Litchfield v Medical Council of New South Wales - [2012] NSWMT 8

Medical Tribunal

New South Wales

Medium Neutral Citation: Litchfield v Medical Council of New South Wales [2012] NSWMT 8
Hearing dates: 23 - 24, 26 April 2012
Decision date: 03 May 2012
Before: Staff J; Dr V de Carvalho; Dr H Pedersen; Ms G Ettinger
Decision:
1.The Tribunal finds that Bruce Desmond Litchfield is a fit and proper person to practice as a registered health practitioner in accordance with the provisions of the Health Practitioner Regulation National Law (NSW).
2.The Tribunal orders that the name of Bruce Desmond Litchfield be reinstated to the Register of Medical Practitioners kept under the Health Practitioner Regulation National Law (NSW).
3.Pursuant to s 149A(1)(b) of the Health Practitioner Regulation National Law (NSW) the Tribunal orders that Bruce Desmond Litchfield's registration be subject to the conditions set out in Annexure A.
4.The Tribunal orders that the applicant pay the costs of the Medical Council of New South Wales.

Catchwords: Application for re-registration following deregistration for professional misconduct in 1996 - finding applicant now of good character and fit and proper person - finding that applicant has genuine insight - Tribunal satisfied no relevant risk of recurrence of professional misconduct - finding that significant changes occurred in applicant's character - finding applicant has overcome flaws of character - application for reinstatement order granted with conditions - costs
Legislation Cited: Health Practitioner Regulation National Law (NSW)
Cases Cited: A Solicitor v Council of the Law Society of New South Wales [2004] HCA 1; (2004) 216 CLR 253
Council of Law Society of New South Wales v Foreman (1994) 34 NSWLR 408
Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448
Health Care Complaints Commission v Dr Bruce Desmond Litchfield (Medical Tribunal of New South Wales, 15 November 1996, unreported)
In the matter of Bruce Litchfield (Medical Tribunal of New South Wales, 16 June 2003, unreported)
Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630
In the Matter of Mansour Hassad Zaidi and The Medical Practice Act 1992 as amended (29 August 1996, unreported)
Re Bruce Litchfield [2006] NSWMT 3
Re Mansoor Haider Zaidi [2006] NSWMT 6
Zaidi v Health Care Complaints Commission [1998] NSWSC 335; (1998) 44 NSWLR 82
Category: Principal judgment
Parties: Bruce Desmond Litchfield (Applicant)
Medical Council of New South Wales (Respondent)
Representation: Counsel:
Mr TJ Rickard (Applicant)
Mr M Lynch (Respondent)
Solicitors:
Crown Solicitor's Office (Respondent)

File Number(s): 40017 of 2011
Publication restriction: Pursuant to Sc 5D cl 7 of the Health Practitioner Regulation National Law the Tribunal has ordered that there be no publication of the name of any patient or of any material capable of identifying any patient

DECISION

This is the third application by Bruce Desmond Litchfield ("the applicant") for orders permitting him to resume practice as a medical practitioner. His name was removed from the Register on 8 August 1997 by the Supreme Court of New South Wales, Court of Appeal: Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630.

The applicant had been the subject of three complaints "that he had engaged in inappropriate sexual conduct towards three female patients".

On 15 November 1996, the Medical Tribunal of New South Wales ("the Tribunal") found the complaints established. The applicant was suspended from practising medicine for a period of nine months and conditions were placed on his registration following his resumption of practice: Health Care Complaints Commission v Dr Bruce Desmond Litchfield (Medical Tribunal of New South Wales, 15 November 1996, unreported).

The Health Care Complaints Commission appealed the decision of the Tribunal. The Court of Appeal upheld the appeal ordering the deregistration of the applicant.

On 16 June 2003, the Tribunal dismissed an application by the applicant for re-registration. The Tribunal ordered that any further review was not to be made for a period of two years: In the matter of Bruce Litchfield (Medical Tribunal of New South Wales, 16 June 2003, unreported).

The Tribunal's conclusion was stated as follows:

"The Tribunal does not accept that the applicant has demonstrated that he has genuine insight into his misconduct or genuine contrition. The Tribunal does accept that the applicant has made significant progress towards his rehabilitation. He has moved from a position of denial to minimisation of his misconduct. He now appears to appreciate that his de-registration was as a result of his misconduct.

The Tribunal has concluded that the applicant consistently denied any wrongdoing between 1992 and at least early 2000. His acceptance of the adverse findings is slowly progressing but was not of any significance until 2001. The applicant continues to assert that he does not recall having engaged in sexual misconduct with the patients and that he did not realise at the time he was engaging in sexual misconduct.

Given the applicants age and the length of time that it has taken him to reach the point he has it could be argued there are real prospects of him not re-establishing his character to the required standard. However, the Tribunal has decided that the progress made in recent times, which appears to be accelerating, should be recognised by permitting the applicant to make a further application in a period of two years.

The Tribunal has concluded that the applicant has not proved that he has overcome the defects in his character disclosed in the findings of the 1996 Medical Tribunal and the Court of Appeal.

The Tribunal is of the opinion the applicant fell well short of persuading it that he should be re-registered.

The applicant has failed to discharge the onus upon him and the Tribunal members unanimously agree that his application should be refused.

As the Tribunal regards the application as premature, and does not find that the applicant is permanently unfit an order will be made under s 94(4) of the Act that the order of de-registration not be reviewed for a period of two years.

The Tribunal will follow the usual practice and order the applicant pay the respondent's costs."

On 29 September 2006, the Tribunal rejected the applicant's second application for reinstatement: Re Bruce Litchfield [2006] NSWMT 3. The Tribunal observed at [4]:

"[4]The principal issue in deciding whether the order remains appropriate is whether Mr Litchfield can be entrusted with the practice of medicine. This issue generated the following questions:

(1) Does the Tribunal accept that Mr Litchfield has been honest in his evidence that he does not remember much of the sexual misconduct proved in proceedings before the Medical Tribunal in 1996?

(2) Does Mr Litchfield have adequate insight into his misconduct?

(3) Has Mr Litchfield satisfied the Tribunal that it is unlikely that he will re-offend?"

The Tribunal's findings in respect of these questions, which appear at [66] - [81] were:

"[66]Dr Klug described Mr Litchfield as discursive, circumstantial and rigid in his responses. He said that Mr Litchfield had been so anxious about his responses to questions that at times it was difficult to decipher clearly what he meant.[67]The Tribunal agrees with Dr Klug's observations. Mr Litchfield's answers to many of the questions put to him were rambling. They dealt with hypothesis or theory and gave the impression that Mr Litchfield was attempting to separate himself from his conduct.[68]This did not assist the Tribunal in its task of assessing the continued appropriateness of the order for deregistration.[69]The Tribunal does not accept that Mr Litchfield was honest in his evidence of the extent to which he remembered details of the incidents involving misconduct.[70]The Tribunal accepts as possible the claim that he did not recall the incidents involving JT and NM. These matters were not raised with him until many years after they occurred.[71]It was apparent that Mr Litchfield did in fact remember that he examined DM's breasts and commented on her tan mark.[72]The Tribunal rejects the evidence that he did not recall parts of the incident involving LW. He was questioned about this incident 11 days after it took place. He gave evidence which suggested that he remembered only aspects of the consultation that he could justify as having some therapeutic basis. He remembered his conversation with LW, the internal examination and the demonstration of acupressure points. His memory did not extend to the examination of her breasts.[73]The Tribunal finds that in respect of the consultation with LW Mr Litchfield was deliberately untruthful in the denials made to police and the 1996 Tribunal. The Tribunal finds that he was similarly untruthful in the evidence concerning this consultation during the current application for review.[74]This dishonesty affected Tribunal hearings in 1996, 2002 and 2006. It also affected the quality of the evidence of Dr Klug and Dr Phillips. Their support was based on acceptance of the integrity of the information provided to them by Mr Litchfield.[75]The Tribunal does not accept that Mr Litchfield has the required level of insight into his misconduct.[76]It was apparent from the summary of the evidence which is set out in these reasons that Mr Litchfield did not fully accept the findings of the 1996 Tribunal. It is not necessarily fatal to an application for reinstatement that a doctor continue to deny the truth of allegations found to have been proved. What is fatal is the inconsistency between an acknowledgment that the allegations were true and the assertion that the conduct involved was in some way justified or misinterpreted.[77]In the Tribunal's view, this was what Mr Litchfield did in repeatedly inferring that the allegations were based on inadequacies in his communication skills and explanations of medical procedures, introducing preventative or alternative medical techniques and engaging in conversation at personal levels.[78]Of particular concern was his statement that it was likely that LW would not have complained if he had not introduced acupressure into the consultation. This suggested that he accepted no other part of her complaint.[79]There was further inconsistency between his acceptance that his conduct was sexually motivated and his proposition that he projected sexual needs or a want of sexual gratification. This evidence had the appearance of an attempt to minimise the serious nature of his misconduct.[80]The Tribunal was not satisfied that Mr Litchfield would not re-offend if reinstated to the register of medical practitioners. This conclusion was reached because it was apparent that Mr Litchfield has not yet come to terms with his misconduct and that he did not, as indicated by Dr Phillips, have a broad understanding of the nature or significance of that misconduct.[81]For these reasons the application is rejected."

Mr M Lynch of counsel, who appeared for the Medical Council of New South Wales ("the Council"), opposed the application. In the event that the application was successful, Mr Lynch provided the Tribunal with proposed conditions which counsel submitted should be imposed. We will return to discuss this matter later in these reasons.

Mr TJ Rickard of counsel appeared for the applicant.

