In Re Dr Geoffrey ANNETTS

[2004] NSWMT 14

New South Wales

Medical Tribunal

CITATION:	In Re Dr Geoffrey ANNETTS [2004] NSWMT 14
TRIBUNAL:	Medical Tribunal
PARTIES:	Dr Geoffrey ANNETTS (Applicant) Health Care Complaints Commission (Respondent)
FILE NUMBER(S):	40011 of 2004
CORAM:	Walmsley, SC DCJ - Deveson, Ms A - Pasfield, Dr M - Black, Dr F
CATCHWORDS:	Application for Review - Doctor's name restored to the Register
LEGISLATION CITED:	S. 92 Medical Practice Act 1992 (NSW) S. 29 Poisons and Therapeutic Goods Act 1966 S. 128 Evidence Act 1995
CASES CITED:	In Re Dr Shariff (MT 2/10/00); Ex parte Tziniallis [1967] 1 NSWR 357
DATES OF HEARING:	16 and 17 December 2004
DATE OF JUDGMENT:	17 December 2004
LEGAL REPRESENTATIVES:	Mr M Ainsworth (Applicant) Mr P Saidi (Respondent)
ORDERS:	1.The Tribunal finds that the applicant is a fit and proper person to practise as a medical practitioner in the State of New South Wales 2. The name of Geoffrey Annetts be reinstated to the Register of Medical Practitioners kept under the Act 3.Pursuant to s 94(2) of the Act, we order that his registration be subject to certain conditions EMPLOYMENT 1.Before commencing practice, Dr Annetts is to attend and observe five half day sessions with a general practitioner approved by the Medical Board of New South Wales, (“the Board”) 2.Dr Annetts is to practise only as a general practitioner in a group practice approved by the Board 3.Dr Annetts is to advise the Board of any change regarding the nature of his place of employment as a medical practitioner 4.Dr Annetts is to provide the Board within three months of the date of commencement of practice with a summary of the steps he has taken to ensure his patient records accord with Medical Practice Regulation 2003, in particular part 3 (records) and schedule 2 (records relating to patients) 5.Before resuming medical practice, he is to nominate a supervisor to be approved by the Board. The supervisor is to monitor and review his clinical practice and compliance with any conditions, in accordance with level 2 supervision of the Board’s guidelines 6.The supervisor is to be provided with a copy of the Board’s guidelines for supervision and a copy of this decision 7.The cost of the supervision be borne by Dr Annetts 8.Dr Annetts is to ensure that (a)he and his supervisor meet on a fortnightly basis for at least an hour (b)that they address case reviews, medical record reviews, communication and assertiveness skills at each meeting (c)a record of matters discussed at each meeting is to be completed in a format which is approved by the Board (d)he authorises the supervisor to forward to the Board, initially on a monthly basis, a report in a format approved by the Board (e) he authorises the supervisor to inform the Board immediately if the supervisor has any concern in relation to Dr Annetts’ compliance with the supervision requirements, other conditions of registration or clinical performance, or if the supervisor relationship ceases 9.Dr Annetts is not prescribe or supply schedule 4D or schedule 8 drugs 10.Dr Annetts is to complete educational courses approved by the Board in pain management, management of patients with substance abuse and dependency and assertiveness skills within twelve months of the date hereof, and provide to the Board evidence of satisfactory completion of such courses 11.Dr Annetts permit the Board at his own expense to conduct a medical record audit within twelve months hereof HEALTH 12.For a period of two years from the date hereof Dr Annetts is to attend for treatment by a general practitioner of his choice at a frequency to be determined by the general practitioner; Dr Annetts is to authorise the general practitioner to inform the Board of failure to attend for treatment, termination of treatment, or if there is a significant change in health status, including a significant temporary change 13.Dr Annetts, for a period of two years, is to attend for treatment by a psychiatrist of his choice at a frequency to be determined by the treating psychiatrist; Dr Annetts is to authorise the treating psychiatrist to inform the Board of failure to attend for treatment, termination of treatment, or if there is a significant change in health status, including a significant temporary change 14.Dr Annetts is to authorise the Board to forward copies of this decision and any subsequent Board review, interview reports, and other information relevant to his health and treatment, to his treating general practitioner and his treating psychiatrist GENERAL 15.Dr Annetts is to attend Board review interviews at the Board’s request 16.The Board may ease any or all of the conditions imposed on Dr Annetts’ registration at a time determined by the Board, or at Dr Annett’s request 17.The Tribunal orders the applicant pay the costs of a one day hearing.

