MEDICAL BOARD OF AUSTRALIA and VEETTILL - [2015] WASAT 124

JURISDICTION : STATE ADMINISTRATIVE TRIBUNAL

ACT: HEALTH PRACTITIONER REGULATION NATIONAL LAW (WA) ACT 2010

CITATION: MEDICAL BOARD OF AUSTRALIA and VEETTILL [2015] WASAT 124

MEMBER: JUSTICE J C CURTHOYS (PRESIDENT)
MS C WALLACE (MEMBER)
DR K JEFFERIES (SENIOR SESSIONAL MEMBER)

HEARD: 12 AND 13 AUGUST 2015

DELIVERED : 6 NOVEMBER 2015

FILE NO/S: VR 66 of 2015

BETWEEN: MEDICAL BOARD OF AUSTRALIA
Applicant
AND
PREMANANDAN VAYAL VEETTILL
Respondent

Catchwords:

Medical practitioner - National Law - Sexual conduct - Professional misconduct - Improper access to patient's records - Unsatisfactory professional performance

Legislation:

Health Practitioner Regulation National Law (WA) Act 2010, s 5, s 39, s 196(2)

Result:

Respondent found to have engaged in professional misconduct

Summary of Tribunal's decision:

The Medical Board of Australia filed an application seeking orders pursuant to s 196(2) of the Health Practitioner Regulation National Law (WA) Act 2010, including that the registration of Dr Premanandan Vayal Veettill be suspended for a period to be determined by the Tribunal, or that Dr Veettill's registration as a medical practitioner under the National Law be cancelled.
The Board's allegations against Dr Veettill were that he engaged in professional misconduct and/or unprofessional conduct and/or unsatisfactory professional performance as defined in s 5 of the National Law arising out of his conduct with a Patient.
Dr Veettill's contact with the Patient arose on 10 March 2013 as a result of a doctor/patient relationship. Following that date, Dr Veettill made contact with the patient through numerous telephone calls and visits to her home. On 30 May 2014, Dr Veettill made contact with the Patient and visited her in her home. While in the Patient's home on 30 May 2014, he sexually assaulted her.
The Tribunal found that:
1) Dr Veettill acted in breach of his professional boundaries in relation to the Patient and acted contrary to 'Good Medical Practice: A Code of Conduct for Doctors in Australia';
2) the circumstances of Dr Veettill's conduct in breaching professional boundaries amounts to unsatisfactory professional performance;
3) Dr Veettill engaged in professional misconduct by sexual misconduct; and
4) Dr Veettill acted contrary to 'Sexual Boundaries: Guidelines for Doctors'.

Category: B

Representation:

Counsel:

Applicant: Mr J Prior
Respondent: Mr P Yovich

Solicitors:

Applicant: Moray and Agnew
Respondent: Panetta McGrath Lawyers

Case(s) referred to in decision(s):

Briginshaw v Briginshaw (1938) 60 CLR 336
Health Care Complaints Commission v Bours (No 1) [2014] NSWCATOD 113
Medical Board of Western Australia and Bham [2006] WASAT 190
Medical Board of Western Australia and Wright [2010] WASAT 48

REASONS FOR DECISION OF THE TRIBUNAL:

Introduction

On 26 March 2015, the Medical Board of Australia (the Board) filed an application (Application) seeking orders, pursuant to s 196(2) of the HealthPractitioner Regulation National Law (WA) Act 2010 (the National Law), including that the registration of Dr Premanandan Vayal Veettill (Dr Veettill) be suspended for a period to be determined by the Tribunal, or that Dr Veettill's registration as a medical practitioner under the National Law be cancelled.
During the relevant period, Dr Veettill was employed by Royal Perth Hospital (RPH). He also worked for Australian Locum Medical Service (ALMS) on an afterhours basis.
ALMS instructed Dr Veettill to visit a patient (the Patient) at her home on 10 March 2013.
The allegations arise from interactions between Dr Veettill and the Patient following Dr Veettill's initial visit to the Patient's home on 10 March 2013. The allegations by the Board relate to Dr Veettill's conduct post 10 March 2013.
The Board's allegations against Dr Veettill (Application [10]), are that he engaged in professional misconduct and/or unprofessional conduct and/or unsatisfactory professional performance as defined in s 5 of the National Law in that he:
a.breached professional boundaries when, without clinical reason, in that he:
i. telephoned the Patient on numerous occasions;
ii.attended the Patient's home; and
iiimet the Patient for coffee;
b.engaged in sexual misconduct when, on 30 May 2014, he:
i.asked the Patient to take her top and bra off;
ii.examined the Patient's left breast;
iii.put his left ear to the Patient's chest, in between her breasts;
iv.fondled and groped the Patient's breasts with his hands;
v.kissed the Patient's breasts and nipples; and
vi.groped the Patient's breasts and torso;
c.acted contrary to:
i.Good Medical Practice: A Code of Conduct for Doctors in Australia (July 2010 and 17 March 2014); and/or
ii.Sexual Boundaries: Guidelines for doctors (28 October 2011).

Professional misconduct

The term 'professional misconduct' is defined in s 5 of the National Law as conduct which includes:
(a)unprofessional conduct by the practitioner that amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; and
(b)more than one instance of unprofessional conduct that, when considered together, amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; and
(c)conduct of the practitioner, whether occurring in connection with the practice of the health practitioner's profession or not, that is inconsistent with the practitioner being a fit and proper person to hold registration in the profession[.]
The first and second limbs of the definition of 'professional misconduct' incorporate the term 'unprofessional conduct' which is in turn defined in s 5 of the National Law as:
[P]rofessional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner's professional peers[.]
This definition includes the various matters identified in subparagraphs (a) to (h) of that definition.
The relevant authorities are set out in the reasons for decision of Health Care Complaints Commission v Bours (No 1) [2014] NSWCATOD 113:
524Interpretation of the legislation is assisted by the body of common law in the area of professional disciplinary matters. The classic common law definition of professional misconduct derives from Allinson v General Counsel of Medical Education and Registration (1894) 1 QB 755, namely:
[Conduct] which could be reasonably regarded as disgraceful or dishonourable by his professional brethren of good repute and competency.
525The essence of this definition was restated by Priestley JA in Qidwai v Brown (1984) 1 NSWLR 100 at 105:
... whether the practitioner was in such breach of the written or unwritten rules of the profession as would reasonably incur the strong reprobation of professional brethren of good repute and competence[.]
…
527Contemporary cases involving unsatisfactory professional conduct and professional misconduct primarily consider the wording of the relevant statute rather than the considerations of moral condemnation found in earlier decisions, expressing their views 'in terms of strong criticism'. (Lucire v Health Care Complaints Commission [2011] NSWGA 99 at 84; Donnelly v Health Care Complaints Commission (NSW) [2011] NSWSC 705).

Unsatisfactory professional performance

The term 'unsatisfactory professional performance' is defined in s 5 of the National Law as meaning:
[T]he knowledge, skill or judgment possessed, or care exercised by, the practitioner in the practice of the health profession in which the practitioner is registered is below the standard reasonably expected of a health practitioner of an equivalent level of training or experience[.]

