Medical Board of Australia v Blomeley
[2014] QCAT 160
| CITATION: | Medical Board of Australia v Blomeley [2014] QCAT 160 |
| PARTIES: | Medical Board of Australia (Applicant) |
| v | |
| Neville Raymond Blomeley (Respondent) |
| APPLICATION NUMBER: | OCR242-13 |
| MATTER TYPE: | Occupational regulation matters |
| HEARING DATE: | On the papers |
| HEARD AT: | Brisbane |
| DECISION OF: | Hon J B Thomas, Judicial Member, assisted by Dr S Pozzi, Dr R Rosengren and Mr P Murdoch |
| DELIVERED ON: | 23 May 2014 |
| DELIVERED AT: | Brisbane |
| ORDERS MADE: | 1. It is recorded that the respondent behaved in a way that constitutes professional misconduct in that between November 2010 and July 2012 in that he engaged in a sexual relationship with a female patient. 2. The respondent’s registration is suspended for a period of 15 months, commencing on 1 July 2014; 3. The chaperone conditions already imposed shall apply for a period of 12 months commencing 1 October 2015; 4. The respondent is reprimanded; 5. The respondent will pay the applicant Board’s costs of and incidental to the proceedings on the scale applicable to matters in the District Court to be agreed or assessed. |
| CATCHWORDS: | PROFESSIONS AND TRADES – HEALTH CARE PROFESSIONALS – MEDICAL PRACTITIONERS – DISCIPLINARY PROCEEDINGS – PROFESSIONAL MISCONDUCT OR UNPROFESSIONAL CONDUCT – GENERALLY – where the registrant engaged in a sexual relationship with at patient lasting almost two years – where the registrant’s conduct amounted to professional misconduct – where the applicant proposed a sanction including a suspended suspension – whether the Tribunal can suspend a suspension – where the registrant is currently in practice and needs to enable the care of his patients to be transferred to others – whether the Tribunal can set a commencement date for suspension Health Practitioner Regulation National Law (Queensland), s 5, s 6, s 193, s 195, s 196(1)(a), s 196(2)(d) Pharmacy Board of Australia v Tavakol [2014] QCAT 112 |
APPEARANCES and REPRESENTATION (if any):
| APPLICANT: | McInnes Wilson Lawyers |
| RESPONDENT: | J Rosengren, instructed by TressCox Lawyers |
This matter was heard and determined on the papers pursuant to s 32 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld) (QCAT Act).
REASONS FOR DECISION
Jurisdiction
This is a reference from the Medical Board of Australia under s 193 of the Health Practitioner Regulation National Law. That law is scheduled to the Health Practitioner Regulation National Law Act 2009 (Qld) and, to the extent that it is set out in the schedule, it is binding law in this State. It will be referred to as ‘the adopted National Law’.
The events the subject of this disciplinary proceeding occurred after the commencement of the adopted National Law which commenced operation on 1 July 2010.
QCAT is the ‘responsible tribunal’ with jurisdiction to deal with references made under s 193 of the adopted National Law.[1]
[1]Health Practitioner Regulation National Law Act 2009 (Qld), s 6; and s 5 (definition of ‘responsible tribunal’ in the adopted National Law).
The basis of this reference to QCAT is the Board’s reasonable belief that Dr Blomeley behaved in a way that constitutes professional misconduct.
The decisions and orders that may be made in these proceedings are relevantly prescribed in s 196 of the adopted National Law. They include findings of ‘unsatisfactory professional performance’ ‘unprofessional conduct’ and ‘professional misconduct’, or of conduct amounting to one or more of those terms, each of which is defined in s 5 of the Act.
Section 196(2) specifies the types of order that may be made by QCAT upon such a referral.
Main Facts and circumstances
Dr Blomeley has been registered as a general practitioner since 1995, and has practiced at the Indooroopilly Day and Night Medical Centre since that time.
Between November 2010 and July 2012 he engaged in a sexual relationship with a female patient. On 26 July 2012 the patient complained to the Board which immediately notified Dr Bromley of the allegation. He promptly admitted the relationship, acknowedged its inappropriateness, confessed his shame and offered an apology to the patient.
A committee appointed by the Board promptly imposed conditions on Dr Blomeley’s registration (17 September 2012). They included a requirement for a Board approved chaperone for all consultations by Dr Blomeley with female patients.