Principles

The relevant principles applicable to the reinstatement application by a deregistered medical practitioner have been dealt with by the Court of Appeal and this Tribunal on many occasions, albeit under the former Medical Practice Act 1992. On the Tribunal's reading of the current legislation, it is all but identical to the repealed Act in respect of review applications. The Tribunal therefore proposes to have regard to the case law developed under the previous legislation in determining this application.

The starting point is that this Tribunal should not assume that a medical practitioner who was de-registered has become a reformed person. As Walsh JA said in Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448 at 461:

"... Reformations 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."

Both counsel accepted that the principles found in Re Mansoor Haider Zaidi [2006] NSWMT 6 at [42] which were originally set out in In the Matter of Mansour Hassad Zaidi and The Medical Practice Act 1992 as amended (29 August 1996, unreported) and approved by the Court of Appeal, in Zaidi v Health Care Complaints Commission [1998] NSWSC 335; (1998) 44 NSWLR 82 were the appropriate principles to be applied. The principles are:

"[1]The purpose of the jurisdiction which is exercised by the Tribunal is not for punishment or further punishment of the former practitioner. Instead the Tribunal's jurisdiction is for the protection of the public which deals with medical practitioners on the basis that they are members of an honourable profession who can be expected without reservation to conduct the affairs of their patients with honour and in whom the patients can place unbounded confidence. What is in question in an application for reinstatement to the Medical Register is whether an applicant is fit and proper to be held out to the rest of the profession, to patients and to the whole of the community as a person worthy of their confidence.

[2]An applicant who seeks to establish fitness to have his name restored to the Register having been earlier removed from it bears the onus of proving the case. It is a heavy onus and the question whether the applicant is a fit and proper person, is one to be trusted to exercise the high responsibilities of the profession is one to be determined on solid and substantial grounds and as an applicant for reinstatement to the Medical Register he is in a more disadvantageous position than an original applicant. He must in effect displace the decision for deregistration which has been made. That decision involves the judgment that the applicant is probably permanently unfit to have his name on the Register. As a consequence, presumptions of fitness which might arise otherwise than from an absence of contrary suggestions can no longer advantage him, precisely because of the removal of his name from the Register on the basis of unfitness.

[3]The ultimate issue is whether the Tribunal can conclude on the basis of all the evidence that an applicant is now a fit and proper person to join other members of an honourable profession in the responsible and trusted activities which are involved in the work of the medical profession, what is at stake is not so much the reputation of the applicant but the Tribunal's assessment of his character, uprightness, honour and trustworthiness. In the case of some offences committed over an extended period with deliberate intent and resulting in serious distress to patients it will be very difficult to contemplate any circumstances in which the name of the offender will be restored to the Register.

[4]It is not a question of what an applicant has suffered in the past. It is a question of his worthiness and his reliability for the future. What in this respect the Tribunal must determine is whether it is satisfied that for the future the applicant will act in accordance with the high standards and responsibilities of the profession. It is difficult to decide what a man will do in the future and the decision in a particular case is to a greater or lesser extent dependant upon the Tribunal's assessment of the applicant. In making that assessment, it may draw inferences from what he has done in the past, and in particular, what led to his being removed from the Register. An understanding of that may assist the Tribunal to determine what are his standards and his understanding of a practitioner's responsibility, and from this, what he is apt to do in the future. Where what has been done in the past has been sufficient to indicate his probably permanent unfitness the Tribunal will require solid and substantial grounds for the conclusion that his standards have changed, his character has been reformed and that he will act honourably."

We would only add in respect of character the observations of Mahoney JA in Council of Law Society of New South Wales v Foreman (1994) 34 NSWLR 408 at [449]:

"Character involves, inter alia, two things: the acceptance of high standards of conduct; and acting in accordance with those standards under pressure."

These are the principles which this Tribunal considers it appropriate to apply in this matter.

Background of applicant

The applicant graduated from the University of NSW in 1979 with MB and BS degrees. He spent the following five years at various Sydney hospitals as an intern. He worked as an intern at Royal North Shore Hospital, senior resident and obstetrics and gynaecology registrar at Ryde Hospital in 1980 and 1981 and as medical registrar at St Luke's Private Hospital in 1982 and 1983.

During this period he undertook further studies. He trained in the RACGP Family Medicine Program. As well he gained a Diploma of Medical Acupuncture and a Diploma of Family Planning including training in IUCD insertions.

In 1984 the applicant went into sole general practice at Woolgoolga in New South Wales. He sold the practice in 1989. During his period at Woolgoolga he was a visiting medical officer to the Coffs Harbour District Hospital.

Upon his return to Sydney he worked at 24 hour medical centres, under the same management, at Warringah Mall, Chatswood and later at Castle Hill and Dural. In 1995 he resigned to undertake a term as a psychiatric registrar with the Missenden Unit at Royal Prince Alfred Hospital as he was considering becoming a psychiatrist.

The applicant did not pursue this option and returned to general practice and successfully completed the first year of a Master of Psychological Medicine at the University of NSW in 1996. He was unable to complete this course because of his suspension and subsequent deregistration.

During the period of the applicant's deregistration he has worked for the majority of the time as a real estate agent.

As his prime interest remains returning to medicine, in 2010 he commenced a Graduate Diploma in Pharmaceutical Science at Griffith University, Gold Coast Campus. In the middle of 2010, he was upgraded to a full bachelor degree. In February 2011, he completed the course and qualified for the Bachelor of Pharmaceutical Science degree graduating in March 2011.

Findings by the Supreme Court of New South Wales Court of Appeal in 1997

In Health Care Complaints Commission v Litchfield, the Court of Appeal summarised the findings of the 1996 Tribunal at 632 - 636 as follows:

"The complaints before the Tribunal relate to inappropriate conduct of a sexual nature by the doctor in the course of professional consultations with three female patients aged between twenty and thirty. Evidence was also given about an incident involving another female patient, DM, which was not the subject of a formal complaint. The facts, as found by the Tribunal, were as follows.

The first patient, JT, was seen by the doctor in his surgery at Woolgoolga on 6 May 1987 for the purpose of having an inter-uterine contraceptive device fitted. After the patient sat up on the examination table, the doctor placed her hand on his clothing over his erect penis.

JT's friend, DM, was the next patient admitted to the doctor's surgery that day. She had attended to drive JT home and to have a pap smear. After this procedure, the doctor asked whether she had had a recent breast examination.

She said she did not "really bother about it". While she was still on the examination table the doctor, standing behind her, put his hand inside her dress and bra and held one of her breasts. DM said she did not want this and sat up quickly.

NM, who was then twenty, consulted the doctor at the Warringah Mall Medical Centre, Brookvale on 27 March 1992 complaining of flat feet. He examined one foot and one lower leg, and then informed her that she was due for a breast examination and pap smear, and asked her to get on to the examination table. She did so. She was not wearing a bra and the doctor handled her breast. Earlier, the doctor had initiated a personal conversation, unrelated to her flat feet, about her boyfriend, her contraceptive precautions, and what he described as her unusual tan. The Tribunal were convinced, to the necessary degree of satisfaction, that the doctor's examination of this patient was carried out for sexual gratification.

The last complaint related to LW, who saw the doctor at the Chatswood 24 Hour Medical Centre on 2 November 1992. She was complaining of loss of appetite, nausea, vomiting and sleeplessness. After minimal history taking, the doctor pulled up her upper garment and palpated both breasts with his fingers.

After pressing both sides of her stomach down as far as the groin, he then resumed his examination "of her breast" and, after discussing acu pressure points, he demonstrated these on her upper chest wall above each nipple and on her perineum between her vagina and anus. He then carried out an irregular vaginal examination. The Tribunal concluded:

"It seems most improbable that this examination was for any genuine medical purpose and we are satisfied that it was at least in part motivated by a desire for some form of sexual gratification."

The applicant's statements and oral evidence

The applicant filed two written statements in respect of the application. He commenced by stating he became quite seriously depressed after the 2006 Tribunal's decision and was prescribed anti-depressant medication by his consultant psychiatrist, Dr Jonathan Phillips. He discontinued this medication after approximately 10 weeks. At the urging of Dr Phillips, he began a treatment program with Dr Ian de Saxe, a consultant psychiatrist with whom he underwent analytic psychotherapy to better understand his personality structure and what was driving him at the time of the complaints. He has been seeing Dr de Saxe for over four years, on a weekly basis for about three years and over a six month period in 2008 on a twice weekly basis. More recently he has been seeing Dr de Saxe three monthly since he moved to Queensland.

The applicant stated that much work had been done with him on strengthening his boundaries in stressful situations and looking at the aetiology of the complaints, specifically his responsibility in how he initiated circumstances that enabled him to take some advantage of the patients in different ways and how, in effect, he abused his power and privilege as a doctor.

He has continued to consult with Dr Phillips over the last four years and recently began seeing a forensic psychologist, Dr Norman Barling, in Broadbeach, Queensland.

The applicant stated that he had benefited enormously from the treatment programs and support of his treating doctors who he said had helped him gain a clear understanding of several matters critical to his application. These were stated to be:

"Firstly that for many years after the complaints were made, I did not genuinely accept the inappropriateness and harmfulness of my conduct. Despite practising a further 4 years without any more complaints, I understand the conclusion of the previous medical tribunal that they were not yet satisfied that I was ready to be reregistered in 2006. I have read the findings of this Tribunal many times and now understand most of their concerns and have reflected on my thinking at that time.

Secondly I now accept that I did suppress some memory in evidence to the previous Tribunals about what I could remember happening at the consultations. I can only say in response to comments in the 2006 decision that, as I now understand things, I believe my evidence was based firstly on a genuine difficulty I had in clearly recalling events without reconstruction, and secondly not being able to truly believe that I could have conducted the consultations in the way I did largely for my own sexual gratification.