Section 39 of the National Law – Guidelines

The Board has developed 'Sexual Boundaries: Guidelines for doctors' under s 39 of the National Law as in force in each state and territory.
Those guidelines complement 'Good Medical Practice: A Code of Conduct for Doctors in Australia' (Good Medical Practice) which were also developed under s 39 of the National Law. The Sexual Boundaries guidelines state:
Section 1.4 of Good Medical Practice states:
'Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively. They must be ethical and trustworthy.'
'Patients trust their doctors because they believe that, in addition to being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients also rely on their doctors to protect their confidentiality.'
Section 8.2 of Good Medical Practice states:
'Professional boundaries are integral to a good doctor-patient relationship, patients and protect both parties. Good medical practice involves:
• maintaining professional boundaries
•never using your professional position to establish or pursue a sexual, exploitative or other inappropriate relationship with anybody under your care. This includes those close to the patient, such as their carer, guardian or spouse or the parent of a child patient
•avoiding expressing your personal beliefs to your patients in ways that exploit their vulnerability or that are likely to cause them distress.'
…
3.Understanding and defining sexual boundaries
Sexual misconduct covers a range of inappropriate professional behaviours including sexualised behaviour, sexual exploitation or abuse, entering into a sexual relationship, and sexual assault. Criminal offences will be investigated by the police.
Sexual Misconduct
Under mandatory reporting requirements practitioners, employers and education providers must report 'notifiable conduct' which includes engaging in sexual misconduct in connection with the practice of the profession. Refer to section 10 of these guidelines for more information.
Sexual misconduct includes:
•      engaging in sexual activity with:
-a current patient regardless of whether the patient consented to the activity or not
-a person who is closely related to a patient under the doctor's care
-a person formerly under a doctor's care
•      making sexual remarks, touching patients or clients in a sexual way, or engaging in sexual behaviour in front of a patient.
In managing sexual boundaries a doctor should be aware that:
•      sexualised behaviour includes any words or actions that might reasonably be interpreted as being designed or intended to arouse or gratify sexual desire
•      sexual exploitation or abuse includes sexual harassment or entering into a sexual relationship
•      sexual harassment is unwelcome behaviour of a sexual nature including, but not limited to, gestures and expressions. The doctor's intention in behaving in this way does not minimise the seriousness of the behaviour. However, if they intended to offend, humiliate or intimidate the patient, then the behaviour would be regarded even more seriously. Sexual harassment includes:
(a)making an unsolicited demand or request, whether directly or by implication, for sexual favours
(b)irrelevant mention of a patient's or doctor's sexual practices, problems or orientation
(c)ridicule of a patient's sexual preferences or orientation
(d)comments about sexual history that are not relevant to the clinical issue
(e)requesting details of sexual history or sexual preferences not relevant to the clinical issue
(f)conversations about the sexual problems or fantasies of the doctor
(g)making suggestive comments about a patient's appearance or body.
•      inappropriate disrobing or inadequate draping for a physical examination, and conducting intimate examinations without adequate prior explanation (and thus without informed consent) may be considered a breach of sexual boundaries
•      sexual assault ranges from physical touching (or examination without consent) to rape and is a criminal offence that should be investigated by the police
•      a sexual relationship describes the totality of the relationship between two people, when the relationship has some sexual element, including any sexual activity between a doctor and their patient. This is the case whether or not the sexual relationship was initiated by the patient.
4.Why breaching sexual boundaries is unethical and usually harmful
A breach of sexual boundaries is unethical and unprofessional because it exploits the doctor-patient relationship, undermines the trust that patients (and the community) have in their doctors and may cause profound psychological harm to patients and compromise their medical care. '
Power imbalance
The doctor-patient relationship is inherently unequal. The patient is often vulnerable. In many clinical situations, the patient may depend emotionally on the doctor. It is an abuse of this power imbalance for a doctor to enter into a sexual relationship with a patient.
Trust
Trust is the foundation of a good doctor-patient relationship. Patients need to trust that their doctors will act in their best interests. It is a breach of trust for a doctor to enter into a sexual relationship with a patient. This breach of trust may impact on that patient's (or other patients') ability to trust other doctors.
Loss of objectivity
A sexual relationship, even if the patient is a consenting adult, may impair the doctor's judgement and compromise the patient's care[.]

Onus and standard

The Board bears the onus of proof. It is to the civil, not criminal standard, but the principles of Briginshaw v Briginshaw (1938) 60 CLR 336 (Briginshaw) apply. That is, while needing to be proved only on the balance of probabilities, the nature and seriousness of the allegations are relevant to the question whether the issues are proved to the reasonable satisfaction of the Tribunal and the process by which reasonable satisfaction is attained.
By reason of the nature of the allegations, the Tribunal must feel an actual persuasion of the occurrence or existence of the relevant facts in determining whether or not the case against the practitioner is made out: Medical Board of Western Australia and Wright [2010] WASAT 48 at [31]; and see Medical Board of Western Australia and Bham [2006] WASAT 190 at [44].

The Board's allegations of fact and Dr Veettill's Response:

On 16 June 2015, the Board filed its statement of issues, facts and contentions (Board SIFC).
Dr Veettill filed his response to the Board SIFC on 10 July 2015 (Dr Veettil's Response).
The Board's allegations of fact as set out in the Board SIFC and Dr Veettill's Response are set out below.
The Board alleges that:
1.The Applicant is established pursuant to section 31 of the National Law and has the functions referred to in section 35 of the National Law, including the referral of matters concerning registered health practitioners to responsible tribunals in participating jurisdictions.
2.The Respondent was during the period 10 March 2013 to 6 June 2014 a registered medical practitioner with general registration pursuant to the National Law.
3.The Respondent was employed by Royal Perth Hospital (RPH) during the Relevant Period.
4.The Respondent was employed as at 10 March 2013 at the Australian Locum Medical Service (ALMS) on an after-hours basis.
5.On 10 March 2013, the Respondent was instructed by ALMS to attend upon the Patient at her home.
6.On 10 March 2013, the Respondent attended the Patient's home and provided medical care to the Patient.
7.Other than on 10 March 2013, the Respondent was not the Patient's general practitioner or treating practitioner.
8.Other than his attendance on the Patient on 10 March 2013, the Respondent had no professional or clinical reason to contact the Patient.
9.During the Relevant Period, the Respondent made 17 telephone calls to the Patient.
Dr Veettill admits paragaphs 1 9.
The Board alleges that:
10.During the Relevant Period, the Respondent visited the Patient at her home on at least two occasions.
Dr Veettill's response is [F10]:
[T]he Respondent admits that he visited the Patient at her home on or around 2 March 2014 and 30 May 2014. The Respondent says further that the visits he made to the Patient on those occasions were in the context of a social relationship which he had developed with the Patient outside of a therapeutic relationship.
The Board alleges that:
11.On or around 30 May 2014, the Respondent:
(a) telephoned the Patient and stated that he had some test results to give her from RPH;
(b)met the Patient at a coffee shop in West Perth;
(c)told the Patient he wanted to refer her to a sleep clinic;
(d)asked to see the Patient that evening; and
(e)arranged to, and subsequently visited, the Patient at her home that evening.
Dr Veettill's response is [F11]:
[T]he Respondent:
(a)admits that he telephoned the Patient on or around 30 May 2014;
(b)denies that he stated that he had some test results from RPH to give to the Patient;
(c)admits that he met the Patient at a coffee shop in West Perth;
(d)denies that he told the Patient he wanted to refer her to a sleep clinic;
(e)denies that he asked to see the Patient on the evening of 30 May 2014 and says further that the Patient suggested they meet in the evening to discuss the potential sale of a property by the Patient to the Respondent; and
(f)admits that he visited the patient at her home on the evening of 30 May 2014.
The Board alleges that:
12.At the Patient's home on 30 May 2014:
12.1the Respondent and the Patient discussed the Patient's health issues and other unrelated matters;
12.2the Patient informed the Respondent that she had pain in her heart and chest;
12.3the Respondent:
(i)said words to the effect of 'Let's have a look';
(ii)asked the Patient to lie on the floor; and
(iii)asked the Patient to remove her top and bra;
12.4the Patient removed her top and bra and laid down on the floor on her back;
12.5the Respondent:
(i)laid down next to the Patient;
(ii)moved the Patient's left arm above her head;
(iii)examined the Patient's left breast;
(iv)told the Patient the examination was normal;
(v)put his left ear to the Patient's chest, in between her breasts, and told the Patient he was trying to hear her heartbeat;
(vi)fondled and groped the Patient's breasts with his hands; and
(vii)kissed the Patient's breasts and nipples;
12.6the Patient stated 'No, no, no';
12.7the Respondent stood and stated words to the effect of' 'Come and sit in the chair', to which the Patient stated 'No';
12.8the Respondent:
(i)pulled the Patient over to a chair;
(ii)sat the Patient on his lap; and
(iii)groped the Patient's breasts and torso;
12.9the Patient repeatedly stated words to the effect of 'No" and 'What are you doing?'; and
12.10the Respondent stopped and the Patient asked him to leave.
Dr Veettill's response is [F12]:
[T]he Respondent:
(a)admits that he discussed the Patient's health issues in a general manner with the Patient and says further that, at that time, the Patient enquired about whether a referral for a sleep study, as suggested by her psychiatric counsellor, was required and requested that he provide her with a referral to a sleep clinic; and
(b)otherwise denies the allegations occurred in paragraph 12 in their entirety.
The Board alleges that:
13.On 18 June 2014, the Applicant took immediate action by imposing conditions on the Respondent's general registration under section 156 of the National Law.