JUDGMENT:

DEPUTY CHAIRPERSON:

1 This is an application under s 92 of the Medical Practice Act (‘the Act’). On 28 November 2000 this Tribunal ordered removal of the applicant’s name from the Register of Medical Practitioners of New South Wales and that no application for review be made until three years had elapsed. By application filed 9 September 2004, a little over three and a half years later, the applicant applied under s 92 of the Act for review of the first order. He maintains he is now a fit and proper person to practise as a medical practitioner and asks for an order that his name be restored to the Register and that he again have the right to practise. Mr M Ainsworth appears for the applicant and Mr P Saidi for the Health Care Complaints Commission (‘the Commission’).

2 For the Commission, Mr Saidi initially said it neither consented to nor opposed the application.

3 However, ultimately, Mr Saidi submitted that the Tribunal would not be persuaded to the requisite degree of proof that the relevant onus had been discharged.

4 When an application is made for re-registration to medical practice the onus is on the applicant to persuade the Tribunal that it is comfortably satisfied on the balance of probabilities that he is a fit and proper person to practise as a medical practitioner.

5 The Tribunal bears the responsibility of protecting the public when considering such an application. It must also consider the need to protect the standards of the medical profession.

6 In ex parte Tziniallis [1967] 1 NSWR 357 the Court of Appeal of New South Wales heard an appeal by a medical practitioner who had lost the right to practise and who had unsuccessfully sought to persuade the relevant tribunal that he ought again have the right to practise. At page 366 Walsh JA said this:

“Reformation of character and of behaviour can doubtless occur but their occurrence is not the usual but the exceptional thing. One cannot assume that a change has occurred merely because some years have gone by and it is not proved that anything of a discreditable kind has occurred. If a man has exhibited serious deficiencies in his standards of conduct and his attitudes, it must require clear proof to show that some years later he has established himself as a different man. The position is somewhat similar to that which exists when application is made by a barrister or a solicitor who has been found guilty of serious misconduct, exhibiting lack of proper standards, seeking reinstatement on the ground that after a lapse of time he has become a fit and proper person to be a member of a profession which requires qualities and standards in which he is known to have been deficient. In such cases it has been frequently said that a heavy onus lies on the applicant.”

7 In Shariff , a Medical Tribunal decision of 2 October 2000 (unreported), the Tribunal said of an applicant for re-registration:

“It is necessary for the applicant to satisfy this Tribunal that the defect which led to the conduct requiring such adverse finding has been overcome. Clear proof is required to satisfy the onus, one cannot rely merely on the effluxion of time.”

8 Before us the Commission tendered the transcript of the proceedings which led to the orders of the Tribunal in the year 2000. It also tendered a record of interview with PSB officers, a letter from the Commission to the applicant’s solicitors prior to the previous proceedings and their response, together with a statement from the applicant which was put into evidence in those proceedings.

9 The evidence before that Tribunal, and the Tribunal’s reasons, show that the applicant was guilty of very serious breaches of his obligations as a medical practitioner to deal properly with drugs of addiction and with his patients, many of whom were drug addicts. There was no evidence before that Tribunal that he personally took drugs of addiction or sold them to others but there was evidence that he was careless with his doctor’s bag so that his then wife was able to gain access to and steal drugs from it. Further, the evidence showed that, even when health authorities drew his attention to his apparent lack of attention to proper prescribing of drugs and proper recording of the prescription of drugs, he did not mend his ways.

10 It is significant on this application to look at the background of the applicant to see the context in which those significant lapses occurred, and to examine the applicant’s history in the four years since the Tribunal’s orders were made.