Thirdly I suspect that at both the 2006 and 2002 hearings, although I understood in a general sense what I had done was wrong and unacceptable, deep down I did not really accept that deriving any sexual gratification from these patients was something I was capable of doing, it was so contrary to what I had always thought were my ethical and moral standards. It was too painful to sincerely believe and my role in it was still not defined in my own mind.

Fourthly at the previous Tribunal, my emotional state at that time combined with the passage of time since the consultations really did make it difficult for me to remember the details of the complaints, (as the Tribunal noted was possible). However, through the psychotherapy sessions, I now have an improved recollection of the events and an understanding of the context in which they occurred."

The applicant's evidence was that he now believes, based on his clearer recollection of what actually occurred, together with a better understanding of himself, that while he had a legitimate medical purpose in what he was doing, he also had a sexual motivation which may also have been influenced by traits in his personality which became exaggerated when fatigued.

He stated that his assertion in 2006 that he had an absolute acceptance of the previous findings "was not really right". He acknowledged that his answers were inconsistent and rambling. It was not until he realised that absolute agreement with the previous findings was not essential that a further door was opened to him. With Dr de Saxe's assistance he said he had been able to explore his inner self and the findings against him with a more open mind. He believes he has become less judgmental of himself and more objective as he followed this path and matured as a person.

The applicant stated that he now more clearly understood that some of his actions during those consultations were instinctive, impulsive and not properly thought out and regrettably were at least in some part, for his sexual gain.

He stated that he now fully recognises the very serious inappropriateness of his conduct during the consultations and considered it improper. Through therapy he has substantially recalled his actions. He stated he was aware of the behaviour that disturbed the four patients and was ashamed of his breach of their trust.

Importantly, the applicant's evidence was that he was now able to sincerely accept his guilt and was deeply contrite. He recognised that his conduct was well below what was expected of a medical professional and was a serious breach of his obligations to patients.

Coming to this realisation had not been easy for the applicant. He stated he can now see how he "went off the track during the consultations by letting my professional boundaries become blurred for my own sexual gratification". Through the extensive therapy he now recognises certain personality traits of his that unfortunately came "to the fore" during the consultations which compounded the inappropriateness of his behaviour.

The applicant stated that he was truly sorry for and sincerely regretted his misconduct and his behaviour towards the patients. He said he had been greatly humbled by the harm that he had caused not only to the patients, but also his family, former colleagues, friends, and the profession. He apologised to all of them. He acknowledged that his previous lack of adequate insight made it harder for all.

The applicant stated with his deeper understanding of his general personality structure and his relationships with others, he had attained a greater level of maturity as a person. He was confident that he now had the necessary insight to understand what, how, and why, he was wrong and the understanding and awareness that it would not happen ever again.

The applicant stated that he believed he now had the awareness and insight to protect the dignity of the patient and the profession and to be trusted in the future as a competent, ethical practitioner.

The applicant acknowledged that if he was successful in his application, he would need supervision and mentoring and that this may also include chaperoning in certain situations. He intended to continue his sessions with either Dr de Saxe or Dr Phillips, or if he practiced in Queensland, Dr Barling.

The applicant acknowledged that it was 15 years since he last practised medicine.

The applicant has gained his continuing professional development points for the last five trienniums, in particular, the last two since 2006. He is close to fulfilling the criteria for the current 2011-2013 triennium. He has also continued to attend seminars over the last few years and to regularly read Australian Family Physician, Medical Observer and more recently the Australian Medical Handbook 2010 and MIMS 2011. Certificates and records of his attendance at the various seminars together with certification of his continuing professional development were attached to his statement.

The applicant has also been undertaking various clinical attachments over the last 12 months with Dr Ian Ferguson GP at Keperra in Brisbane, Dr Ross Walker, Cardiologist in Chatswood, Sydney and Dr Ramanathan GP in Beecroft, Sydney.

The applicant believes his knowledge of current drugs and other pharmaceuticals is up to date following his completion in February 2011 of his Bachelor of Pharmaceutical Science degree at Griffith University.

If his application was successful his preference was to take up a salaried position in a medical centre where there were at least three or four other doctors practising so that they could provide mentoring and be a source of advice.

The applicant annexed a draft service agreement between himself and Life Care Medical Group Pty Ltd. He stated that Dr Edmund Bateman, the managing director of Primary Health Care had provisionally also offered him a position at Main Street Medical and Dental Centre in Beenleigh in Queensland if he was re-registered. He stated that Dr Bateman was aware of the findings against him and likely need for supervision by a suitably qualified practitioner.

The applicant concluded his written statement by confirming that he truly believed that he had gained the necessary insight into his previous behaviour and now understood the defects in his personality and the circumstances that contributed to the complaints. He is absolutely confident that he would never again take advantage of his position as a doctor and behave that way again. He assured the Tribunal that if he were re-registered, he was determined to fulfil the obligations and responsibilities of being a respected member of the medical profession and would guard and cherish that membership with care and honour. He again expressed his true sorrow for the misconduct and harm and distress it had caused others.

The applicant filed a further statement dated 12 April 2012. He confirmed that he had continued to update his medical skills and knowledge and fulfil the criteria for the current 2011-2013 triennium. He confirmed that copies of references annexed to his initial statement given by former female patients in or around 2000 and advised that he did not provide any of those patients with the Court of Appeal decision and did not remember exactly what he told them about his situation. He advised that he had more recently written to each of the patients in February this year and provided them with a copy of the Court of Appeal decision and asked them to comment on their original reference. He received updated references from three of the six patients that had originally provided references.

The applicant attached further character references from the following:

Dr T Ramanathan (general practitioner);

Mr Mark Tomlinson (accountant);

Dr Roger D Lindsay (dentist);

Ms Robyn Lamb (social worker - cohead of Allied Health Children's Hospital);

Dr Michael Panetta (general practitioner);

Ms Lee Millard (his partner);

Dr Ian Ferguson (general practitioner); and

Mr Tony Ghanem (his current employer).

He stated that he had had further discussions with both Dr Ramanathan and Mr Frank Terranova about possible employment if re-registered. He had also had discussions with another medical centre provider, Dr Paul McCarthy. The applicant stated that all three had indicated they would be prepared to employ him in the full knowledge of his circumstances and the fact that if re-registered, it was highly likely he would be subject to certain supervision and monitoring conditions.

The applicant stated that since his last statement he has continued to receive treatment from Dr Barling and Dr de Saxe. He had had 11 sessions with Dr Barling and 8 with Dr de Saxe. His sessions with Dr Barling were aimed at developing further strategies to strengthen his boundaries, developing further awareness of emotional regulation and improving his management of patient expectations. He said that he had come to understand that he had been too directive in the past and needed to give better explanations of what he intended to do and that this was even more important with new patients.

With respect to the further consultations with Dr de Saxe, he stated he had an improved understanding of how the emotional tension he was under during the period of the complaints contributed to the weakening of his boundaries and his failure to explain himself properly and sensitively. He said all of this had contributed to inappropriate conduct during the consultations.

He further stated that he also recognised much more clearly, and this was also something he gained more insight into, from his sessions with Dr O'Brien; that there had been a degree of "unthinking sexual behaviour on his part". He stated that he now believed that he had gained a significant insight into what was happening in his life and medical practice in the period of the complaints. He said that his memory of what happened in the four consultations "had improved a lot" since the last Tribunal hearing, although not to the same degree in all cases. He now fully accepted that with Patient JT, whom he had treated previously on several occasions, he was becoming emotionally attracted to her and that his behaviour, after the procedure was completed, was sexually motivated and gave him some level of gratification. With respect to Patient DM and Patient NM, he had a less clear recollection of what took place. Both of them were first time patients and he said he did not genuinely recall any sexual gratification. In respect of Patient LW, also a new patient, he now recognised that some of what he did had some sexual basis and gave him some sexual gratification but he did not recall being aroused.

The applicant also stated that in all cases he fully acknowledged that what he did and his overall behaviour during the consultations "was totally inappropriate (in respect of all four patients) and sexually motivated (on at least two occasions)". He stated that he didn't believe that anything he did was premeditated, and perhaps with two of them he was not even really conscious of what he was doing at the time. However, he acknowledged that his behaviour was unacceptable and repeated that he was extremely sorry for all the hurt and harm that he had caused to the four patients as well as his friends, family and the profession.

The applicant concluded that the further sessions he had with his doctors, the greater clarity that had developed in his mind about what happened and why, together with his better understanding of his personality allowed him to confirm he would not make the same mistakes again.

The applicant was subjected to extensive cross-examination. As was observed by the 2006 Tribunal decision, a feature of his oral evidence was a tendency to hypothesise answers and to give rambling responses. Both psychiatrists called by the applicant, Drs Phillips and de Saxe, observed that this was a feature of his personality.

Relevantly, the applicant gave evidence that since the 2006 Tribunal hearing, as a result of psychotherapy, he now had a memory of the consultation with JT which occurred in 1987. His evidence was that after he took her pulse, he held her hand momentarily against his erect penis. He was in an excited state. He acknowledged that he had previously denied having any recollection of this conduct. His evidence was that through psychotherapy, he had been assisted in his understanding that there was some erotic counter transference. He said that he realised in hindsight that he was somewhat attracted to this patient. He agreed that he had denied this when questioned during the 2006 Tribunal proceedings and said that his:

"insight wasn't such that I had a memory; I hadn't had any flash backs in terms of memory. And it's something that through the therapy that I have had I mean, these issues are something that I've even sleep [sic] about at night, you know; they've just been some issues that I have struggled with for a very very long time."