Dr Veettill admits paragraph 13.
The Board's contentions are as follows:
1.It is contended that the Respondent by his conduct in paragraphs 9 and 10 of the Facts acted in breach of his professional boundaries in relation to the Patient.
2.It is contended that the Respondent by his conduct in paragraphs 9 and 10 of the Facts engaged in professional misconduct, alternatively unprofessional conduct, alternatively unsatisfactory professional performance as defined in section 5 of the National Law.
3.It is contended that by his conduct in paragraphs 11 and 12 of the Facts the Respondent engaged in sexual misconduct.
4.It is contended that by his conduct in paragraphs 11 and 12 of the Facts the Respondent has engaged in professional misconduct, alternatively unprofessional conduct, alternatively unsatisfactory professional performance as defined in section 5 of the National Law.
5.It is contended that the Respondent by his conduct in paragraphs 9 and 10 and/or 11 and 12 acted contrary to Good Medical Practice: A Code of Conduct for Doctors in Australia (July 2010 and 17 March 2014).
6.It is contended that the Respondent by his conduct in paragraphs 9 and 10 and/or 11 and 12 acted contrary to Sexual Boundaries: Guidelines for doctors (28 October 2011).
7.It is contended that by the sum of his conduct in paragraphs 9 and 10 and 11 and 12 the Respondent engaged in professional misconduct as defined by section 5 of the National Law.
Dr Veettill denies each of the Board's contentions.

The evidence

The Patient and Dr Veettill provided written statements, gave oral evidence and were crossexamined.
The Board's case relied primarily on the evidence of the Patient.
Exhibits A K were tendered in evidence.

Common ground

It is common ground that:
a)the first interaction between the Patient and Dr Veettill was when he attended her home on 10 March 2013;
b)on that occasion Dr Veettill attended as a medical practitioner;
c)excluding the three calls of 10 March 2013, Dr Veettill telephoned the Patient's mobile number on 28 occasions;
d)excluding the three calls of 10 March 2013, 11 of those calls lasted 11 seconds or less;
e)Dr Veettill made the post 10 March 2013 calls on 10 different days from 11 March 2013 to 2 June 2014 inclusive: 11, 12 and 14 March 2013; 15 and 16 April 2013; 7 May 2013; 2 and 3 March 2014; 30 May 2014; and 2 June 2014;
f)Dr Veettill did not necessarily speak to the Patient on each of the occasions on which he telephoned the Patient's number, particularly when the calls were 11 seconds or less;
g)on two of those days, 14 March 2013 and 7 May 2013, Dr Veettill made single calls lasting eight seconds and 11 seconds respectively;
h)substantive calls were made on eight days;
i)on 2 March 2014, Dr Veettill accessed the RPH computer to look at the Patient's medical records. He printed those records out (Exhibit B, NR2) and provided them to the Patient at a later date;
j)Dr Veettill did not access the RPH records pursuant to a doctor/patient relationship; and
k)on 30 May 2014, Dr Veettill:
i)met with the Patient at a coffee shop near an apartment owned by her;
ii)telephoned her on a number of occasions; and
iii)attended at her home that evening and there was physical contact between them.

Primary matters in issue

The primary matters in issue relating to the alleged sexual conduct by Dr Veettill are:
a)What was the nature of the relationship between Dr Veettill and the Patient after 10 March 2013?
b)How many times did Dr Veettill visit the Patient's home?
c)Did Dr Veettill behave in a manner that was sexually inappropriate towards the Patient and did he engage in sexual contact towards her?
Dr Veettill conceded that if the Tribunal substantially or entirely accepted the Patient's evidence of the interaction between her and Dr Veettill on 30 May 2014, then that interaction would constitute professional misconduct, whether or not a doctor-patient relationship existed.
The primary issue relating to Dr Veettill's access to the Patient's RPH records is how should the conduct be characterised as professional misconduct, unprofessional conduct or unsatisfactory professional performance?

Some background information

Until about 30 June 2013, the Patient had been employed by a resort company in the sale of vacation credits (T: 14 15).
The Patient also owned an apartment in the city which she let for shortterm accommodation (T: 15).
The Patient had business cards (Exhibit F, PV2; Exhibit G) for her short term accommodation business. She used those business cards only for the short term business accommodation (T: 15).
The Patient suffered from severe back pain from time to time.
On 9 March 2013, Dr Abolarinwa, another locum from ALMS, had attended at the Patient's home and treated her for severe back pain (Exhibit A, page 51; Exhibit B [4]).

