National Disability Insurance Agency v KKTB, by her litigation representative CVY22

Case [2022] FCAFC 181


FEDERAL COURT OF AUSTRALIA

National Disability Insurance Agency v KKTB, by her litigation representative CVY22 [2022] FCAFC 181

Appeal from: KKTB v National Disability Insurance Agency [2021] AATA 5457
XZJY v National Disability Insurance Agency [2021] AATA 5459
YHPS v National Disability Insurance Agency [2021] AATA 5456
File numbers: NSD 15 of 2022
NSD 16 of 2022
NSD 17 of 2022
Judgment of: MORTIMER, THAWLEY AND ABRAHAM JJ
Date of judgment: 17 November 2022
Catchwords: ADMINISTRATIVE LAW – National Disability Insurance Scheme – three Tribunal decisions in relation to  reasonable and necessary supports for individuals with severe to profound disabilities – level of support required from registered nurses as opposed to disability support workers – whether Tribunal findings supported by or rationally open on evidence – whether failure to consider submissions – whether denial of procedural fairness – appeal dismissed
Legislation:

Administrative Appeals Tribunal Act 1975 (Cth) ss 43(2), 43(2B), 44

National Disability Insurance Scheme Act 2013 (Cth) ss 3, 4, 17A, 33, 34, 35, 103, 209

National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018 (Cth)

National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) rr 3, 5, 7

Cases cited:

BJO18 v Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs [2020] FCAFC 189; 281 FCR 594

Collins v The Queen [2020] NSWCCA 198

Commissioner for Australian Capital Territory Revenue v Alphaone Pty Ltd [1994] FCA 1074; 49 FCR 576

DAO16v Minister for Immigration and Border Protection [2018] FCAFC 2; 258 FCR 175

Donohue v Westin [2022] VSC 37

Dranichnikov v Minister for Immigration and Multicultural Affairs [2003] HCA 26; 197 ALR 389

Endeavour Coal Pty Limited v Association of Professional Engineers, Scientists and Managers, Australia [2012] FCA 764; 206 FCR 576

Fattah v Minister for Home Affairs [2019] FCAFC 31; 268 FCR 33

Gupta v Minister for Immigration and Border Protection [2017] FCAFC 172; 255 FCR 486

Haritos v Commissioner of Taxation [2015] FCAFC 92; 233 FCR 315

IMM v The Queen [2016] HCA 14; 257 CLR 300

Khawaja v Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2013] AATA 264

KKTB v National Disability Insurance Agency [2021] AATA 5457

McGarrigle v National Disability Insurance Agency [2017] FCA 308; 252 FCR 121

Milburn v National Disability Insurance Agency [2018] AATA 4928

Minister for Immigration and Border Protection v MZYTS [2013] FCAFC 114; 230 FCR 431

Minister for Immigration and Citizenship v SZMDS [2010] HCA 16; 240 CLR 611

Minister for Immigration and Citizenship v SZQRB [2013] FCAFC 33; 210 FCR 505

Minister for Immigration and Ethnic Affairs v Wu Shan Liang [1996] HCA 6; 185 CLR 259

Minister for Immigration and Multicultural Affairs v Yusuf [2001] HCA 30; 206 CLR 323

MQGT v Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs [2020] FCAFC 215; 282 FCR 215

Mulligan v National Disability Insurance Agency [2015] FCA 544; 233 FCR 201

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AGLC
National Disability Insurance Agency v KKTB, by her litigation representative CVY22 [2022] FCAFC 181
Case
[2022] FCAFC 181
Decision Date

CaseChat Overview and Summary

The case involves three appeals against decisions of the National Disability Insurance Agency (NDIA), brought by individuals with severe to profound disabilities. The appeals were heard and dismissed by Mortimer J of the Federal Court of Australia. The primary issue was whether the NDIA's decisions regarding the level of support required from registered nurses, as opposed to disability support workers, were supported by the evidence and whether the NDIA had properly considered the submissions made by the appellants. The court also had to determine whether the NDIA's decisions denied the appellants procedural fairness.