The applicant explained that he had had flash backs as to what occurred in 1987 since the last Tribunal hearing in 2006. By flashbacks he meant memories that had been repressed which have now been uncovered. He stated that he had also had flashbacks in relation to LW. His evidence was that there were other acupressure points that he demonstrated with LW. He said he now understands that those points that he touched or demonstrated were inappropriate and he analysed with Dr de Saxe the motivations behind touching those points. He accepted that one of the acupressure points was on the breast and one was slightly above the breasts of LW. These flashbacks occurred after approximately 12 to 18 months therapy with Dr de Saxe on or around 2008.

Asked to explain why 11 days after he performed the examination on LW, he did not inform the police what had occurred, his evidence was he looked at his medical notes as an aide memoire and "basically just defended myself on the basis of what I could recall at that time and looking at the medical notes". He was shocked. He made a statement to the police saying he saw the patient in the late afternoon, but in fact he had seen her at 10.00am or 10.30am. His explanation was that he had actually suppressed his memory about LW and that he had "some kind of filter in my psyche which has obviously protected me".

The applicant rejected the proposition that at the time he was confronted with the allegations, he falsely denied them knowing he may have got into serious trouble if they were admitted "as opposed to psychically blocking the memories". The applicant's evidence was that he had been in shock and had suffered an element of post traumatic stress disorder. He believed his consultations with Dr Elizabeth O'Brien, psychiatrist, retained by the Medical Council of New South Wales ("the Council") and the reading of her report had been "catalystic" in terms of improving his insight.

The applicant informed Dr O'Brien that in relation to LW, that the contents of the treatment given to her could have been personally sexual. The applicant had difficulty in recognising this but in hindsight he accepted that it was the case. The applicant accepted that he had obtained some gratification in respect of his consultation with LW. He attributed this understanding to his consultations with Dr O'Brien and further consultations with Dr de Saxe, his treating psychiatrist. His evidence was his:

"suppressed memory has been pretty rock solid and it has been taken, sorry it has taken a big shock, frankly to make it shift and such that and to some extent there's been something of a watershed I think since I saw Dr O'Brien and quite genuinely something of a watershed and I believe that that on top of all the work I have done with Dr de Saxe she has been catalystic."

In respect of the patient JT, in explaining his watershed experience, the applicant said all he could say was that it was 9½ years before the complaint was put to him and:

"in hindsight the fact of the analysis of her complaint, the fact I had seen her ten times and the fact that that part of the consultation was memorable [the insertion of an IUD] helped me in the last couple of years to come to that understanding as well as as well as a memory flashback you know as well as which seems to have come to me out of the therapy that I've been in with Dr De Saxe and Dr Barling."

He accepted that he had been deluding himself previously by not accepting that there was some sexual basis for his conduct in respect of LW. He accepted the earlier Tribunal's finding that he sought some sexual gratification from LW. He stated he agreed with the findings of the 1996 Tribunal in respect of LW. His evidence was that he was not proud of seeking sexual gratification during the consultations with JT and LW. It was something that has caused him great distress and disgust. In respect of each of JT and LW, the applicant recognised that there was a therapeutic purpose to the examination in each case, but now recognises that there was a sexual component to each consultation.

In respect of DM and NM, the applicant's evidence was he analysed their complaints further and had difficulty in recalling sexual gratification in their cases, but conceded that it was probable in their cases that there was some sexual gratification derived. However, he stated there was some therapeutic basis in respect of these two patients.

When asked "are there any other things that you would do differently now" (when seeing patients if he was re-registered), the applicant stated:

"I'm in a more vulnerable situation, legal situation than other doctors, so I need to take extra care and have a chaperone present for intimate examinations. So, as I said yesterday, I also believe modern medicine is supportive for the patient, so, should a patient see me at my surgery requiring an intimate examination, and if a chaperone is not available at that time, I would need to rebook them at a time that would be appropriate."

Despite criticism of his evidence by Mr Lynch, which we will deal with shortly, overall the Tribunal found the applicant to be an honest and reliable witness. Our assessment was that he was not endeavouring to be deliberately evasive in answering questions put to him. It was obvious that he found the experience stressful as he observed on at least one occasion.

Psychiatrists' evidence

The applicant relied upon reports from Dr Jonathan Phillips, Consultant Psychiatrist, dated 16 August 2011; Dr Ian de Saxe, Consultant Psychiatrist dated 9 September 2011, Dr Norman Barling, Psychologist, dated 19 August 2011 and Professor Carolyn Quadrio, Specialist Psychiatrist, dated 3 March 2001. Each was required for cross-examination, except Dr Quadrio.

Since 2006, the applicant has seen Dr Phillips on approximately 50 occasions; Dr Barling on approximately 35 occasions and Dr de Saxe on approximately 175 occasions.

The applicant was initially referred to Dr Phillips by the Medical Board of New South Wales in 1997. The applicant began consulting Dr Phillips prior to his application to the Tribunal in 2006. Dr Phillips formed the view that the applicant would benefit from psychotherapy and referred him to Dr de Saxe. In his report Dr Phillips observed that in his opinion, the applicant had some rigid and narcissistic personality traits, but never qualified for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR Axis II personality disorders. He observed that the applicant had a firmer understanding and recollection of his past actions which were more than likely assisted through therapy offered by Dr de Saxe. He stated that there was a caveat in respect to emotionally charged memory. In his opinion, memory can become obliterated, fragmented or altered as a consequence of the person overusing the psychological defence mechanism of denial, repression and suppression which are more likely to interfere with emotionally charged memories.

On Dr Phillips' evaluation, the applicant has made considerable progress in regaining memory for the incidents of importance. He was not convinced, however, that he had perfect recollection and doubted, at this late time, that he would be able to regain any significant further memory of the incidents. Dr Phillips stated that the applicant had made substantial progress in respect of the matter of insight, again with the assistance of Dr de Saxe. He was satisfied that he now has insight into the improper and unethical actions which he took in the past and now recognises that his actions were damaging to the victims.

Dr Phillips observed that it was hard for a psychiatrist to judge contrition. However, he stated the applicant appeared to be genuinely sorry for the damage he had brought to his victims and he had spoken with feeling about this matter on a number of occasions. When he first came into his care, the applicant was highly self focused and had difficulties empathising with the experience of his victims.

Dr Phillips observed this situation had now changed. In commenting on the applicant's re-education, assuming his re-registration, Dr Phillips' opinion was he would need to be assigned as a medical officer at a teaching hospital either in the metropolitan area or in a large rural city. In his view, it would only be in those settings where the applicant could be guaranteed a proper rotation of clinical terms and proper supervision and guidance. He was unsatisfied that the applicant would be offered the breadth of experience that is available in a teaching hospital or high level supervision that could be guaranteed if he worked in a private group general practice. He believed a minimum period of 12 months as a medical officer in a teaching hospital was required.

During cross-examination he said this was his "fail safe" view.

In light of the above considerations and noting that the applicant had matured significantly over the years, and now lives in a stable relationship with his partner, Dr Phillips believed his chance for re-offending was very low.

During oral evidence Dr Phillips stated that the applicant had been a slow but steady learner and has been able to retreat from traits and certain rigidity in the way he saw things. He had a tendency to be somewhat self focused and perhaps not automatically empathetic with others. Dr Phillips said self focus was probably the biggest issue in explaining why mechanisms had precluded the applicant from remembering some of the individual conversions with the patients. Dr Phillips' evidence was that:

"None of us like to recall painful events, embarrassing events, difficult events, failures, we do not. There are mechanisms which work at conscious level and unconscious level to in fact put a wall between the conscious brain and those memories.

The conscious mechanisms are, well, the conscious mechanisms is one of repression where you consciously think I don't want to remember that and you push it away. The more unconscious mechanisms is repression and denial, and in truth there is not much between them where, at a subconscious or unconscious level painful material is sequestered away and is not immediately available to memory.

This has been a major problem for Mr Litchfield. It was a major problem when I was seeing him more frequently in the past, and I have no doubt it was a significant issue that Dr de Saxe worked on in his frequent psychotherapy.

...

I think it could never be said that any person has perfect insight or perfect contrition or perfect anything. One sits on a bell curve somewhere and Mr Litchfield has moved a great deal from where he was, with difficulty, but he has moved a great deal and he has, on my evaluation, reasonably good insight now, a good level of contrition and that is quite a movement from the past.

Dr Phillips' evidence was that he was sensitive to people who lie in front of him or try to deceive him. However, he stated he had never had that with the applicant, but he recognised that his construction of events, probably based on what he best understood was the situation at the time, could easily be perceived to be dishonest. However, he did not believe that the applicant had acted in an openly dishonest manner with him.

Dr Phillips was asked the following:

"Q.Is it possible that in gaining your insight there is a series of events and then for some trigger reason there is like a, I'll use the word a watershed, that everything comes together and you cross that final hurdle?

A. This is the socalled "aha" experience that the psychotherapists talk about, where an accumulation of information gained over a long period of time suddenly fits together, a bit like a jigsaw going together, and a person then has a much better understanding. I'm a mere general psychiatrist and it doesn't happen every day in my practice, but certainly it can occur where people get a moment in time, and I'm not suggesting a split second, but a short period of time where in fact many bits can be put together to make sense of something that happened in the past. So often when people, when you are working with people in therapy, they talk about a greyness or an opaqueness or uncertainty where they can't get to the details they need, and analytical psychotherapy is probably the best tool to help people break through and obtain that."