10 March 2013

On 10 March 2013, at some time prior to 10 pm, the Patient placed a call to ALMS because her severe back pain had still not resolved (Exhibit B [5]). ALMS instructed Dr Veettill to attend the Patient's home (Exhibit F [20]).
On his way to the Patient's home, Dr Veettill called the Patient's mobile number three times. Each of the calls was of very short duration: 11 seconds, 36 seconds and 6 seconds (Exhibit D).
It is apparent from the fact that Dr Veettill was able to call the Patient on his way to treat her that he must have received the Patient's mobile number from ALMS.
The Patient's evidence was that Dr Veettill rang to advise who he was and that he would be there shortly (T: 22; Exhibit B [10]). Dr Veettill's evidence was to the same effect (Exhibit F [23] [25]). The Patient also said that during these telephone calls, she told Dr Veettill that the front door was unlocked, to come right in, and that her bedroom was immediately to the right (Exhibit0B_0[11]; T: 24). Dr Veettill denied this.
The Patient's evidence is that when she was lying on her queen size bed (Exhibit B [13]; T: 25), she heard Dr Veettill at the front door and called him in (Exhibit B [12]). Dr Veettill's evidence is that the Patient opened the front door when he rang the bell (Exhibit G [26] [30]). Dr Veettill's evidence is that after opening the door for him, the Patient sat on the edge of her bed (Exhibit F [30]).
The Patient's evidence was that she was in pain (Exhibit B [5]).
Dr Veettill's evidence is that he 'could immediately see from [the Patient's] demeanour and facial expression that she was in severe pain' (Exhibit F [27]).
Dr Veettill asked the Patient about her back pain. He asked her to stand up while he examined her (Exhibit B [15] [16]; T: 25).
Dr Veettill accepted that on 10 March 2013, the Patient was complaining of severe back pain. He denied that the patient was physically incapacitated (T: 115).
The ALMS Patient Treatment Report (the Report) completed by Dr Veettill is that the Patient 'had difficulty in bending and had muscle spasms' (Exhibit F [32]). The Report, under the heading 'record of examination findings' states 'Muscles Tender, Specific, Can't Bend, No spinal tenderness, Nil Neurology …' (Exhibit A, page 12).
The Patient's evidence is that Dr Veettill gave her an injection in her buttocks and a tablet for her back pain (Exhibit B [19]).
Dr Veettill accepted that he gave the patient an injection but denied that he gave her a tablet (T: 116).
The Report records that Dr Veettill injected 'Morphine 10 Mg IM'.
Dr Veettill's evidence is that he administered an injection of Diazepam, rather than morphine, to relieve the muscle spasms (Exhibit F [33]; T: 142).
Dr Veettill stated that he made an error in the Report when he entered morphine rather than Diazapam. He said that he corrected the Report in about June 2014. He did so after checking the Report against the separate record of scheduled drugs (T: 142 144).
Dr Veettill denied that he changed the record because of the nature of the complaint that had been made by the Patient (T: 144).
It is of concern that Dr Veettill waited until after the complaint had been made by the Patient to correct the Report.
The Patient's evidence is that she was in pain, tired and drowsy after receiving the medication (Exhibit B [26]).
It is clear from the evidence of both parties that when Dr Veettill attended on 10 March 2013, the Patient was in severe pain. The fact that the locum's attendance on the previous day was unable to resolve the pain, suggests that the Patient had experienced pain for an extended period of time. The Patient's evidence that she was in pain, tired and drowsy after the injection is consistent with the objective facts.
The Patient's evidence is that after giving her the injection, Dr Veettill told her that he needed to stay to monitor her (Exhibit B [20]). He then walked to the other side of the bed and lay down beside the Patient without seeking the Patient's permission (Exhibit B [21]). The Patient's evidence is that she was uncomfortable that Dr Veettill did this.
Dr Veettill's evidence is that he did not lie on the bed but that he sat on the edge of the bed at the Patient's invitation and that he waited about 5 minutes after administering the injection (Exhibit G [36] and [38]).
There was some conversation between them (Exhibit B [22] [27]; T: 26 27). Dr Veettill's evidence is that the Patient was very talkative. His evidence was that she had a business which provided 'world class accommodation in multiple cities around the world if you paid a membership sum in advance' (Exhibit F [41]).
The Patient denied that she discussed her work or her business with Dr Veettill on 10 March 2013. She said that she was sick at that time (T: 28 29). She did admit that she discussed her work in general terms on a later date.
Dr Veettill's evidence was that the Patient escorted him to the front door, then went back to get her business card and invited him to contact her if he was interested (Exhibit F [40] [47]).
The Patient's evidence is that she remained in her bedroom throughout Dr Veettill's visit. She did not show him out (T: 20 21).
Dr Veettill's evidence was that the Patient gave him the card and said 'If you are interested in my accommodation scheme give me a ring' (Exhibit F [41] [41]; T: 111, 116).
The Patient denied that she gave Dr Veettill a copy of her business card at the end of his visit on 10 March 2013 (Exhibit G). She explained that her business cards were lying on the dining table at her house. She denied that she got off her bed to give him a business card. She explained that the reason that she had rung for a doctor in the first place was because she was unable to walk.
The Patient denied that she told Dr Veettill that he should contact her if he was interested in the accommodation scheme. She also denied that the calls he made to her in the following days were to discuss these matters (T: 40 41).
The Patient denied that she gave Dr Veettill her telephone number. She denied that she had given him any of her personal contact details (T: 29).
Dr Veettill's evidence that the Patient went to the front door with him and returned to get a business card is premised on the fact that there was an attempt by the Patient to sell vacation credits to him.
The Patient called ALMS because she was in some pain. She was given an injection of Diazepam. Given the patient's physical condition, it is implausible that she would have attempted to persuade Dr Veettill to purchase vacation credits.
There was no reason for the Patient to have given Dr Veettill her business card so that he had her telephone number. Dr Veettill already had her number. He had rung her three times that evening.
Further, the business card (Exhibit G) did not relate to the vacation credit scheme, so it made no sense to give it to him.
Where the evidence of the Patient and Dr Veettill conflicts, the Tribunal prefers the evidence of the Patient as to the events of 10 March 2013.

The phone records 11 March to 7 May 2013

The phone records (Exhibit D) show that Dr Veettill called the Patient on seven occasions between 11 March 2013 and 7 May 2013. The calls on 14 March 2013 and 7 May 2013 can be discounted because they were of 8 and 11 seconds respectively. There were two calls on 16 April 2013. Therefore there were four separate days on which Dr Veettill and the Patient spoke in this period. In addition to Dr Veettill calling the Patient on 15 April 2013, there were the two calls from the Patient to Dr Veettill.

11 March 2013

Dr Veettill telephoned the Patient at 14:02 on 11 March 2013. The call lasted just under 10 minutes (Exhibit D).
Dr Veettill's evidence was that he obtained the Patient's telephone number from her business card (Exhibit F [49]; T: 118). The Patient's evidence was that on 11 March 2013, Dr Veettill told her that he obtained her number from her (ALMS) records (Exhibit B [32]).
The Patient's evidence was that Dr Veettill told her that the reason for the call was to see how she was going. She told him that she 'wasn't good, was still in pain, very fatigued and he said he would come to my house to review me' (Exhibit B [30] [34]).
Dr Veettill's evidence was that he rang to 'find out more about the membership scheme'.
Dr Veettill admitted that he enquired about the Patient's health but denied that it was intended to be a follow-up from the consultation of 10 March 2013 (Exhibit F [53]).

12 March 2013

Dr Veettill's evidence is that he telephoned the Patient on 12 March 2013 about the accommodation scheme, that is, the vacation credits scheme, and that she gave him full details of the scheme (Exhibit F [16]).
Dr Veettill's evidence is that the Patient told him that the membership was $10,000 $30,000. He was not interested because the fees were too high and most of the accommodation was in Europe (Exhibit F [58]).
The Patient did not give any specific evidence as to this call.

15 April 2013

Exhibit B, NR1 showed that the Patient telephoned Dr Veettill twice on 15 April 2013. The first call at 21:27 was about five minutes and the second at 21:35 about 18 minutes. Those were the only occasions on where the Patient telephoned Dr Veettill.
The calls were about three minutes apart. The Patient's evidence is that she thought that she did not get through on the first occasion and rang again (T: 36).
Dr Veettill explained that he put the Patient's number in his contacts because she had said to ring her later about the accommodation service on 10 March 2013 (T: 123).
On this occasion he gave evidence that he entered the Patient's number and first name in his contacts list about two or three days after he first met her in a doctor/patient capacity on 10 March 2013 (T: 124). Earlier in his evidence, Dr Veettill claimed that he put the Patient's telephone number in his contacts list about two to three weeks after 10 March 2013 (T: 117).
The Patient's evidence is that she rang Dr Veettill because she was in a crisis situation with her health and she was not able to see her regular General Practitioner (GP) until 16 April 2013. She rang him because he was familiar with her condition and knew about her overall situation (Exhibit D [56]).
Dr Veettill's evidence is that he was initially unable to talk at that time because he was driving (Exhibit F [60]). Dr Veettill called the Patient at 22:49 (Exhibit D).
Dr Veettill's evidence is that during the second call the Patient requested a medical certificate but that he told her that he was unable to provide one. She then started to discuss her work and problems that she was having with her niece who also worked with her. He said he was busy at the time but that they could discuss the matter further later (Exhibit F [11] [12]).
The Patient denied that she requested a medical certificate from Dr Veettill on 15 April 2013 (T: 73).

16 April 2013

Dr Veettill rang the Patient's number twice on 16 April 2013 at 21:34 for 38 minutes and at 22:30 for 26½ minutes (Exhibit D).
Dr Veettill's evidence is that the conversations were mostly about the Patient's work and family issues, particularly her niece. He stated that no medical issues were discussed and that he did not provide any medical advice or treatment (Exhibit F [63] [68]).
The Patient's evidence is that Dr Veettill spoke to her for about an hour discussing her crisis situation and his medical recommendations (Exhibit B [59]).