The court found that the NDIA's decisions were supported by the evidence and that the NDIA had properly considered the submissions made by the appellants. The court held that the NDIA had not erred in law, and the appeals were dismissed. The court found that the NDIA had given proper weight to the evidence of Ms Merran, a registered nurse with extensive experience in the field, and that the Tribunal's findings regarding her evidence were not irrational or illogical. The court held that the NDIA had considered the appropriate factors in determining the level of support required by the appellants and that the decisions were not flawed by a failure to consider relevant submissions or a denial of procedural fairness.

The court dismissed the appeals and ordered that the appellants pay the respondents' costs of and incidental to the appeal. The court also ordered that the parties file any agreed orders as to lump sum costs by 1 December 2022, and if they were unable to agree, the question of an appropriate single lump sum would be referred to a Registrar for determination.

Orders

Orders of the court

1. The appeal be dismissed.

2. The applicant pay the respondent’s costs of and incidental to the appeal, to be fixed by way of a single lump sum referable to the three proceedings before the Court on appeal, being proceedings NSD15/2022, NSD16/2022 and NSD17/2022.

3. On or before 1 December 2022 the parties are to file with the Court any agreed orders as to lump sum costs.

4. In default of agreement pursuant to order 3, the question of an appropriate single lump sum be referred to a Registrar for determination.

Note: Entry of orders is dealt with in Rule 39.32 of the Federal Court Rules 2011.

Background

Background to the litigation

For the reasons set out below, each of the appeals should be dismissed.BACKGROUND The background to the proceedings is not disputed. That background is set out in the reasons of the Tribunal, from which this summary is largely taken. Each respondent is a participant in the National Disability Insurance Scheme, as governed by the NDIS Act. Each respondent is a person with severe to profound disabilities, and is significantly reliant on those who care for them:(a)KKTB was 28 years old at the time of the Tribunal’s decision. She was born in 1993 with complex disabilities and suffers from chronic health conditions. She was adopted in 1994, at the age of one year. KKTB is described in her NDIS participant plan as a person “with Down Syndrome and a condition called Holoprosencephaly”, who suffers from “a number of other complications including Diabetes Insipidus, Gastric Oesophageal Reflux Disorder, gouty arthritis and hypothyroidism”. KKTB’s holoprosencephaly, the participant plan indicates, “causes severe problems with how the skull and facial features develop”, which is the reason that KKTB has “a severe intellectual disability and need[s] help in all areas of [her] life”. This includes “full care and assistance with all personal care”, as well as “all daily activities”. KKTB’s participant plan indicates that she “is unable to stand, walk or move [herself] on the floor”, that she has “a lot of difficulty controlling movements in [her] hands”, and that she does not “use words to communicate”, though she vocalises and “makes sounds to let people know when [she is] happy or sad or trying to get their attention”. (b)XZJY was 40 years old at the time of the Tribunal’s decision. She was also born with complex permanent disabilities and suffers from chronic health conditions. XZJY’s NDIS participant plan indicates that she was born with Cornelia de Lange syndrome, which is “a genetic condition that has caused [her] face to have a particular shape, [her] eyebrow’s to be thick and [her] eyelids to be shaped the way they are”. As a result of her conditions, XZJY has “major growth delay, intellectual disability, limb defects and gastrointestinal problems”. Her participant plan indicates that she does not “use words, and [she] needs assistance with all daily activities”.(c)YHPS was 46 years old at the time of the Tribunal’s decision. He was born with Down syndrome and a club foot, the latter of which limits his mobility. He has also developed other chronic conditions, including severe loss of sight. YHPS’s NDIS participant plan indicates that his “disability means that [he] need[s] full care and assistance with all daily activities including meals, drinks, personal care, showering, dressing, communication, and moving around”. If an even plainer appreciation were needed of the challenges each respondent faces in their daily lives, and the challenges faced by those who care for them, the evidence before the Tribunal also contained a series of photographs depicting the respondents engaged in some of their daily activities.