In cross-examination, Dr Phillips was asked about the "a Ha" experience:

"Q. I think, in the course of his discussions with Dr O'Brien he conceded sexual gratification as a motivation in one only of the four cases. After receipt of Dr O'Brien's report he concedes that on at least two of them there was sexual motivation as I read to you. It is a very curious timing for the realisation that sexual motivation had applied initially from when he told Dr O'Brien in respect of one patient and 2 months later in respect of two or more?

A. I think there are 2 hypotheses. One is that he is facing a tribunal and he came to realise that it might be in his favour to acknowledge sexual gratification. The other is the relatively "a Ha" experience of and I think we are talking about Dr Elizabeth O'Brien?"

Dr Phillips in re-examination was asked:

"Q.... My friend took you to the "a Ha" moment that Mr Litchfield gave evidence about yesterday. If I was to say to you that on my understanding of that evidence that that was in relation to what happened with just one of those patients, namely LW would that be such a huge surprise to you that having gone through the shock process as you describe it with Dr O'Brien, that one element in respect to one of those patients became clear?

A. Not at all. As I said before I know Dr O'Brien well. We have worked in the same practice, in the past, worked together in the clinic in various roles. She's extremely forthright and goes straight to the point and I think it would have been a harrowing experience and harrowing experiences can quite often be very useful."

Dr Phillips' evidence was that the applicant's apparent inability to answer questions directly was caused by a "discursive style of thinking". His evidence was:

"People think in different ways. Ideally a person should think A, B, C, D and so on in a logical sequence. Many people tend to roll out sideways and introduce irrelevant material or become preoccupied by stuff which is really irrelevant and he is good at that."

Dr Phillips gave evidence that there were three groups of doctors:

"The number 1 is the 'bad' group of doctors. The second group of doctors is the 'sad' group of doctors who have some established problem which leads to a failure of boundary regulation. The third group of course are the socalled 'mad' doctors who are driven by delusions and hallucinations and they are quite rare but I have seen several."

Dr Phillips stated that he has always persistently had the view that the applicant fitted into the second category. He stated:

"If the person fits into the first category then I could never, ever, consider the person returning to a profession where you have huge responsibility and where you are dealing with people day in and day out."

Dr Barling's opinion based on consultations over almost a two year period, psychometric testing and his progress through therapy was:

Mr Litchfield has achieved greater insight into his sexual misconduct and has achieved the treatment goals of the above program. The therapeutic process of working through the above program has broadly served to increase his awareness of his behaviour, thoughts, and feelings, in relation to patients and colleagues, and to better observe professional boundaries and ethical behaviour. Overall his efforts in therapy just as in other aspects of his life have shown persistence, and motivation to move forward.

Mr Litchfield's boundaries and motives with patients have been examined in relation to his personality characteristics of neuroticism, extraversion, openness, agreeableness and conscientiousness.

As a result of therapy and the achievement of greater insight into his behaviour it is my clinical opinion that Dr Litchfield is a very low risk of re-offending.

From my 15 years of experience with sexual offenders, for both treatment and assessment, it is my forensic and clinical opinion that Mr Litchfield is of very low risk of re-offending to society, patients or clients, in whatever capacity he may seek to engage in the future, whether within a medical context, a pharmaceutical context, family and social context or society generally.

Should he be reinstated on the Register and to practice medicine again, he has agreed to peer supervision on re-entry into practice. He has also agreed, and I would be prepared to monitor his progress and to reinforce therapeutic gains monthly, for twelve months.

He was also of the opinion that the applicant did not meet the criteria for a personality disorder.

During cross-examination, Mr Lynch asked Dr Barling to indicate what discussions he had had with the applicant regarding his application for re-registration. He declined to provide an answer to this question on the basis of doctor/client privilege. This lead Mr Lynch to submit that little weight should be given to Dr Barling's opinion. We agree with this submission.

Dr de Saxe stated that an issue which arose during the therapy was the applicant's apparent lack of empathy which sometimes included those with whom he was interacting. An example was his inappropriate responses to social cues or indicators when he was attempting to end sessions with the applicant. Such behaviour supported the idea that to some extent his difficulties with patients stem from excessive attention to detail which was an idea suggested by Dr Quadrio, another psychiatrist who had assessed the applicant in respect of an earlier application.

These were matters that Dr de Saxe sought to address during his therapy. He initially saw the applicant twice weekly for some months which decreased to once weekly. In Dr de Saxe's opinion the applicant suffers a personality disorder of a narcissistic type. He noted that Dr Phillips and Dr Quadrio did not share this opinion. However his remained unchanged. He noted whether the applicant had a personality disorder or character disorder, it was unimportant from the perspective of attempting and understanding his internal psychological makeup. What is of great importance is the personality traits which are dominant and the effect they have on the applicant's work and personal life. He acknowledged that the term "personality disorder" was not particularly useful as new perspectives into the origins of personality traits have led to treatment possibilities which did not exist at in earlier times.

Dr de Saxe noted that an issue of central importance had been a difficulty the applicant experienced in accepting that he had conscious sexual motivations in his interactions with the patients whose complaints led to his loss of registration. From Dr de Saxe's perspective, it had been difficult to determine whether this restriction had stemmed from simple dishonesty, shame, or indeed, a genuine lack of intent on his part in the incidents concerned in the matter. Following the work he had done with the applicant, Dr de Saxe was certain that there was no issue of simple dishonesty. The applicant had not demonstrated other behaviour which might suggest anti-social personality traits. He observed with difficulty, the applicant had been able to admit that there probably was an unconscious, or partially conscious sexual intent on his part in performing the inappropriate examinations.

Dr de Saxe's opinion was that there might have been powerful feelings of shame experienced by him. He observed he was a very intelligent and thorough person and a very dedicated doctor, hence his lapses were likely to be a source of deep and considerable shame which had earlier rendered it very difficult for him to admit to and think about then.

Dr de Saxe's opinion was that the applicant did not have a genuine seductive intent in respect of the incidents. However, he did not exclude the possibility that the applicant sought to derive a degree of sexual gratification from his dealings with the female patients. Dr de Saxe observed that it was precisely because of his lack of intent to seduce them, that it had been more difficult for him to deal with the latter possibility, namely that, there may have been spur of the moment lapses of control which caused offence to the women.

Dr de Saxe's opinion was that the applicant had gained useful insight into his misconduct which was the subject of complaints. This heightened insight, he observed, would ease his return to practicing medicine again without hindrance. He believed he had significant contrition and had gained extensive insight into his difficulties concerning empathy and boundaries. He said that both he and the applicant had understood that his lack of empathy might have contributed to the applicant's dealings with the women involved in the proceedings.

Dr de Saxe's opinion was that the applicant was exceptionally unlikely to re-offend if allowed to practice again. He believed he would be exceptionally alert to the boundaries he maintained with other people. He would maintain a far greater degree of professional formality than in the past and monitor the interpersonal cues given out by others. He recommended that the applicant continue regular psychotherapy with either himself or another therapist which should be fairly frequent in the early days of returning to practice, for instance, fortnightly, and could be reduced in the months thereafter. He believed that the applicant should return to practice operating either in a group general practice with supervision, or in a general hospital emergency department, or general practice clinic facility.

Asked to comment on the applicant's rehabilitation Dr de Saxe stated:

"My impression is that Mr Litchfield has undergone a significant process of personal rehabilitation over the past few years. Most notably, Mr Litchfield's relationship with his partner, and his move to Queensland to join her, represents an encouraging sign that Mr Litchfield's emotional life has settled. This contracts with the state of his interpersonal life at the time of the matters at hand.

Mr Litchfield has worked consistently in his therapy with me to understand better the processes which led to the original complaint against him, and my observation is that he does have a much increased awareness of himself which will be protective in the future.

Not only will this protect Mr Litchfield's patients, but indeed, himself, from further incidents with the potential to ruin Mr Litchfield's reputation and career.

During the time in which Mr Litchfield has been consulting me, I have been aware of his regular attendance at continuing professional development courses, and he has now completed a degree in pharmacology over the past 3 years. I understand he scored highly in this degree. It is likely that studying for this degree will be very useful in aiding Mr Litchfield's return to medical practice.

...

It is my view that Mr Litchfield's medical knowledge and skills are likely to be such as to enable him to practice competently, given the amount of further training he has done in recent years.

..."

Dr de Saxe's evidence was he did not believe that the applicant was consciously pre-meditatively motivated regarding his conduct. He stated that the applicant never believed that he had deliberately tampered with these women with a sexual motivation. That is different from saying that he accepts that there was some sexual gratification even though the primary motivation was not sexual.

Dr de Saxe's evidence was that he never had any sense that applicant was ever deliberately lying to him. Dr de Saxe's evidence was that where his answers appeared inconsistent from previous Tribunal hearings, that was because of various defence mechanisms that he had in place at the time.

Dr de Saxe accepted that as a result of a combination of Dr O'Brien's sessions, her report and his subsequent consultations with both himself and Dr Barling, that a "watershed" occurred in terms of his understanding and insight.

The Council's evidence

Mr Lynch tendered copies of two additional reports of Dr de Saxe dated 18 February 2009 and 29 July 2009.

Relevantly, Mr Lynch also tendered reports of Dr Linda Mann dated 15 January 2012 and 15 April 2012. Dr Mann is the Director of the Prevocational Education and Training, GP Synergy, which is based in Sydney. Dr Mann's report dealt with the applicant's medical experience prior to deregistration and the educational activities that he had undertaken since deregistration and his competence and readiness to commence work as a general practitioner if re-registered. Dr Mann considered the opinions of the applicant's treating specialists as to supervision, training and suitability to practice if re-registered.