11 The applicant was born on 13 November 1955 and is aged 49. He was raised in the Sydney suburb of Gladesville, the second of five children of a pharmacist and a teacher. He attended Gladesville Public School and Sydney Boys’ High School. At the latter he won a prize for all round performance. In his youth he was an active sportsman and a musician. He attended the University of New South Wales and graduated with the degrees MB and BS in 1982.

12 He then worked for ten years in public hospitals. In 1982 he served an internship at Concord Hospital. From 1982 to 1986 he was at Westmead Hospital as RMO, RMO2, Senior Registrar and Surgical Registrar respectively. In 1987 he was RMO at Mildura Base Hospital and in the same year spent a period at Darwin Base Hospital. In 1988 he worked at Ryde Hospital as Orthopaedic Surgical Registrar. In that year he passed the FRACS surgical primary examination. In 1989 he was employed at Westmead Hospital as Surgical Registrar. In 1990 he was employed at Lidcombe Hospital as Surgical Specialties Registrar. He underwent surgical training. He tried unsuccessfully to gain admission to a training scheme. There was only a limited number of places each year. He told the Tribunal there were many applicants each year for very few positions and he did not succeed in any year when he tried to obtain one of those positions. He finally reached the view that he would need to go overseas to become a surgeon. But, as he had married and had a young family, he decided to move to general practice where the immediate financial prospects were better.

13 At the end of 1989 he began to experience auditory hallucinations. He was admitted to the North Side Private Psychiatric Clinic for ten days under the care of specialist psychiatrist Dr Bruce Westmore and was discharged with a diagnosis of either schizophreniform disorder or brief reactive psychosis.

14 In 1991 he was working at Yamba, near Coffs Harbour, doing two weeks locum in general practice, when he had a second psychotic episode. He left Yamba and returned to Sydney and again came under the care of Dr Westmore. He was put on medication, initially Largactil and later Zyprexa. He has been on the latter ever since.

15 Dr Westmore encouraged him to report his psychiatric illness to the Medical Board and he did that. In about 1996 the Medical Board appointed consultant psychiatrist Dr Jonathon Phillips to offer a joint opinion with Dr Westmore as to his fitness to practise. According to Dr Westmore they jointly opined that the applicant had a mental illness which was well controlled with medication and essentially in remission and that there were no psychiatric reasons why he needed to remain under the Board’s supervision. He was then discharged from the Board’s supervision. He has had no further psychotic episodes.

16 From May 1992 until the year 2000 he worked in general practice at the West Ryde Medical Centre.

17 In the few years following their marriage he and his wife had three children. In 1993 his wife began to suffer from a number of medical problems, involving inter alia, a hysterectomy and a pulmonary embolus. She became anxious and dependant. She became bedridden for long periods. His parents and her parents would help out domestically in caring for the three children. At one point the applicant’s wife left the matrimonial home to live in a caravan in the back garden of the home, taking the children with her.

18 At some time in about 1996, and again in 1998, the Health Department warned the applicant that his drug prescribing habits were giving rise for concern. It appears that he had by then become seen by addicts as an easy mark. His right to prescribe Schedule 8 drugs was withdrawn. He then began prescribing benzodiazepines rather than opioids and opiates to the patients to whom he found it hard to say “no” . He had had no training in substance dependence, chronic pain, or palliative care of terminally ill patients.

19 In July 1997, the year after he was first warned by Health Department officials about his prescribing habits, his wife rang him at work and said that she had been stabbed. He rang for police and ambulance and returned home to find her with a knife in her back. A second stabbing occurred about two weeks later. She was found with a knife in her abdomen. In an incident in August in 1997 she was observed to have knife wounds in a thigh. Shortly after the third stabbing she falsely claimed to police that the applicant was her assailant. Soon after, the police came to his surgery during business hours and arrested him and charged him with malicious wounding. He was held at the Silverwater Gaol, bail having been refused, for about two and a half weeks. He was eventually granted bail on a $200,000 surety.

20 The committal took place between a year and eighteen months later. He had, as it turned out, unanswerable alibi evidence. The Department of Public Prosecutions dropped the proceedings. Though he received a costs order against the police he was still out of pocket about $5000.