The complainant had been Dr Blomeley's patient between 2000 and 2010, during which there had been various consultations for various complaints. She then started mentioning difficulties with her marriage and the efforts that she and her husband were making to restore sexual intimacy to their marriage.
Both the Board and Dr Blomeley accept that a ‘relationship’ commenced during a November consultation, and that sexual intercourse first occurred some weeks later. It is accepted that thereafter a sincere relationship ensued with both parties having strong feelings for the other.
Dr Blomeley was at that time having difficulties and unhappiness in his own marriage.
The doctor patient relationship continued during the affair.
Some problems were occasioned by the female patient making contact with Dr Blomeley’s wife. He and his wife went overseas for about three weeks, during which the female patient made numerous attempts to contact him. The relationship between Dr Blomeley and the female patient finally terminated around July 2012.
It is accepted by both the Board and Dr Blomeley that at the commencement of the relationship the female patient was vulnerable, and that the relationship has had an adverse impact on her mental health. She had consulted him previously for matters including marriage difficulties and was under treatment for depression.
At material times, Dr Blomeley has acquired and maintained a high profile in the field in sports medicine, holding positions with Queensland Cricket, the Brisbane Roar Football Club, and the University of Queensland Rugby Club. He is medical officer for the Queensland Academy of Sport, the Greenslopes Private Hospital and Brisbane Private Hospital. He also engages extensively in community activities including Rotary projects such as District Chairman of Interplast (a not for profit organisation which sends teams of volunteer health professionals to developing countries in the Asia Pacific Region). He has recently been invited to coordinate a medical team for Rotary and serve on a mercy ship conducting work in Africa anticipated to commence in mid-2014.
Dr Blomeley has been subjected to adverse publicity in the form of a Courier-Mail article containing his photograph, and a report under the caption ‘Say Aah’.
In consequence of the present proceedings he has been required to stand down from his position as Chairman of the sports medical network of the Royal Australian College of General Practitioners and to resign as director from all companies in the Auscare Medical Group and from the Queensland Academy of Sport. He also voluntarily stood down from his position at Queensland Cricket.
Discussion
Plainly Dr Blomeley's maintenance of a sexual relationship with his patient was substantially below the standard of conduct reasonably expected of a registered medical health practitioner of equivalent training or experience, and it satisfies the definition that is contained in both paragraphs (a) and (c) of the definition of "professional misconduct" in s 5 of the adopted National Law. A finding to this effect should therefore be recorded pursuant to section 196(1)(a).
Dr Blomeley has practiced for 37 years, and has been a fellow of the Royal Australian College of General Practitioners for 26 of them.
There was one previous occasion of unsatisfactory professional conduct in 2003, when Dr Blomeley was disciplined for providing pethidine to a drug dependent patient. On that occasion conditions were imposed on his registration in respect of his prescribing of controlled drugs for a period of 12 months.
That episode apart, he has served his profession and the community well for 37 years. Numerous references from his colleagues, peers and patients attest to his dedication, skill, care, and usual good character. The 2003 incident is relevant, but viewed in the context of the whole evidence it should not be given any overpowering impact.
The affair the subject of this charge is said to have been ‘a consensual and genuine relationship and one of mutual dependence’. However the fundamental point is that it stemmed from an unequal relationship. It was his special duty, not the patient's, to maintain the appropriate professional boundaries.
His conduct was a fundamental breach of professional duty, and the sanction should carry some general deterrence against like conduct by others.
The sanctions proposed by the Medical Board of Australia consist of a combination of orders which would carry a considerable impact against Dr Blomeley. Apart from the obvious reprimand, the Board proposes that he be suspended from practice for two years with the suspension to be suspended after 18 months for an operational period of two years, that he pay the Board’s costs (which are likely to be very substantial), and that further ancillary orders should be made for 12 months supervision after his return to practice, including an extension of the chaperone conditions already imposed until the end of the operational period, with the further requirement that Dr Blomeley bear the costs associated with compliance with those orders.
There are a number of factors which need to be taken into account in possible mitigation of the sanction to be imposed.
From the outset, Dr Blomeley acknowledged his misconduct, and fully cooperated with the investigation and disciplinary process. His early acceptance spared the complainant the ordeal of recounting her experience before the Tribunal. He has shown contrition, and has apologised.