Dr Mann's opinion if the applicant was re-registered read:

"I consider that effective retraining for this applicant would be 12 months in close supervision spread between a teaching hospital and a general practice. The most effective way to achieve this would be for the applicant to have three terms in a supervised JMO position in a Metropolitan teaching hospital and two terms within the Prevocational General Practice Placement Program. This spread of terms is common for Junior Medical Officers within New South Wales. It ensures exposure to acute medicine within the hospital environment and exposure to up-to-date clinical standards. The closeness of the four levels of general practice supervision, which are part of the Prevocational General Practice Placement Program, provides the most careful and graded supervision for this applicant. He would be able to graduate to supervised independent practice with the protection of experienced GP supervision, regular teacher visits from external experience general practitioners, and exposure to teaching both in the hospital and with the Regional Training Provider, which supervises the Prevocational General Practice Programme placements."

Report of Dr Elizabeth O'Brien psychiatrist

As we have already observed Dr O'Brien was retained as an expert by the Council.

Dr O'Brien was not required for cross-examination. Relevantly, in response to questions put to her in writing by the Council, Dr O'Brien's gave the following opinion. It is convenient to set out the majority of her report:

'1.Does the applicant now have genuine insight into the appropriate nature of his conduct which resulted in him being deregistered; and

2.Are there presently any underlying character defects which would make it inappropriate for the applicant to be restored to the Register?

In my opinion, Mr Litchfield has acquired further insight into the appropriate nature of his conduct, particularly the sexual gratification motivation in one case, which resulted in his being deregistered. I do not think, given the fluxion of time and the efforts already expended by Mr Litchfield in this regard, that he is likely to be able to progress further in relation to the remaining cases.

In terms of underlying character defects which would make it inappropriate for the applicant to be restored to the register, I think that Mr Litchfield has made an extensive assessment of his own personality characteristics and the elements of his temperament that have led him to err in terms of boundary violations, insensitive interpersonal interactions and a lack of empathy in regard to the impact of his behaviour on his patients.

3.Your attention is drawn specifically to the following statements made by the applicant:

"I realise at the time of the complaints I was under some stress. I believe I acted too hastily and without proper consideration of appropriate boundaries of behaviour."

In your view, do "stress" or "acting hastily" have any likely role to play in the cause of the misconduct by the applicant?

In the case of JT, Mr Litchfield has come to appreciate that the stress of emotional isolation and loss of significant personal support did lead him to behave in a way towards the patient that was sexually motivated, although it has taken him considerable time and psychotherapeutic work to be able to identify this context.

In the cases of NM, LW and DM, Mr Litchfield has less clarity in regard to the motivation of sexual gratification, but has identified with good effect and appropriately the other deficits in his approach to the examinations of these women. The NM and LW complaints occurred when Mr Litchfield was in a setting dissimilar to his rural practice, under considerable stress in terms of the volume of patients and his own temperament and approach to patients.

In my opinion, stress and acting hastily have, in these two complaints, a role to play in the misconduct of the applicant and these elements have been appreciated and addressed by Mr Litchfield.

...

5.In paragraph 29, the applicant comments that he has done much work in strengthening his boundaries in stressful situations and looking at the aetiology of the complaints and specifically his responsibility in how he initiated and created circumstances that enabled him to take some advantage of the patients. Does the applicant now recognise appropriate professional boundaries and adequately appear to understand his responsibility in creating the circumstances which lead to his misconduct?

Through the years since 1996, when Mr Litchfield categorically denied that he had behaved inappropriately, he has made significant advances, initially in terms of his style of interactions with patients with reference to professional boundaries, and more recently understanding his own personality vulnerabilities. In one complaint Mr Litchfield has identified the contextual elements that contributed to his inappropriately engaging with the patient in a sexual manner and has appreciation and remorse for the trauma occasioned the patient.

6.In paragraph 32, the applicant states that he did not genuinely accept the inappropriateness and harmfulness of his conduct. Does the applicant now genuinely have insight into the improper and unethical nature of his past actions and now recognise the damage his actions caused to his victims?

From approximately 2002, following the initial treatment with Dr Phillips, Mr Litchfield has acquired a more appropriate level of insight and understanding of the harmfulness and inappropriateness of his conduct with these patients and hence has been able to acknowledge and take responsibility for generating their distress and the complaints.

In the case of JT, Mr Litchfield has also been able to realise the contribution of his own isolation and stress towards his making an inappropriate gesture with this patient and is both ashamed and remorseful about the inappropriateness of his behaviour. Mr Litchfield does express remorse and regret for the trauma occasioned all of the patients who complained. Mr Litchfield has put considerable effort into examining the nature of his practice, and identifying both the underlying ethical dimensions necessary to changing his behaviour and the strategies involved to protect his patients and himself and further complaint.

7.Please explore with the applicant his statement that he now understands most of the 2006 Tribunal's concerns.

Mr Litchfield has acknowledged that the inconsistencies in his evidence in the 2006 Tribunal were related to his inability to acknowledge to himself that he had sought sexual gratification in the medical encounters with the complainants. In the case of JT, Mr Litchfield is now able to identify and understand this motivation. In the other cases, while accepting that the patients experienced his behaviour as inappropriate and of a sexual nature, he has been unable fully to identify and comprehend the sexual motivation for his actions. He nonetheless accepts that this is a shortcoming in his memory and understanding, and given the period of time from which the complaints originate, he is in my opinion unlikely further to advance in this area.

8.In relation to paragraphs 33 and 34, please provide your opinion as to the level of understanding the applicant currently has as to the role that his own sexual gratification had in the misconduct. Does the applicant still have difficulty admitting that he sought to derive sexual gratification in his dealings with the complainants?

In relation to paragraphs 33 and 34, I consider Mr Litchfield's comment that he had such difficulty in coming to terms with his own motivation that he denied this to himself and others makes sense psychologically and contributes to understanding the inconsistencies in his evidence to date. (The second query has been addressed above).

9.Please explore with the applicant his comment in paragraph 36 "while I had a legitimate medical purpose in what I was doing I also had a sexual motivation which may also have been influenced by traits in my personality which became exaggerated with fatigue"

In my opinion, this statement goes to the difficulties Mr Litchfield has in separating out his various motivations and his ongoing tendency to conflate the motivations. This clearly could impress as an evasion of responsibility and an effort to minimise the element of sexual gratification that Mr Litchfield acknowledges was present in these examinations. His inability effectively to recall his own stances during these examinations, apart now from that with JT, goes some way to explaining the contradictions inherent in the statement. While on the one hand accepting that sexual motivation was involved in these procedures, he nonetheless continues to maintain that there was a therapeutic element as well. In my opinion, given Mr Litchfield's inability fully to recall his own motivation, this conflation represents an effort to "make sense" of his behaviour given the absence of that actual recall. This particular hiatus in his memory and hence ability to coherently process what he did and why, has remained a difficulty for him throughout the previous hearings.

It is my understanding that Mr Litchfield's reference in paragraph 37 of his statement to "It was not until I realised that absolute agreement with previous findings is not essential that a further door was open to me" indicates he is able to appreciate that he has made some advances in one case, but is not able in all honesty, to understand the other cases since his lack of recall precludes this.

...

12.Please comment on paragraphs 35 and 36 that the applicant previously had difficulties in remembering the details of the complaints but "now had an improved recollection of the events and an understanding of the context in which they occurred". What significance, if any, does the loss of the applicant's memory of the four (4) misconduct incidents, separated by time and involving different patients have when assessing the applicant's current insight?

In regard to Mr Litchfield's comments that he "now had an improved recollection of the events and an understanding of the context in which they occurred", I consider that this is accurate in terms of the complaint from JT, but that the difficulty Mr Litchfield has in recalling the exact details of the other cases does represent a limit to his insight into his motivations. Given Mr Litchfield's inability to remember accurately his motivations in the other complainants' cases, there is a limitation in terms of his insight into those episodes. Overall though, he has accepted that his behaviour was inappropriate, understood that there were elements in his own temperament and behaviour which occasioned distress to his patients and has considered these elements extensively, I do not believe that this represents an impediment to his practicing medicine with a very significantly reduced risk of reoffending.

13.What strategies has the applicant developed to maintain professional boundaries, control his impulses and ensure ethical behaviour?

Mr Litchfield is able to describe at some length the approaches that would ensure better practice in future, in particular recognising the necessity for a sensitive approach to his patients and especially in the area of intimate examinations. These approaches include explanation of the procedures, obtaining consent, avoiding haste and pressuring the patient to accept his interventions prior to their explicit readiness to do so. This may involve Mr Litchfield's seeking to have a chaperone present as it common practice with male practitioners with many female patients, offering a further appointment to pursue those preventative health measures when the patient presents primarily with other complaints, and referring to female practitioners if the patient prefers those elements of her medical care to be undertaken by a female practitioner. Mr Litchfield is now very conscious of his own behaviours and would seek support from a senior colleague/mentor if he identified particular concerns, and would discuss such concerns with a treatment psychologist or psychiatrist.

SUMMARY

Mr Litchfield has gained further insight into the sexual motivation of the behaviours which led to his complaints in at least one case. While unable to elucidate this motivation in the remaining cases, he nonetheless accepts that there was a combination of both sexual gratification seeking on his part compounded by inappropriate interactions with his patients in the manners addressed above.

Mr Litchfield is a poor candidate for discussing his internal psychological processes, often relying on the terminology of his treating therapists and struggling to account for his own introspective processes and subjective understandings. The capacity to introspect and articulate clearly one's internal experiences is a personality characteristic that exists to varying degrees in all people, and in Mr Litchfield's case it is my observation that he would rank quite low on scores that assessed this capacity. This element of his personality in my opinion cases him to present as he has been described, finding it difficult to be coherent and at times appearing obtuse in his efforts to identify these internal psychological processes. Nevertheless, he has shown a tenacity and willingness to gain more skill in this area and to apply it to his own understanding of his temperament, his behaviour and finally to the elements of sexual gratification that he was able to identify in his interactions with one patient.