21 At about the time of the stabbings, it would appear, his ex-wife stole opiates from his doctor’s bag.

22 Over the year following his arrest he lived with his parents, as a result of its being a bail condition. His wife obtained an apprehended violence order against him and he was unable to see his children. The press was alerted to the fact of the committal proceedings.

23 There was a s 66 hearing on 17 November 1999 and then an audit was conducted on the applicant’s practice by Dr Peter Cline. Dr Cline’s report was extremely critical of aspects of the applicant’s prescribing conduct. At about the same time as Dr Cline was reported, the Commission made the complaint which led to his removal from the register. The complaint which led to his removal from the register asserted that he had prescribed drugs of addiction, namely pethidine and morphine, inappropriately, in some cases where applications under s 29 of the Poisons and Therapeutic Goods Act had been refused, for periods in excess of two months absent authority, or contrary to the terms of authorities which had been issued.

24 Allegations were made as to inappropriate prescribing of Temazepam, prescribing pethidine to family members, failing to keep a drug register, failing to account for a large number of ampoules of morphine and pethidine, inappropriately prescribing Panadeine Forte and Rivotril, and failing to keep proper records of his prescriptions of drugs of addiction. He did not contest the allegations save for one, which alleged that he had prescribed Temazepam and other drugs with reckless disregard for the interests of a particular patient. That allegation was dismissed. The Tribunal found the allegation had not been proved to the requisite degree of proof. In dealing with that allegation, the Tribunal said, among other things:

“The Tribunal accepts the practitioner’s assertion that he had no training in drug and alcohol medicine. Further, the Tribunal accepts the assertion that he had no training in drug and alcohol medicine. Further, the Tribunal accepts the practitioner’s assertion that he now knows that his practice of prescribing such benzodiazepines was dangerous but that he did not believe it to be dangerous at the time of the prescribing of the drugs.”

25 In the report of Dr Clyne, to which we earlier referred, Dr Clyne concluded that there were episodes of patient care likely to be unacceptable to the applicant’s peers and that he personally, would not have liked the applicant to treat his family.

26 Before the previous Tribunal the Commission and the applicant put a joint submission that the appropriate order be removal from the register and that no application for review be lodged for three years. The Tribunal accepted that joint submission, being “comfortably satisfied that the practitioner engaged in a course of conduct which facilitated twenty-six of his patients to abuse drugs which was contrary to the interests of those patients and the community” .

27 His conduct was found to have been improper and unethical and he was found guilty of unsatisfactory professional conduct and unprofessional conduct (S 36 & 37 of the Act). Those findings were made on 28 November 2000.

28 The applicant then tried for eight months to obtain alternative employment. During his eight months of unemployment he lived on unemployment benefits and savings and received support from his parents and friends. He revealed to potential employers his history as a deregistered doctor.

29 He and his wife ultimately were divorced in, it seems, April 2001, although their property matters were not resolved until last year. His ex-wife obtained custody of the children who are now aged about twelve, fourteen and sixteen. Ultimately, he was left with assets worth in the region of $10,000, the bulk of the matrimonial assets having been assigned to his ex-wife.

30 Soon after the divorce his ex-wife made another series of significant and false complaints about him to the police. Again, the police appear to have taken them at face value. They helped her find a place to live, a refuge, whose whereabouts he did not know of, and whereby he again lost contact with his children.

31 In July 2001 he managed to find work with Westpac Bank as a teller. He has been in that position ever since, having worked in several branches. He currently earns $30,000 per annum. He says that he has, over the years, paid for his children’s financial support and that the sum currently being paid is $120 per week.

32 In July/August 2003 the status of the custody of his children was reopened. His ex-wife, in Family Court proceedings, conceded that she had made false allegations against him. She was granted a certificate under s 128 of the Evidence Act. So she cannot be prosecuted for the mischievous damage caused to and suffered by the applicant. He now sees his children regularly, although they still live with their mother and are ambivalent about contact with him, even though they have known for at least a year that their mother concedes the falsity of her allegations. He says that he prefers to leave it to the children to take the initiative with contact.

