appellant to summons and call RPH staff.
89 SAT's files also indicate that the appellant wrote to the President on 22 June 2011 complaining that there were documents 'missing' from the documents that had been produced by RPH and others: the personal files of Ms Kovac and Ms Nanthakumar (described in a summons filed by the appellant as a clinical nursing specialist); a first reference letter from Dr Heaysman to Mr Hwee; a staff appraisal of the appellant completed in October 2009 and the booking records of Dr Manners from April to November 2009.
90 It was apparent that the Tribunal was confronted with a difficult problem in managing the hearing. On the one hand, the appellant sought to refute the diagnosis that she suffered from a delusional disorder by proving that her allegations and complaints about her treatment by the staff at RPH were true. On the other hand, there was an obvious risk that the hearing would degenerate into a collateral inquiry into the appellant's complaints. That tension may have formed part of the context in which the Tribunal refused to order that further documents be produced or that witnesses be required to attend the hearing.
91 The Tribunal raised with the appellant her request for further documents at the completion of the respondent's evidence at the hearing on 28 July 2011. The appellant was asked whether she disputed that she suffered from an impairment that affected her then capacity to work as a registered nurse. On being advised that she dispute that matter, the Senior Member of the Tribunal responded by observing that, 'the bullying is completely irrelevant. It has no relevance whatsoever, because you're fine and ready to work tomorrow' (ts 104). The Senior Member continued:
If your case is that you are fine, that you have no impairment, there's nothing wrong with you, then that's all you have to prove. … You have to bring evidence that you're fine. … So we don't have to worry about all the witness summonses an all the documents because we don't need them. We just need you to show us you're fine. (ts 105)
92 The appellant stated that she understood the point being made by the Tribunal and there then followed a discussion in which the Tribunal agreed that it would make arrangements for Dr Heysman, Dr Loke and Mr Hwee to be called as witnesses. However, the appellant again raised the question of whether the Tribunal would summons members of the staff at RPH to the hearing. She explained that it was because of the bullying that she had been referred by the Hospital to the respondent and that 'without the bullying, without the impairment' (ts 108). The Senior Member responded by referring to the evidence of Dr Spear and to his opinion that the appellant's delusional disorder pre-dated her employment at RPH. After a further exchange, the Senior Member stated:
Okay, I'll tell you once more why they're not relevant, all right, and this is the last time I'm going to tell you why they're not relevant: the board is running the simple case that you have an impairment, that you are not well. You're saying, 'I don't have an impairment. I am well.' So that's the evidence you need to bring. Whatever went down in the hospital is irrelevant to that.
If it caused an impairment, it caused an impairment. If it didn't cause an impairment, it didn't cause an impairment. But the fact is whether it did or it didn't, the evidence from the board is that you have an impairment. (ts 113)
93 There was a further exchange about the relevance of the appellant's allegations of bullying during which the Senior Member again returned to the evidence of Dr Spear that the appellant's delusional disorder had been manifest for some time.
94 It appears that the Tribunal did not fully appreciate the appellant's arguments regarding the relevance of her allegations of bullying at points during the discussion at the hearing on 28 July 2011. The Tribunal seems to have initially thought that the allegations had been made as an explanation for the appellant's medical presentation and it reverted to that position at one point later in the exchanges with the appellant. It did, however, also refer to the evidence that had been received as part of the respondent's case that the appellant had suffered from a delusional disorder from well before she had commenced her employment with RPH.
95 The extent to which, if at all, the Tribunal misconceived the appellant's argument regarding the relevance of her allegations that she had been bullied during her employment at RPH was not entirely clear. The possibility that the Tribunal had misconceived the argument would be significant if the psychiatrists who had examined the appellant had relied entirely on her account of what had occurred at RPH to form their diagnoses – in other words, if they had concluded that her account was delusional and that she, therefore, suffered from a psychiatric disorder. However, as has been explained, there was a consensus among the doctors that the appellant had suffered from a disorder order that was long standing. That was based on the history that she had provided, including her description of symptoms that occurred before she had travelled to Perth to work. Those symptoms included beliefs about the behaviour of a doctor who had no connection with RPH.
'Amendment 1'
96 The document entitled 'Amendment 1' contained a commentary on the transcript of all of the hearings that were conducted in the respondent's application in SAT. It comprised 13 closely-typed pages. It contained numerous complaints, none of which could be properly characterised as a ground of appeal. Some of the complaints provided further detail on matters that have already been considered in these reasons: for example, the appellant's request for witnesses to be summonsed to give evidence and her claims that not all documents in the possession of RPH had been produced. She also repeated and added to the complaints and criticisms she made of her treating and examining doctors. Some of the matters that she raised did not appear to have been points that were made before the Tribunal. In any event, none of the complaints could support her allegation that the doctors had given false testimony or had misdiagnosed her condition, intentionally or otherwise.
Result
97 The appellant's application for leave to appeal out of time is refused. I will hear further from the parties on the extent to which these reasons should be published having regard to the subject matter of the proceedings, the suppression order that was made by the Tribunal and the appellant's objection to that order.
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