On the basis of the information that I have been provided by your office and my interviews with Mr Litchfield, I coincide in my opinion with the earlier opinions of Drs Quadrio, Phillips and Klug, that Mr Litchfield is unlikely to reoffend in the future. It remains, with respect, the prerogative of the Tribunal, to determine if Mr Litchfield has satisfied on the balance of probabilities that he is now a fit and proper person to be registered."

Mr Lynch tendered a further report of Dr O'Brien dated 5 March 2012 in which Dr O'Brien stated that having read the reports of the applicant's treating doctors, they did not cause her to alter any of the opinions expressed in her earlier report dated 13 February 2012.

Consideration

The question for determination is whether the standards of the applicant have changed, his character has been reformed and that he will act honourably in the future if readmitted to practice as a medical practitioner. For the reasons that follow, this question should be answered in the affirmative.

The critical difference between these proceedings and the earlier proceedings for reinstatement is that the applicant, as a result of psychotherapy (approximately 175 consultations with Dr de Saxe and three consultations with Dr O'Brien), now can recall his misconduct with JT and LW and accept that it was for sexual gratification and was seriously inappropriate. He now accepts his guilt. The applicant's failure to admit his past misconduct was a significant barrier to the success of his earlier applications. His admissions allow the Tribunal to draw some comfort from the fact that such conduct is unlikely to recur in the future.

It follows that this Tribunal in reaching its conclusion must make findings in respect of the credibility and honesty of the applicant. We have already found that in respect of these proceedings, the applicant was a witness of truth at [63]. This finding is consistent with, in particular, Dr de Saxe and Dr Phillips' opinion that the applicant was honest with them.

Mr Lynch urged us to reject the applicant's evidence raising the following examples as demonstrating a lack of candour. Counsel pointed to the continuing qualification in respect of insight as demonstrated by the applicant insisting in his evidence this his conduct was not motivated in some cases by sexual gratification, but motivated by the purpose of therapeutic treatment of the patients.

Mr Lynch gave by way of example the applicant, taking the pulse of JT during which her hand touched his erect penis and the acupressure points chosen by the applicant in the consultation with LW.

The Tribunal has reviewed the evidence of the applicant, particularly his cross-examination by Mr Lynch. In all cases, there was a therapeutic purpose for each of the patients attending the applicant's surgery. What the applicant did during part of each consultation had a therapeutic purpose. For example, the carrying out of a proper abdominal examination for Patient LW who attended complaining of vomiting, nausea and abdominal cramping, was a therapeutic procedure. Similarly, the taking of JT's pulse after the insertion of the IUD. However, the applicant accepted that there was no therapeutic purpose in placing JT's hand on his erect penis and that he could have chosen alternate acupressure points in respect of LW.

We have earlier observed, as have the experts in their evidence, that the applicant has difficulty in getting to the point in answering questions directly. On many occasions, his answers were confusing, partly due to their length. However, taking into account the total context of his evidence, the applicant unconditionally accepted that he was seeking sexual gratification in respect of JT and LW. He accepted the touching of LW's breasts was not therapeutic.

Our understanding of the applicant's evidence is that he was saying that there was, from a medical perspective, a therapeutic purpose for parts of the various examinations he conducted with the patients. However, in respect to at least three patients, he acknowledged that the purpose of his carrying out certain examinations was for his sexual gratification. In respect of the fourth patient, DM, he conceded, in hindsight, it was probable he sought some sexual gratification during her consultation. She was a first time patient in 1987 and he had little recollection of the consultation. If the conduct with DM was other than momentary, impulsive and aberrant it is likely the applicant would have remembered it.

Understood this way, we reject the contention that the applicant does not have real insight into his conduct.

Mr Lynch also pointed to an answer given by the applicant as to whether he accepted, without qualification, the findings made by the original Tribunal in respect of LW. Counsel referred to the applicant's evidence "I accept the majority of the findings made with respect to LW in a congruent way".

Asked which findings he did not accept, the applicant gave various answers over the following two pages of transcript which Mr Lynch submitted were not responsive to any of the questions he put, leaving the Tribunal in an unsatisfactory position. As we read the applicant's evidence, in response to what findings made by the Tribunal concerning LW he did not accept, the applicant firstly discussed the meaning of the term "sexual gratification", which he had discussed with his treating specialists, before going on to make a distinction between the sexual gratification that he obtained from JT, where his evidence was that he was sexually excited by her, but drew a distinction to not having the same attraction to LW. However, the applicant concluded his answers with this evidence:

"A.No, no. Look I said I agree with the findings of the, I agree with the findings of the 1996 Medical Tribunal.

Q. Why did you say that you accept the majority of them?

A. I wanted to qualify my understanding of obviously it has caused me great shame and I simply wanted to qualify the aspects of sexual gratification in my answer.

Q. You haven't accepted in truth that you were motivated by sexual gratification in your misconduct concerning LW, have you?

A. I have. I have completely."

Later in the cross-examination, the applicant was asked why this Tribunal should accept that he was genuinely sincere when he indicated to the same effect on previous occasions. His evidence was:

"A.I genuinely and it's been unfortunately it's taken a rather long time, but I genuinely did not see initially how my personality traits have contributed as fully as I now do. But even more significantly and this is in particular the last couple of two or three years particularly in the last six to 12 months that I see that, even though I therapeutically still believe I, in most cases, was doing the right thing, that in the process of doing that, unfortunately I sought some gratification from the at least the three former complaints and the fourth patient was a very long time ago as well, in 1987, who I don't have much recollection of.

The point is that I recognise that now it's sincerely recognised that I used the parts aspects of these consultations for some degree of sexual gratification, which I now deeply regret, and I now am I'm sorry, I'm speaking again too much, your Honour."

Q.Please proceed, you are explaining to the tribunal?

A.I just want to say that not only have I have a great sense of empathy for any harm done to the patients but I've and great deal of contrition I also wish to take the opportunity to express my contrition to my dear family and my friends and former colleagues and to the profession for blemishing it. I just feel that I just want to say that."

Having considered all of the applicant's evidence, the Tribunal finds that the applicant has come to terms with his misconduct and that a discernable change has occurred in the applicant since the 1996 hearing and the subsequent hearings. The Tribunal accepts the applicant's evidence and that he has an honest recollection of the incidents.

Mr Lynch acknowledged that the appropriate principles for determining this application were those set out in Zaidi referred to earlier in this decision. Counsel particularly emphasised the observations of the Court of Appeal that in the case of some offences committed over an extended period with deliberate intent and resulting in serious distress to patients, it will be very difficult to contemplate any circumstances in which the name of the offender will be restored to the register.

Mr Lynch observed that the conduct of the three complaints extended over a significant period of time. One occurred in 1987. The second which occurred on the same day in 1987 was not the subject of a formal complaint. Two further incidents occurred in 1992 separated by approximately eight months. Counsel submitted that it was difficult to contradict the characterisation that they were done with deliberate intent in the sense that they were not done accidentally and that the 1996 Tribunal found that they were done for the purpose of sexual gratification.

In our view, the use of the word "deliberate" by the Court of Appeal was directed to intentional, premeditated, fully considered conduct, rather than conduct that was impulsive. The evidence of the applicant, together with that of his medical experts (Dr de Saxe characterised the misconduct as "spur-of-the-moment", impulsivity which was characteristic of patients with borderline personality structure) was that the conduct was impulsive and not premeditated. The 1996 Tribunal's finding was that the conduct engaged in by the applicant was for the purpose of sexual gratification. It did not expressly find that the applicant carried out the acts of misconduct with deliberate intent.

In summary, the previous applications by the applicant for re-registration failed because the applicant continued to assert that his conduct was justified in some way or misinterpreted; he did not accept the seriousness of the conduct; he did not have the required level of insight into his misconduct; he did not have genuine contrition; and he had given untruthful evidence during those hearings and to the police.

It is clear from a consideration of all the evidence that the applicant no longer seeks to justify his position and has come to terms with the misconduct that he engaged in with each of the patients. He has made significant progress in terms of his insight into his misconduct since the 2006 hearing with the assistance of his treating doctors and Dr O'Brien. The issue of insight is and has been of significant concern to this Tribunal.

In February 2012 as a result of his consultations with Dr O'Brien, the applicant was able to recognise the inappropriateness of his conduct with LW and that it was for sexual gratification. This is clearly a further development in respect of his insight. He also accepts that during the consultation with JT he engaged in sexually motivated behaviour and obtained sexual gratification from it. He does not have a clear recollection of what happened during the consultations with DM and NM, but he accepts, given what took place as recounted by the patients, he most probably did obtain some sexual gratification. This represents a significantly different position to what pertained in 2006.

The applicant also has a better understanding of his personality characteristics. It is clear from the evidence that a discernable change has occurred in the applicant in this respect. He displays, according to the medical experts, a number of traits that include impulsiveness, obsessiveness, lack of empathy and boundary issues, although the medical experts were not in agreement as to whether the applicant suffered a personality disorder. They agreed that each of these traits was manageable and "able to be mellowed with appropriate strategies".

The applicant admits and accepts the seriousness of his conduct and its total inappropriateness. The evidence discloses that he has geniune insight into his motivations and his personality characteristics. A significant change has occurred in respect of the applicant's understanding of his misconduct since 2006 which is confirmed by the medical experts and his character referees to which we have had regard.

Having regard to all of the evidence, including the documentary evidence relied upon by the applicant, this Tribunal is satisfied that the applicant has a genuine insight into his misconduct that he did not previously have, and that it is appropriate that the orders sought be made.