The matter the subject of the telephone calls between 11 March and 16 April 2013

It is difficult to understand why the Patient would have entered into discussions with Dr Veettill other than on the basis that she understood those discussions to be between a patient and doctor. The Patient had met Dr Veettill in a patient/doctor relationship. If she was interested in selling vacation credits, it is hard to understand why her sales pitch would include her medical history and the stress her niece was causing her at work. If Dr Veettill was a potential client, these kinds of discussions seem entirely counterproductive. On the other hand, they are entirely consistent with the type of information that would be provided in a patient/doctor relationship.
Where the evidence of the Patient and Dr Veettill conflicts, the Tribunal prefers the evidence of the Patient.
The Patient understood her contact with Dr Veettill to be pursuant to a doctor/patient relationship.

Did Dr Veettill visit the Patient's home in the period 11 March to 16 April 2013?

The Patient's evidence was that Dr Veettill always called her before he visited her (T: 34). He did not visit her on every occasion that he telephoned her (T: 34). The Patient's evidence is that Dr Veettill would call and ask how she was. She told him that she wasn't well, they discussed her health and her symptoms and he would sometimes say that he would come and visit her (Exhibit B [37]).
The Patient was positive that Dr Veettill visited her home on at least five occasions (T: 33; Exhibit B [36]). Her evidence was that Dr Veettill came to see her on at least four occasions during the period 10 March 2013 to 16 April 2013 (T: 16; 49 52), i.e. on three occasions between 11 March 2013 and 16 April 2013.
The Patient was unable to remember the specific days on which Dr Veettill attended
The Patient said that Dr Veettill came to her house again within one or two days after 10 March 2013 (Exhibit B [35]; T: 16).
Dr Veettill's evidence was that he attended at the Patient's house on three occasions: 10 March 2013, 2 March 2014 and 30 May 2014. That is, that he attended only once in 2013. He said that he did not go into the Patient's house on 2 March 2014 (T: 111).
In reexamination the Patient confirmed that, excluding 10 March 2013 and 30 May 2014, she thought that Dr Veettill had come to her house on three occasions, the first, fairly shortly after 10 March 2013. On each occasion that he attended her home, he came into the house (T: 104). In reexamination the Patient described her condition, when the three visits took place after the initial consultation on 10 March 2013, as being in a bad way, physically, emotionally and mentally (T: 106).
The Patient gave evidence that Dr Veettill medically examined her on each occasion he visited her (T: 53). The Patient accepted that Dr Veettill examined her in the front bedroom and in the lounge/dining area.
There was ample opportunity for Dr Veettill to pick up one of the Patient's business cards from the table.
On two of the three occasions between 11 March and 16 April 2013, inclusive, when Dr Veettill attended her home, he examined her breasts. There is no allegation arising from these examinations (Exhibit B [47] [52]).
The Patient gave evidence that during one of the house calls, Dr Veettill said that she was beautiful. She that that it was an unusual remark for a doctor to make to a patient (Exhibit B [53]).

Where the evidence of the Patient and Dr Veettill conflicts, the Tribunal prefers the evidence of the Patient concerning the period from 11 March to 16 April 2013. It follows that Dr Veettill did attend the Patient's home on three occasions between 11 March and 16 April 2013, inclusive.

The Patient's 26 February 2014 admission to RPH

On 26 February 2014, the Patient was admitted to RPH after experiencing shortness of breath and chest pain during a flight from Melbourne. She was discharged on the same day (Exhibit B [62]; Exhibit C, page 9 and page 17).

2 March 2014

There was a gap of about 10 months between Dr Veettill's last call to the Patient on 16 April 2013 and his next call on 2 March 2014.
On 2 March 2014, there was a burst of calls by Dr Veettill.
Exhibit D shows there were nine calls by Dr Veettill to the Patient's number on 2 March 2014. Six of these calls were of a duration of 10 seconds or less. There were three substantive calls, one at 10:31 of about 30 minutes, one at 13:36 of just over 2½ minutes and one at 18:08 of about 10 minutes.

Dr Veettill's explanation for the initial call on 2 March 2014

Dr Veettill's explanation as to why he rang the Patient on 2 March 2014 was:
When I was scrolling through my contact list I found this number. Well I thought she was an old friend of mind. I just rang her as a courtesy call.
(T: 119)
It is difficult to understand how six telephone calls between 11 March 2013 and 16 April 2013 could provide the foundation for describing the Patient as an 'old friend'.
The use of the term 'old friend' by Dr Veettill was plainly not a slip of the tongue as he used that expression in his witness statement (Exhibit F [73]).
Dr Veettill's description of the Patient as 'old friend' simply does not ring true.
Dr Veettill further gave evidence that he initially rang on 2 March 2014 to see what had happened with the Patient's niece (T: 121).
The Patient ceased work in June 2013. In crossexamination, she accepted that she lost her job because of her niece who worked for the same company. She conceded that she had spoken to Dr Veettill about her niece. Her evidence was that she spoke to him about her niece because of her medical condition and the way the resultant stress was affecting her (T: 38 39).
The Patient gave evidence that in the course of the 2 March 2014 conversations, she discussed her recent hospitalisation, her health issues and her symptoms with Dr Veettill (Exhibit B [63]).
Dr Veettill denied that the main point of the telephone discussions was the Patient's health (T: 122 123).
Dr Veettill accepted that during the 10:31 telephone call on 2 March 2014, that the Patient 'discussed what had happened to her and why she had to be admitted to Royal Perth Hospital and generally the treatment she had' (T: 132). Dr Veettill's evidence confirms this topic of conversation (Exhibit F [77]).
The Patient denied that she told Dr Veettill that she was unhappy with her treatment at Royal Perth Hospital, but rather that Dr Veettill told her that her treatment had not been good (T: 65).
Dr Veettill's evidence was that he asked the Patient if she had undergone blood testing at RPH and she advised that she had done so and had all the results at home (Exhibit F [81]).
On 2 March 2014 Dr Veettill rang the Patient at 18:08. That conversation lasted a little over 10 minutes, that is, until about 18:18 (Exhibit D). Exhibit B NR2 shows that Dr Veettill printed out the Patient's test results from Royal Perth Hospital on 2 March 2014 at about 18:12, that is, during this telephone conversation.
The Patient denied that during the conversations of 2 March 2014 she discussed blood tests, although she said that Dr Veettill mentioned blood tests after the conversations of 2 March 2014 (T: 67). Her evidence was that he told her on a later occasion, that he had acquired the records, although she could not remember when she told him (T: 67).
Dr Veettill gave evidence that the Patient asked him to access the RPH records (T: 132).
Dr Veettill gave evidence that he needed the Patient's number to access that patient's records and that he used the number which the Patient gave him to access the Patient's records (T: 133 134; Exhibit F [89]). The Patient denied that she gave Dr Veettill any information to enable him to access her RPH results.
The evidence of Dr Alison Johns, the Acting Director of Clinical Services at Royal Perth Hospital is that a unique login is required by a clinician in order to access the Royal Perth Hospital. Once that clinician gains access, then a patient search can be conducted in the system using the patient's name or date of birth and/or the unique medical records number (Exhibit C, page 2). It is apparent from Dr Johns' evidence that Dr Veettill would not have required the unique medical records number from the Patient in order to search the records. The Patient's name would have been sufficient.
Dr Veettill stated that he was unaware that a patient's records could be accessed using only the patient's name (T: 135). It is difficult to accept that Dr Veettill would have been unaware that a patient's results could be accessed using their name. Requiring a medical records number on each occasion would be impractical, given that it is unlikely that patients would always have it with them, especially if a patient was admitted on an emergency basis.
Dr Veettill gave evidence that he attended the Patient's home on 2 March 2014 after he had printed the blood test results but that he did not give them to her (T: 138 139).
Dr Veettill gave evidence that he attended the Patient's house on 2 March 2014 'because she suggested to pay a visit because she was sick' (T: 139).
In his witness statement, Dr Veettill gave evidence that the Patient suggested that he should visit her at home if he had time. He interpreted this as suggesting that they should meet socially (Exhibit F [82]).
The Patient gave evidence that in the telephone conversation of 2 March 2014, it was Dr Veettill who suggested that he come and visit her. She denied that Dr Veettill in fact visited her on the evening of 2 March 2014 (T: 66).
It is difficult to see how this conversation could be construed as other than arising from a patient/doctor relationship.
Where the evidence of the Patient and Dr Veettill conflict concerning the telephone conversations of 2 March 2014, the Tribunal prefers the evidence of the Patient.