33 The applicant appears to have done well in his bank employment. The Tribunal has been provided with a number of references about him. Bank colleagues speak well of him, as does his brother-in-law, Mr Anderson, from the St George Bank, and a financial planner, Mr Ruppert, who has known him for about six years. Perhaps more significantly, there are three references from medical colleagues, all of whom practice at the West Ryde Medical Centre where the applicant formerly practised. The Medical Director, Dr Chan, says “We would be supportive of his re-application.” He goes on to say “Supervision will be provided if needed.” Dr Mah, of that practice, has known him since 1998 when they were fellow residents at Ryde Hospital. Dr Mah has a special interest in and has post graduate qualifications in psychiatry. He observed inter alia “From a psycho-social point of view it was possible that as [the applicant] was facing stress, pressure and rejection on the home front he was subconsciously seeking acceptance on his work front”. He described him as a caring and competent physician. Dr Tambimuttu described him as sincere and hardworking.

34 The applicant says he has maintained his medical knowledge in that he has undergone an RACGP check program which involves reading a monthly magazine and completing written tests. He has also attended CME meetings monthly with the Hornsby/Ku-ring-gai Division of General Practice. He says he has obtained familiarity with a practitioner’s obligations to keep proper records and as to supply of Schedule 8 drugs. He has involved himself in community activities, including his childrens' school P&F.

35 The applicant concedes that his conduct which led to his removal from the register was inappropriate and that he was misguided. He says he believes his judgment to have been seriously affected by his domestic circumstances at the time. The Tribunal accepts that that is so.

36 It became relevant in the applicant’s Family Court proceedings for him to see his former treating psychiatrist, Dr Westmore. Dr Westmore saw him on 5 December 2002 and wrote a report about him on 6 December 2002, noting that his psychiatric condition was stable and that he was complying with his medication and did not abuse or misuse drugs or alcohol. Dr Westmore saw him for the purpose of this application. That occurred on 29 June 2004. He was asked, inter alia, to comment on his character. He said this:

“I’m always reluctant to comment on the issues of character or whether a person is of good standing. I think those issues can only be determined by tribunals and courts. There is, however, no history of Mr Annetts having any further problems with the criminal justice system and his previous difficulties appear not to have been of his own making. The Tribunal may consider those matters when considering the broader issue of character and good standing.”

37 The applicant told Dr Westmore that his deregistration had occurred because he was over-prescribing narcotics and his ex-wife had taken narcotics from his doctor’s bag. He said he had not seen a psychiatrist for two years and was still taking anti-psychotic medication, namely Zyprexa. He denied any auditory hallucinations. Referring to his inappropriate prescribing and handling of drugs, he told Dr Westmore he had found it difficult to handle patients who could not take “no” for an answer but he would handle that issue now by referring such patients.

38 Dr Westmore considered that he was operating at a higher level of general functioning than when he had been exposed to a number of acute or chronic stressors. He could see no psychiatric reason why the Tribunal ought not consider reinstatement. Dr Westmore was not cross-examined.

39 The Commission had the applicant assessed for the purpose of this application by a consultant psychiatrist, Dr Carne. He saw the applicant on 8 November 2004 and reported about him that day. As had Dr Westmore, he accepted the history without corroboration. The applicant before us said he had been truthful when giving histories to Dr Westmore and to Dr Carne and we accept that assertion. We are satisfied too, that he was truthful in his evidence to us.

40 He acknowledged to Dr Carne that he may have been unwittingly labelled an easy source by drug abusers and criminals. Dr Carne says that the applicant demonstrates good insight into his circumstances and predicament and that his judgment was unimpaired. Dr Carne concluded that given the Health Department’s warning in 1997 before withdrawal of his right to prescribe schedule 8 drugs occurred while the falsely laid malicious wounding charges were pending, the warning probably had little impact.