The applicant has expressed his deepest and sincere contrition both in his written and oral evidence to not only the patients but his family and friends and to the profession in general. We find he has genuine contrition.

Mr Lynch was also critical of the applicant in that he had received correspondence from the Royal Australian College of General Practitioners in respect of the Quality Improvement and Continuing Professional Development Program, referring to him as "doctor". There is no evidence before this Tribunal that he has held himself out to be a medical practitioner. Nor is there evidence that he has called himself "doctor". He speculated that it was the practice of the College to address any participant in a course as "doctor".

My Lynch also criticised the applicant for failing to provide the six patients that he sought references from in 2000 with the decision of the Court of Appeal and reasons for his deregistration, submitting he was deceptive. The applicant maintained that each of the patients were aware that he was not practicing as a doctor at the time he approached them. He subsequently provided each of the patients with the relevant decisions.

The Tribunal finds that given the substantial and genuine insight that the applicant has into his misconduct, his greater maturity, his settled personal life with a supportive partner, and the deep thought he has given as to strategies he would adopt in future practice (such as obtaining informed consent, not undertaking certain procedures, referring patients, the need for a chaperone), and his clear understanding that this is his last chance to practice medicine, that there is very little risk that the applicant will re-offend. His standards have changed and in the Tribunal's view, the applicant now understands and can assess how he must conduct himself as a member of the honourable profession of medicine.

The four medical experts were similarly unanimous in that there was little risk of the applicant re-offending stating as follows:

Dr Phillips

"I believe his chance for re-offending will be very low."

Dr Barling

"Mr Litchfield is a very low risk of re-offending."

Dr de Saxe

"Mr Litchfield is exceptionally unlikely to re-offend."

Dr O'Brien

"Mr Litchfield is unlikely to re-offend."

In respect of Dr O'Brien's assessment, this was made prior to the applicant's complete acknowledgement of his misconduct in respect of LW.

The Tribunal is mindful that there was no criticism of the applicant's clinical skills and over the past few years he has been dedicated to building up his medical skills by completing a Bachelor in Pharmaceutical Science Degree. He has also and maintained his continuing education program.

However, the applicant has not practiced medicine for the over 15½ years.

Matters such as this are inevitably finely balanced. This Tribunal has had the advantage of being assisted during this hearing by two experienced medical practitioners, and a community member who has chaired Professional Standards Committees for over ten years. It must be said their experience has been most helpful in respect of determining this matter and in determining what conditions should be imposed upon the applicant.

Upon consideration of all the evidence, the Tribunal is satisfied, consistently with the need to protect the public and with the need to protect the medical profession, that it is no longer appropriate that the previous orders remain in force. We find firstly, that the applicant has overcome the defects in his character. Secondly, the applicant is now of good character and fit and proper to be held out to the rest of the profession, to patients and the whole of the community as a person worthy of confidence and trust. In making these findings we are mindful that the relevant time to determine such matters is at the date of the hearing: A Solicitor v Council of the Law Society of New South Wales [2004] HCA 1; (2004) 216 CLR 253 (at [21]).

In the event that the Tribunal reached this conclusion, Mr Lynch proposed certain conditions should be imposed on the applicant's registration. With some modification, based on the views of the members of the Tribunal, and the evidence of the medical experts, including Dr Mann, we determine that the conditions set out in Annexure A to this decision should be imposed upon the applicant's registration.

Orders

1.The Tribunal finds that Bruce Desmond Litchfield is a fit and proper person to practice as a registered health practitioner in accordance with the provisions of the Health Practitioner Regulation National Law (NSW).

2.The Tribunal orders that the name of Bruce Desmond Litchfield be reinstated to the Register of Medical Practitioners kept under the Health Practitioner Regulation National Law (NSW).

3.Pursuant to s 149A(1)(b) of the Health Practitioner Regulation National Law (NSW) the Tribunal orders that Bruce Desmond Litchfield's registration be subject to the conditions set out in Annexure A.

4.The Tribunal orders that the applicant pay the costs of the Medical Council of New South Wales.

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ANNEXURE A

Practice Conditions

A.To practise only in a public hospital approved by the Medical Council of New South Wales and accredited for Prevocational Training to a position at Post Graduate Year 2 Level and only under direct/immediate supervision, of an on-site, senior colleague at all times. This supervision is to be Level 1 supervision (as detailed in the Medical Council's guidelines). This condition is to remain in force for a minimum period of 12 months.

B.To nominate a clinical supervisor for approval by the Council and to authorise this supervisor to provide reports, in a format approved by the Council, on a monthly basis. This supervisory arrangement is to remain in place for a minimum period of 12 months, with the supervision period being extended, if upon consideration of the supervision reports received, the Council deems such extension necessary.

The registrant is to:

a)To meet with the clinical supervisor on a weekly basis.

b)To provide the approved clinical supervisor with a copy of the Council's Supervision Guidelines and a copy of this Decision and these Orders.

c)To authorise the clinical supervisor to inform the Council immediately if there is any concern in relation to his compliance with the supervision requirements, compliance with other conditions of registration, clinical performance, or if the supervisor relationship ceases.

d)In the event that the approved supervisor is no longer willing or able to provide the supervision required, to forward the details of a replacement supervisor for approval by the Council within 21 days of the cessation of the original supervisory relationship.

e)To bear responsibility for any costs incurred in meeting this condition.

C.Subject to satisfactory reports, at the conclusion of a period of 12 months working in a public hospital, Mr Litchfield may seek the approval of the Council to be employed in an accredited teaching general practice (accredited by the RACGP). The group practice must be comprised of a minimum of three doctors.

D.Mr Litchfield is to inform the Council within 14 days of such employment the name of an accredited supervisor in the practice.

E.The accredited supervisor is to provide a report to the Council in respect of Mr Litchfield after three months employment and again after six months employment. Mr Litchfield is to be employed in an accredited teaching general practice for a minimum of six months. Should he wish to change his employment within the period of six months, he is to seek the approval of the Council to work in an alternate accredited teaching general practice.

F.This supervisory arrangement is to remain in place for a minimum period of six months, with the supervision period being extended, if upon consideration of the supervision reports received, the Council deems such extension necessary.

G.To attend for treatment by a psychiatrist of his choice, initially once per week for the first three months of employment and then at a frequency to be determined by the treating psychiatrist. He is to advise the Council within 14 days of this decision the name of the psychiatrist.

H.The Medical Council of New South Wales is the appropriate review body for the purposes of Division 8 of Part 8 of the Health Practitioner Regulation National Law (NSW).

However, should Mr Litchfield seek to change or remove any of the conditions imposed as a result of this Tribunal's orders when his principal place of practice is anywhere in Australia other than in New South Wales, sections 125 to 127 inclusive of the Health Practitioner Regulation National Law are to apply, so that a review of these conditions can be conducted by the Medical Board of Australia.

Decision last updated: 09 May 2012

Medium Neutral Citation:	Litchfield v Medical Council of New South Wales [2012] NSWMT 8
Hearing dates:	23 - 24, 26 April 2012
Decision date:	03 May 2012
Before:	Staff J; Dr V de Carvalho; Dr H Pedersen; Ms G Ettinger
Decision:	1.The Tribunal finds that Bruce Desmond Litchfield is a fit and proper person to practice as a registered health practitioner in accordance with the provisions of the Health Practitioner Regulation National Law (NSW). 2.The Tribunal orders that the name of Bruce Desmond Litchfield be reinstated to the Register of Medical Practitioners kept under the Health Practitioner Regulation National Law (NSW). 3.Pursuant to s 149A(1)(b) of the Health Practitioner Regulation National Law (NSW) the Tribunal orders that Bruce Desmond Litchfield's registration be subject to the conditions set out in Annexure A. 4.The Tribunal orders that the applicant pay the costs of the Medical Council of New South Wales.
Catchwords:	Application for re-registration following deregistration for professional misconduct in 1996 - finding applicant now of good character and fit and proper person - finding that applicant has genuine insight - Tribunal satisfied no relevant risk of recurrence of professional misconduct - finding that significant changes occurred in applicant's character - finding applicant has overcome flaws of character - application for reinstatement order granted with conditions - costs
Legislation Cited:	Health Practitioner Regulation National Law (NSW)
Cases Cited:	A Solicitor v Council of the Law Society of New South Wales [2004] HCA 1; (2004) 216 CLR 253 Council of Law Society of New South Wales v Foreman (1994) 34 NSWLR 408 Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448 Health Care Complaints Commission v Dr Bruce Desmond Litchfield (Medical Tribunal of New South Wales, 15 November 1996, unreported) In the matter of Bruce Litchfield (Medical Tribunal of New South Wales, 16 June 2003, unreported) Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 In the Matter of Mansour Hassad Zaidi and The Medical Practice Act 1992 as amended (29 August 1996, unreported) Re Bruce Litchfield [2006] NSWMT 3 Re Mansoor Haider Zaidi [2006] NSWMT 6 Zaidi v Health Care Complaints Commission [1998] NSWSC 335; (1998) 44 NSWLR 82
Category:	Principal judgment
Parties:	Bruce Desmond Litchfield (Applicant) Medical Council of New South Wales (Respondent)
Representation:	Counsel: Mr TJ Rickard (Applicant) Mr M Lynch (Respondent) Solicitors: Crown Solicitor's Office (Respondent)
File Number(s):	40017 of 2011
Publication restriction:	Pursuant to Sc 5D cl 7 of the Health Practitioner Regulation National Law the Tribunal has ordered that there be no publication of the name of any patient or of any material capable of identifying any patient