He has also taken steps to reinforce and improve his understanding of professional boundaries. In one sense this may be thought to involve learning the glaringly obvious, but useful insights on the subject of preventing boundary violations in clinical practice have been identified by expert professionals including Dr Kable. Dr Blomeley has attended six one hour counselling sessions with Dr Kable who has expressed the opinion that Dr Blomeley does not represent any continuing danger to the public in any way and that he is most unlikely to reoffend.
He has suffered a good deal of collateral disadvantage as a result of his conduct and of the present proceedings. Chaperone conditions were imposed on his practice in September 2012 and recorded in the public register. He has fully complied with these.
There has also been embarrassing publicity including the above-mentioned Courier-Mail article. The fact that Dr Blomeley’s public profile means that he has suffered greater public disgrace then a less well-known figure. This however is essentially a consequence of his high profile and is not in itself a circumstance of mitigation.
On the other hand he has been obliged to resign from numerous positions which he valued, and these are direct consequences of the conduct in question and its aftermath. These include resignations as medical director at the Queensland Academy for Sport, director of companies in the Auscare Medical Group, and his standing down from positions in the Royal Australian College of General Practitioners and Queensland Cricket.
Dr Blomeley does not oppose the making of an order that he pay the costs of these proceedings.
The power to award costs is conferred by s 195 of the National Law. The reference in that section to ‘costs it (the Tribunal) considers appropriate’ confers a general discretion which displaces the restrictive regime that would otherwise apply under s 100 – s 107 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld). Such an order does not form part of the sanction, but it may in an appropriate case be taken into account in the assessment of the sanction.
The costs which he will be obliged to pay will be very substantial, and from his financial perspective will be as burdensome as a very heavy fine.
Numerous cases were cited in which medical practitioners have been disciplined for sexual misconduct with a patient. These include Ibrahim v Medical Board of Australia,[2] Medical Board of Australia v Yasin,[3] Medical Board of Australia v Namdam,[4] Medical Board of Australia v North,[5] Medical Board of Australia v Jones,[6] Medical Board of Australia v Mallon,[7] Medical Board of Queensland v Thurling,[8] and Re: A Medical Practitioner.[9]
[2][2005] QHPT 302.
[3][2011] QCAT 300.
[4][2011] QCAT 65.
[5][2012] QCAT 546.
[6][2012] QCAT 362.
[7][2010] QCAT 311.
[8][2003] QCA 518.
[9][1995] 2 Qd R 154.
These cases show a range of suspensions between three months and two years, with the suspensions themselves being suspended after various periods, along with operational periods of the most part between two years and five years.
In the present matter the Board seeks a suspension of two years to be suspended after 18 months with an operational period of a further two years. Quite simply, this Tribunal does not have the power to make such an order, for reasons stated in Psychology Board of Australia v Cook [2014] QCAT 162 and Pharmacy Board of Australia v Tavakol [2014] QCAT 112. It is unnecessary to rehearse those reasons here. This tribunal does not have the power to suspend a suspension. A simple order of suspension for a fixed period is the appropriate order.
Dr Blomeley is currently in practice, and it is desirable that the suspension should commence on a date which will enable the care of his patients to be transferred to others with a minimum of disruption. Questions concerning the form in which orders of suspension may be made are discussed in Psychology Board of Australia v Cook (above), and it is unnecessary to repeat that discussion here. It is enough to say that s 127 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld) and the terms of s 196(2)(d) of the adopted National Law permit an order to be made that directs a suspension to commence on a future date.
Taking all the above matters into consideration, and aided by discussion with the assessors in this case, it seems to me that in the present case there should be a suspension of 15 months.
It is also appropriate that there be a reprimand which will be recorded in the register and an order for payment of the Board’s costs.
On the evidence there would be very little ongoing benefit to be derived from the undertaking of further education or supervised practice. He has already undertaken appropriate study and advice with apparent benefit, and the consequences of further transgression must be all too obvious. I do not think that Dr Blomeley should be burdened with the further ancillary orders suggested by the Board, other than that the chaperone conditions should apply for a period of 12 months when practice is recommenced.
Orders
It is recorded that the respondent behaved in a way that constitutes professional misconduct in that between November 2010 and July 2012 in that he engaged in a sexual relationship with a female patient.
The respondent’s registration is suspended for a period of 15 months, commencing on 1 July 2014;
The chaperone conditions already imposed shall apply for a period of 12 months commencing 1 October 2015;
The respondent is reprimanded;
The respondent will pay the applicant Board’s costs of and incidental to the proceedings on the scale applicable to matters in the District Court to be agreed or assessed.
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