Did Dr Veettill visit the Patient on 2 March 2014?

Dr Veettill's evidence was that on 2 March 2014, he attended the Patient's house within an hour of printing off the results (T: 113).
Dr Veettill's evidence is that it never occurred to him to post, scan and email or fax the medical records to the Patient (T: 154).
Dr Veettill's evidence is that he printed the results at the Patient's request on 2 March 2014 and placed them in his car (Exhibit F [89]). His evidence was that he did not give the Patient her results when he was allegedly at her home on 2 March 2014, because she did not request them when he was there (Exhibit F [92]). It is at least strange that Dr Veettill should have printed out her RPH results at the Patient's request, put them in his car and then not given them to her because she did not request them. It also sits oddly with his claim that he called the Patient on 30 May 2014 to give her the results. There is no evidence that the Patient rang Dr Veettill to request her RPH results.
The Tribunal does not accept Dr Veetill's evidence that he attended the Patient's house on 2 March 2014. Had he done so, he would have given the Patient her RPH medical records.
Where the evidence of Dr Veettill and the Patient conflicts, the Tribunal prefers the evidence of the Patient.
The Tribunal finds that Dr Veettill did not attend the Patient's home on 2 March 2014.

3 March 2014

Dr Veettill called the Patient again on 3 March 2014 at about 4 pm in the afternoon. The call lasted for about 10½ minutes (Exhibit D). His evidence is that he called to enquire about her wellbeing (Exhibit B [95]).

30 May 2014

In order to put the events of 30 May 2014 in context, a table of calls is set out below:

Table of calls 30 May 2014

CALLER	RECEIVER	START TIME Approx	END TIME Approx	LENGTH OF CALL
Dr Veettill	Patient	14:33	14:40	6'22"
Patient	SGIO	15:08	15:26	17'41"
Patient	Prestige	15:26	15:30	4'03"
Patient	PB	15:47	15:54	7'20"
Patient	PB	16:27	16:31	3'55"
Dr Veettill	Patient	17:03	17:35	32'6"
Patient	PB	17:51:42	17:51:45	0'3"
Dr Veettill	Patient	17:51.46	17:54	2'14"
Patient	PB	18:01	18:03	1'39"
Patient	PB	18:28	18:38	9'57"
Patient	PB	19:02	19:03	0'50"
Dr Veettill	Patient	19.07	19.11	3'37"
Dr Veettill	Patient	19:15	19:17	1'30"
Dr Veettill	Patient	19:24	19.26	1'22"
Dr Veettill	Patient	19.29	19.29.10	0'5"
Dr Veettill	Patient	19:29	19:29:51	0'5"
Dr Veettill	Patient	19:30	19:30.09	0'5"
Dr Veettill	Patient	19:30	19:34	4'0"