41 Dr Carne raised the following issues of concern. First there were the applicant’s difficulties in asserting himself to demanding patients and refusing their demands for inappropriate quantities and types of medication; secondly his lack of knowledge as he saw it of the appropriate treatment for substance dependent patients; thirdly, there was the lack of knowledge of appropriate treatment for patients suffering from chronic pain. Dr Carne said the specific counselling he would expect him to undertake to address these issues would be psychological or psychiatric treatment, teaching assertiveness skills, professional advice and help in dealing with demanding patients, specific professional training in the areas of substance dependence, chronic pain and palliative care of terminally ill patients if he chose to continue to treat such patients.

42 Since he had not had counselling, he thought necessary lessons had not been learnt, however he thought it unlikely the stresses of general practice would lead to a relapse in his psychiatric condition, especially given that he had managed the wrongful arrest and imprisonment and malicious prosecution and deregistration without relapsing. He continued that if the applicant were permitted to practice again the Tribunal ought consider the following, that for a period he be supervised by a senior general practitioner, that he be excluded from prescribing benzodiazepines, opioids and opiates, that he undertake an assertiveness course to deal with difficult or demanding patients and continuing education courses in management of substance dependent patients, chronic pain patients and palliative care patients. The period of monitoring, he thought, should be determined by the senior general practitioner who carried out the monitoring. He suggested review by the “Tribunal” (we think he probably meant the Board), and that the period of restriction of schedule 8 and schedule 4 prescriptions be determined according to progress in courses undertaken, practice outcomes monitored by the supervising general practitioner and reviews, (which we take to mean by the Board).

43 In concluding his report, having referred to the period when the applicant’s medical conduct was poor, he said this:

“Mr Annetts' failure to prescribe appropriately was partly a matter of inadequate training but may also have been due to “over-absorption” in his medical practice as his only source of psychological and emotional reward. This I believe contributed to a loss of perspective and to the behaviour of concern”.

44 The applicant gave evidence before us and was extensively cross-examined. He had recently tried to enrol in a course in drug and alcohol prescribing. Though he had paid the fee for the course the course did not proceed, due to a lack of students. He says however that when the course is offered in the year 2005 he will undertake it. He said that he would like to return to his old practice. He has given thought to how he might re-enter practice. Initially, he said, he would observe, and then he would work part time and eventually full time. He would be happy not to have the right to prescribe schedule 8 and schedule 4 drugs and would be willing to be bound by such conditions as the Tribunal imposes on his right to re-enter medical practice.

45 He agreed that he was a “soft touch” and that he ought do such courses and will do such courses as are reasonably available, to enable him to overcome his admitted lack of assertiveness. On his behalf his counsel requested that such courses as he might be required to enrol in as a condition of re-registration be in the Sydney area rather than elsewhere, due to a lack of financial resources.

46 The applicant agreed that he was given a number of warnings from about 1996 onwards. Though there were several instances of prescribing drugs under schedule 8 or schedule 4 for which he had no authority at the time, this being just before he was deregistered, he could give no explanation for that and he said he thought that he had complied with such conditions as were imposed on him. He agreed in cross-examination that he had been given a number of warnings by PSB officers visiting as many as two or three times, warning him about his prescribing habits and that he therefore had been on notice that his right to practice was at risk, yet did not mend his ways, continuing with his bad prescribing practices and his poor record keeping.

47 It was put to him that the stressors of significance had begun in 1997, some time after his bad prescribing habits had begun, but the Tribunal is satisfied that there was a lengthy period of several years leading up to the stabbing episodes in July/August 1997 when in fact he was under significant stressors of a domestic kind. He conceded that he could have undertaken assertiveness training before now. However his counsel did put to us that one aspect of continuing education he has undertaken since deregistration has been a course in dealing with difficult patients.

48 Asked how he would deal with patients with a drug addiction, he said that he would be better able to say "go elsewhere" and he feels that he would be stronger now in making such decisions and making such statements, given that the doctors with whom he hopes to be working, know of his recent history.

49 He has discussed the question of supervision with Dr Chan of his former practice. He has, as we have noted, indicated that he is happy to assist with supervision. However the question of supervision must be a matter for the Medical Board to assess before any particular practitioner is chosen for that task.

50 The Tribunal is satisfied that the defect which led to the conduct requiring the adverse finding in the year 2000 has been overcome. This is not just because of the affluxion of time. The Tribunal is persuaded that he has learned from the events of 1996 to 2000 that his prescribing methods were poor and why, as was his note taking. The Tribunal is persuaded that he now has good insight into his shortcomings, that that is insight he did not have when previously in practice, and that he has insight as to his need for assertiveness training, training in ways of dealing with difficult patients, particularly of the type he allowed himself to be manipulated by before, and in his need for a period of supervision. Counsel for the Commission submitted that it is not enough that the stressors present before have been removed. That submission we accept, but we are persuaded further, and positively, to the Briginshaw standard of proof, that the applicant has not just been removed from the stressors but has such greater insight that he has sufficiently overcome the defect which led to his deregistration. The Tribunal is persuaded that he is a fit and proper person to practise medicine.

51 The Tribunal finds that the applicant is a fit and proper person to practise as a medical practitioner in the State of New South Wales. We order that the name of Geoffrey Annetts be reinstated to the Register of Medical Practitioners kept under the Act. Pursuant to s 94(2) of the Act, we order that his registration be subject to certain conditions.

52 Before commencing practice, Dr Annetts is to attend and observe five half day sessions with a general practitioner approved by the Medical Board of New South Wales, (“the Board”); he is to practise only as a general practitioner in a group practice approved by the Board; he is to advise the Board of any change regarding the nature of his place of employment as a medical practitioner; he is to provide the Board within three months of the date of commencement of practice with a summary of the steps he has taken to ensure his patient records accord with Medical Practice Regulation 2003, in particular part 3 (records) and schedule 2 (records relating to patients); before resuming medical practice, he is to nominate a supervisor to be approved by the Board; the supervisor is to monitor and review his clinical practice and compliance with any conditions, in accordance with level 2 supervision of the Board’s guidelines; the supervisor is to be provided with a copy of the Board’s guidelines for supervision and a copy of these reasons; the cost of the supervision be borne by Dr Annetts; Dr Annetts is to ensure that he and his supervisor meet on a fortnightly basis for at least an hour; that they address case reviews, medical record reviews, communication and assertiveness skills at each meeting; a record of matters discussed at each meeting is to be completed in a format which is approved by the Board; he is to authorise the supervisor to forward to the Board, initially on a monthly basis, a report in a format approved by the Board; he is to authorise the supervisor to inform the Board immediately if the supervisor has any concern in relation to Dr Annetts’ compliance with the supervision requirements, other conditions of registration or clinical performance, or if the supervisor relationship ceases; Dr Annetts is not to prescribe or supply schedule 4D or schedule 8 drugs; Dr Annetts is to complete educational courses approved by the Board in pain management, management of patients with substance abuse and dependency and assertiveness skills within twelve months of the date hereof, and provide to the Board evidence of satisfactory completion of such courses; that Dr Annetts permit the Board at his own expense to conduct a medical record audit within twelve months hereof; for a period of two years from the date hereof Dr Annetts is to attend for treatment by a general practitioner of his choice at a frequency to be determined by the general practitioner; Dr Annetts is to authorise the general practitioner to inform the Board of failure to attend for treatment, termination of treatment, or if there is a significant change in health status, including a significant temporary change; Dr Annetts, for a period of two years, is to attend for treatment by a psychiatrist of his choice at a frequency to be determined by the treating psychiatrist; Dr Annetts is to authorise the treating psychiatrist to inform the Board of failure to attend for treatment, termination of treatment, or if there is a significant change in health status, including a significant temporary change; Dr Annetts is to authorise the Board to forward copies of this decision and any subsequent Board review, interview reports, and other information relevant to his health and treatment, to his treating general practitioner and his treating psychiatrist; Dr Annetts is to attend Board review interviews at the Board’s request, and the Board may ease any or all of the conditions imposed on Dr Annetts’ registration at a time determined by the Board, or at Dr Annett’s request.

53 Having regard to the course of the application, the Tribunal thinks the appropriate order is that the applicant pay the costs of a one day hearing.

54 We order the return of the exhibits.

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