The 14:33 call

Dr Veettill gave evidence that in late May 2014 he discovered the Patient's RPH records when he was cleaning his car.
Dr Veettill could offer no explanation as to why he kept the Patient's confidential medical results in his car other than that he forgot about them (T: 140).
Dr Veettill gave evidence that he telephoned the Patient on 30 May 2014 in order to give her the results (T: 139). The Patient denied that she was happy when Dr Veettill made contact with her on 30 May 2014 (T: 96).
On the first occasion on which Dr Veettill rang the Patient at about 14:33, she was at her shortterm rental apartment. Dr Veettill gave evidence that during the first conversation, the Patient invited him for a coffee on 30 May 2014 (T: 154).
The Patient denied that she requested a meeting. The Patient's evidence was that Dr Veettill said that he had to give her her results. She said that she was too busy. Dr Veettill insisted on meeting her (Exhibit B [69] [75]).
Dr Veettill arrived at about 3 pm. The Patient's evidence was that Dr Veettill parked in front of the property and that she met him in the front of the building (T: 81).
The Patient gave evidence that before going for tea, she may have brought him through the apartment (T: 82).
Dr Veettill claimed that on 30 May 2014, when he parked his car in front of the Patient's apartment, she said 'I have an apartment I have a property for sale would you be interested' (T: 154). The Patient denied that she was interested in selling or renting her apartment to Dr Veettill (T: 82; 96).
The apartment was not occupied at that time. The Patient was getting it ready to rent out (T: 81). Dr Veettill's evidence was that the Patient stated that she would have to sell the apartment because of financial difficulties but that she wanted to keep her house (Exhibit B [110]). Although the Patient denied that she was interested in selling her apartment, she was interested in selling her home (T: 97).
Dr Veettill gave evidence that in August 2014, the apartment was advertised for sale (T: 155). He conceded that there was no for sale sign on 30 May 2014 (T: 155).
The Patient and Dr Veettill went for a tea afterwards. The Patient said that was to discuss the results (T: 82).
The Patient's evidence is that while they were having a cup of tea, the results were discussed and Dr Veettill said that they were normal (T: 83, 156).
The Patient's evidence is that Dr Veettill told her he needed to give her a referral for a sleep study after the cup of tea (T: 89 90). Dr Veettill denied that there was a discussion about a referral to a sleep clinic at that time (T: 156 157). Dr Veettill conceded that while sleep clinics were discussed, this discussion occurred at the Patient's home later that evening (T: 157).
The Patient denied that when she and Dr Veettill parted after having a cup of tea in West Perth, that she encouraged him to meet her again later (T: 89). It is clear that from the Patient's evidence (T: 89 91) that she was very tired. The Patient told Dr Veettill that she was going home to sleep (T: 90). Dr Veettill's evidence is that when he called the Patient after 5 pm, she said she was tired and sleepy (Exhibit F [114]). It was put to the Patient in crossexamination that she was not exhausted and did not need to sleep. The Patient did not agree with that and stated that it was 'absolutely not true' (T: 94).
Dr Veettill's evidence is that the Patient told him that she had to go to Welshpool because her car had been involved in a collision (Exhibit F [113]).
Dr Veettill's evidence was that the Patient invited him to call her after 5 pm to continue the discussion on the property (Exhibit F [115]).
The Patient did not recall going to Welshpool on the way home. At about 3.08 pm the Patient did make a telephone call of about 18 minutes to SGIO's insurance claims line (Exhibit H). There were subsequently two calls at about 3.30 pm, each of about four minutes in length to Prestige Accident Repairs (Prestige) in Welshpool (T: 85 86).
The Patient did not recall whether or not she had told Dr Veettill about needing to get the car repaired (T: 86). The Patient could not recall whether she went to Prestige on 30 May 2014 (T: 86 87).
At 3:47 pm, the Patient rang a mobile number ...404. It was put to her that this call was to PB, a real estate agent. The Tribunal infers that Dr Veettill sought to establish that the Patient rang PB as a consequence of Dr Veettill being interested in buying the apartment. The Patient said that PB was involved in 'house and land' rather than being a real estate agent.
PB was in fact the Patient's partner and they had been in a relationship for 15 years. The Patient's evidence is that she rang him on 30 May 2014 because they were in a relationship and not for business reasons (T: 102).
The Patient's evidence is that during one of the calls that evening, she told Dr Veettill that she wanted to sleep, but that he kept on ringing and harassing her (T: 91).
The Patient's recollection was that he had rung her after she had about an hour's sleep. She stated that she remembered this because she looked at her phone and noticed that it was approximately an hour and she was positive about that (T: 91 92). It is clear from the phone records set out above, that at no stage did the Patient sleep for an hour between 5 pm and 6 pm on the evening of 30 May 2014. Dr Veettill sought to make something of this, as establishing that her memory was flawed and therefore unreliable. The Tribunal finds that the Patient was wrong in her recollection that she slept for an hour but the Tribunal does not find that this impacts on her credibility.
The Patient's evidence is that in a subsequent telephone conversation on 30 May 2014, Dr Veettill insisted on seeing her again (T: 90). Dr Veettill's evidence is that the subsequent meeting was initiated by the Patient (Exhibit F [114]).
The Patient's evidence is that Dr Veettill told her that he needed to come over to refer her to a sleep specialist. She told him that she did not have the energy to cook dinner let alone see him again and she was going back to sleep. Dr Veettill said that he would bring something over for her to eat. He went on and on about it and she gave in (Exhibit B [87] [91]).
The Patient denied that on the evening of 30 May 2014, she was perfectly capable of telling Dr Veettill not to come (T: 97).
Dr Veettill's evidence is that the Patient suggested that they meet at a multi-cuisine restaurant near Domino's. His evidence was that when he reached Domino's, he rang her at 7.24 pm and she then suggested he pick up some takeaway food and that they dine at her home (Exhibit F [119] [122]).
Dr Veettill's explanation for the number of calls is that the Patient wanted food from a particular restaurant and he needed directions.
The Patient did not ring Dr Veettill. Dr Veettill made nine calls to the Patient from 5 pm onwards. Three of these calls were about five seconds. That leaves six calls.
When Dr Veettill arrived, the Patient and he sat at the dining room table and ate.
There was a discussion about the Patient's weight. The Patient's evidence is that Dr Veettill told her she needed to lose weight. As he was saying this, he was grabbing and pinching at her (Exhibit B [100] [102]). Dr Veettill's evidence is that the Patient told him she needed to lose weight and showed him photos of herself (Exhibit F [126] [127]).
The Patient's evidence is that they discussed Ayurvedic medicine (Exhibit B [97] [98]).
Dr Veettill's evidence is that there was a discussion of her depression and her sleep problems (Exhibit F [130] [131]). The Patient's evidence is that they discussed her sleep problems and that she showed him various sleep therapy clinics on her laptop computer screen (Exhibit B [99]).
Dr Veettill accepts that the Patient looked up sleep clinics on her laptop (Exhibit F [131]). Dr Veettill conceded that later that evening, the Patient used her laptop computer to look at sleep clinics and that she was talking to him about sleep clinics (T: 158 159). He denied that she was speaking to him as a doctor (T: 159).
Dr Veettill's evidence is that they then discussed the sale of the apartment (Exhibit F [132] [134]).
Dr Veettill's evidence is that the Patient showed him a lesion on her neck and asked if he would nick it for her. Dr Veettill went to his car and got a sterilised needle and nicked the lesion (Exhibit F [136] [138]). Dr Veettill conceded that he used a needle from his medical bag to prick a boil on her neck (T: 160).
Dr Veettill gave evidence that the Patient said to him 'You are caring. You know how to care. Bring me romance' (Exhibit B [140] [144]) and that the conversation continued in a similar vein (T: 160; Exhibit B [139]).
Dr Veettill said that he was concerned by this conversation. Dr Veettill's evidence was that he could not have left because he was in a difficult situation (T: 161).
Dr Veettill's evidence was that there was a discussion about the Patient's concern about breast cancer (Exhibit F [147] [151]). His evidence was that the Patient requested him to have a look at her breasts (Exhibit F [151]).
The Patient's evidence is that she told Dr Veettill that she was still having pain in her left breast and chest and that he said for her to lie on the floor because he would examine her to check her breasts and chest (Exhibit B [103] [104]).
The Patient's evidence as to what happened next is:
107.I remember questioning this and said words to the effect of 'what? there?' while pointing to the floor.
108.Dr Vayal Veettil said words to the effect 'yes that is fine' and asked me to take my top and bra off.
109.I was wearing a top and leggings.
110.I did what Dr Vayal Veettil asked as I trusted him as a doctor. I got down on the rug on the floor. I expected that Dr Vayal Veettil was going to give me a medical examination.
111.I was laying on my back, with my arms down the side of my body.
112.Dr Vayal Veettil got down on the rug next to me, on my right side.
113.He directed and assisted me to move my left arm above my head and examined my left breast. He touched both breasts.
114.Dr Vayal Veettil then told me the examination was normal and not to worry and that I have no breast lumps.
115.I felt very uncomfortable because he was too close and I could smell his body odour and breath. I could see patches of dampness from perspiration under the arms of his shirt.
116.Dr Vayal Veettil then put his left ear on my chest, in between my breasts.
117.He told me he was trying to hear my heartbeat and that everything appeared to be normal.
118.He suddenly started kissing my breasts and then fondled and groped my breasts with both his hands.
119.I was in shock, and didn't know what to do.
120.I remember repeating 'No no no. What are doing?'. I said it out aloud. I pushed him away and got up.
121.There was an armchair nearby and Dr Vayal Veettil got up and said 'Come and sit on the chair'
122.I said no but he grabbed me and pulled me over to the chair anyway and forced me to sit on his lap with my back against his front.
123.Dr Vayal Veettil continued to grope my breasts and torso.
124.He wouldn't let me go, and was holding on very tightly. He was rubbing his groin area against me while I kept saying no and kept struggling to get away from him.
125.I kept saying 'No' and 'What are you doing?'. I was trying to pull away from him to get off him. I was trying to escape from his hold on me.
126.I didn't know what was going to happen next. I was really scared and fearful that he could do worse and no one would be able to hear me as I was alone with him in my own home.
127.I managed to struggle away from him. I grabbed and put my top back on.
128.I was in shock and I was trying to get calm and compose myself in order to handle the situation and make sure it didn't escalate. I remember him having this distinct smirk on his face that I will never forget.
129.He had calmed down. I asked him to leave. He still asked me to give him a hug after what he had just done to me.
130.I just said no, but he came up and hugged me anyway. He towered over me because he is so much taller than me. Even after I said no, he just did it anyway. He behaved as if nothing had happened.
131.He was dismissive and he showed no remorse for what he had just done to me.
132.He left. I do not remember how soon after he left. I was in shock.
(Exhibit B)

After he graduated in 1989, Dr Veettill worked as a general medical practitioner whilst studying to specialise in adult internal medicine.
In 2006, Dr Veettill and his family migrated to Australia on a 457 visa, and he practised in Melbourne for 2½ years until he moved to Perth in 2009. He then worked at Royal Perth Hospital (RPH) for six years and with the Australian Locum Medical Service in 2012-2013, during which he attended over 5,000 home visits.
Dr Veettill became a member of the Royal Australian College of Physicians (RACP) as an Adult Medicine Basic Trainee. Dr Veettill completed all the requisite certified training time (36 months) and was studying for his written and clinical examinations at the time of the conduct.
Dr Veettill passed the RACP's written examination in March 2014 and was due to take his final clinical examinations in August 2014 in order to complete that training. As a result of the notification that led to this matter, he was unable to complete the examinations, and he is unlikely to be able to do so for the foreseeable future.
The notification was made by the Patient on 10 June 2014 and conditions were imposed upon Dr Veettill's registration on 18 June 2014. Those conditions were:
1.[Dr Veettill] is not to contact the patient involved in the notification at any time by any means.
2.[Dr Veettill] will not contact or meet with female patients outside of a clinical setting.
3.[Dr Veettill] may only practise within a hospital or private consulting rooms.
4.[Dr Veettill]:
a.     will not consult with, or treat, any female patients without an adult female chaperone, who is acceptable to the patient, present throughout the consultation or treatment; and
b.    must complete a log sheet for female patients consulted or treated in the form of the chaperone log provided by the Medical Board of Australia (the Board), which is to be countersigned by the chaperone in attendance, and submitted to the Board on a fortnightly basis, other than when completing his FRACP clinical examinations.
5.[Dr Veettill]:
a.     must inform AHPRA of all of his employers and places of practice and any changes to such on an ongoing basis;
b.    consents to AHPRA providing all of his employers and places of practice with a copy of the conditions of his registration; and
c.     consents to his employer(s) reporting to AHPRA on his professional performance.
6.All costs associated with the conditions will be borne by [Dr Veettill].
Due to the imposition of conditions upon Dr Veettill's registration, Dr Veettill had to be redeployed by RPH to work on clinical projects. RPH advised that the cost of employing a nurse chaperone (which would be required if Dr Veettill was to continue in his clinical role) was prohibitive and that therefore Dr Veettill needed to be employed in a role which did not involve patient contact.
Dr Veettill was not allowed to undertake any clinical practice for in excess of seven months which will prevent him from applying for the RACP clinical examinations.
Dr Veettill practised medicine for approximately 25 years until June 2014, when the notification of these matters led to his ceasing to practise.
As a consequence of the conditions on his registration, Dr Veettill's employment contract with RPH which had been renewed annually for the last six years, was not renewed with RPH.

Is there a need to protect the public against further misconduct by Dr Veettill?

Trust is a fundamental aspect of the relationship between a patient and a medical practitioner. That trust is particularly important when a medical practitioner visits a patient at his or her home.
Dr Veettill's conduct and the circumstances in which it occurred are evidence of a need to protect the public against further misconduct by him.

Is there a need to protect the public through general deterrence of other practitioners?

There is a need for a strong penalty to protect the public from misconduct through general deterrence of other medical practitioners, particularly in the case of medical practitioners visiting a patient at his or her home, and particularly in the case of locums.
Locums often visit patients after hours. Generally, if a patient calls a locum after hours, it is because his or her regular doctor is unavailable and he or she is in distress.
Patients are often more vulnerable in their own home particularly if they live alone.
The public must feel sufficiently confident to call locum services after hours otherwise they may be exposed to unnecessary pain or distress or deterioration of their health if they wait until business hours.

Is there a need to protect the public by reinforcing high professional standards and denouncing transgressions?

Sexual assault is an anathema to the high professional standards expected of medical practitioners in order to protect the public. Any penalty must reflect the need to maintain medical practitioners' high professional standards.
The maintenance of professional boundaries is particularly important in this case. Had Dr Veettill not breached those boundaries by telephoning the patient and subsequently meeting her for a coffee and visiting her home, it is hard to imagine that the assault of 30 May 2014 would ever have occurred.

Dishonesty

This factor does not apply.

Breach of an Act, Regulations, Guidelines or Code of Conduct

Dr Veettill's sexual assault is potentially an offence under s 323 of the Criminal Code.
Dr Veettill has breached s 8.2 of the Good Medical Practice: A Code for Conduct for Doctors in Australia (July 2010 and 17 March 2014) and Sexual Boundaries: Guidelines for Doctors (28 October 2011), both of which were developed and approved by the Board for reference by the profession.

Incompetence

Factor 6 does not apply.

Was the incident isolated?

The incident of professional misconduct was isolated. The other conduct stretched over two separate time periods.

8) Dr Veettill's disciplinary history

There have been no previous adverse findings made against Dr Veettill. Therefore, prior to the conduct which resulted in the adverse finding by the Tribunal in this proceeding, he had practised medicine with a completely unblemished disciplinary record for approximately 24 years, eight of them in Australia.

9) Whether or not Dr Veettill understands the error of his ways, including an assessment of any remorse and insight (or a lack thereof) shown by Dr Veettill

Dr Veettill had the right to have the allegations made against him tested fully at a hearing about whether the conduct was unprofessional conduct as a medical practitioner.
It is of concern that Dr Veettill lacks insight into his conduct, however, this is a matter to be considered in the light of all other matters.

10) Are there any special skills possessed of Dr Veettill?

Dr Veettill does not possess any special skills that would influence any penalty to be imposed.

11) The practitioner's personal circumstances

At the time of the conduct, Dr Veettill had two jobs and was studying for examinations which are extremely difficult. It is a reasonable inference that he was under significant stress. While the practitioner's conduct is not directly relevant to the protection of the public, it is relevant to whether the conduct is likely to be repeated. Having regard to Dr Veettill's previous history, the Tribunal is satisfied that if Dr Veettill does not again place himself in stressful circumstances, it is far less likely that the conduct would be repeated.

Are there any other matters related to Dr Veettill's fitness to practise?

This factor does not apply.

Conclusion

The Tribunal is satisfied that although Dr Veettill has fallen below the high standards to be expected of such a practitioner, he has not done in such a way as to indicate that he lacks the qualities of character which are the necessary attributes of a person entrusted with the responsibilities of a practitioner. The Board is satisfied that although Dr Veettill's conduct was serious, having regard to his previous history, it should be treated as an isolated incident influenced by the stressful situation in which he placed himself. The Tribunal is satisfied that, upon completion of the period of suspension, Dr Veettill will be fit to resume practice.
The Tribunal notes that Dr Veettill has effectively been suspended since June 2014. The Tribunal is also satisfied that an additional period of 12 months is sufficient to protect the public. The conditions imposed on 18 June 2014 should apply to Dr Veettill's 12 months of practice after his suspension ends.
Dr Veettill is to pay the Board's costs and disbursements at the scale provided for as if the proceedings had been in the Supreme Court of Western Australia.

Orders

1.Dr Premanandan Vayal Veettill is reprimanded.
2.Pursuant to s 192(d) of the Schedule to the Health Practitioner Regulation National Law (WA) Act 2010, Dr Premanandan Vayal Veettill's registration is suspended for a period of 12 months from 1 March 2016.
3.Pursuant to s 196(2)(b) of the Schedule to the Health Practitioner Regulation National Law (WA) Act 2010, Dr Premanandan Vayal Veettill's registration from 1 March 2017 to 1 March 2018 is subject to the following conditions:
(a)Dr Veettill will not contact or meet with female patients outside of a clinical setting;
(b)Dr Veettill may only practise within a hospital or private consulting rooms;
(c)Dr Veettill:
(i)will not consult with, or treat, any female patients without an adult female chaperone, who is acceptable to the patient, present throughout the consultation or treatment; and
(ii)must complete a log sheet for female patients consulted or treated in the form of the chaperone log provided by the Medical Board of Australia, which is to be countersigned by the chaperone in attendance, and submitted to the Medical Board of Australia on a fortnightly basis, other than when completing his clinical examinations at the Royal Australian College of Physicians .

(d)Dr Veettill:
(i)must inform the Australian Health Practitioner Regulation Agency of all of his employers and places of practice and any changes to such on an ongoing basis;
(ii)consents to the Australian Health Practitioner Regulation Agency providing all of his employers and places of practice with a copy of the conditions on his registration; and
(iii)consents to his employer(s) reporting to the Australian Health Practitioner Regulation Agency on his professional performance.

4.Dr Premanandan Vayal Veettill is to pay the Medical Board of Australia's costs and disbursements at the scale provided for as if the proceedings had been in the Supreme Court of Western Australia, to be assessed if not agreed.

I certify that this and the preceding [54] paragraphs comprise the reasons for decision of the State Administrative Tribunal.
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JUSTICE J C CURTHOYS, PRESIDENT