Evidence

Evidence Before The Court

Full text does not contain this section.

Decision

Reasons for decision

Rule 7, contained in Sch 1, sets out a number of considerations relevant to the determination of whether supports are most appropriately funded through the NDIS. Rules 7.1-7.3 state as follows:7.1 The Act limits the supports that can be provided or funded under the NDIS to supports that are not more appropriately funded or provided through other service systems, for example as part of a universal services obligation or in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.7.2 The considerations set out in this Schedule must be taken into account by the CEO in deciding whether a support is more appropriately provided or funded by the NDIS or another service system.7.3 For the avoidance of doubt, while this Schedule sets out considerations relevant to whether a support should be considered to be more appropriately provided or funded through another service system, it does not purport to impose any obligations on another service system to fund or provide particular supports.Note: The considerations set out in this Schedule are derived from the Principles to determine the responsibilities of the NDIS and other service systems, agreed to by the Council of Australian Governments, and dated Friday 19 April 2013. That document also includes principles relating to aged care. They are not relevant to this Schedule, but are given effect to in section 19 of the Act, and the National Disability Insurance Scheme (Becoming a Participant) Rules 2013. (Original emphasis.)THE TRIBUNAL’S DECISIONS The Tribunal delivered written reasons in relation to XZJY on 15 December 2021, accompanied by oral reasons in relation to KKTB and YHPS. The Tribunal then delivered written reasons in relation to KKTB and YHPS on 9 February 2022 and 14 February 2022, respectively. In each decision, the Tribunal set aside the internal review decisions, and in their place decided that the Agency was to approve funding for the level of registered nursing support that had been sought by each of the review applicants. The XZJY reasons were the primary reasons, with the KKTB reasons and YHPS reasons significantly reproducing relevant parts of the XZJY reasons. In the XZJY reasons at [10] the Tribunal explained:[XZJY’s] application was heard together with applications by two other residents of the shared accommodation who were also seeking additional support by a Registered Nurse. While many of the applicable principles are the same, the needs of the Applicants vary. For this reason, I intend to publish separate reasons for my decision in each application, although significant parts of these reasons will be reproduced in the other applications. Unless otherwise specified, references in these reasons to the Tribunal’s reasons are references to the Tribunal’s XZJY reasons. Significantly for the reviews, and for the appeals in our opinion, at [2], the Tribunal also made the following observations:The Agency argued very strongly that I should find that it is appropriate that the care [XZJY] needs should be delivered in a manner described as the Delegated Model of Care. However, in considering the care which should be provided to [XZJY], it is important to keep in mind that the real issue for consideration is what is the reasonable and necessary support to be provided to [XZJY] as an individual, not which one of two competing so-called, models of care is appropriate. My decision in this matter relates only to the needs of [XJZY] taking into account her disabilities, her health conditions and the environment in which she lives. It should not be read as an endorsement of a particular model of care in other circumstances.(Original emphasis.)

Ratio Decidendi

Legal Principle Established

The question of law must be answered aversely to the Agency, and the ground of appeal supporting it must be rejected.Irrationality/illogicality in the Tribunal’s findings about Ms Merran (question of law 2, ground 2) This question of law, and the ground supporting it, are put in the alternative to the first question of law, but in substance challenge the same findings and reasoning by the Tribunal about Ms Merran’s evidence. The Agency contends that:the treatment of Ms Merran’s evidence on credit grounds was central to, and dictated, the Tribunal’s consideration of s 33(5), and Ms Merran’s evidence was not truly considered because it was wrongly diminished in weight due to the issue of her credit.…As set out above, the propositions underlying the reasons that the Tribunal gave for subordinating Ms Merran’s evidence to A/Prof Wilson (and Prof Dowse) were not supported by, or rationally open on, the evidence. The Tribunal thus identified wrong issues (‘personal interest’ and ‘real concern’), and in doing so asked itself the wrong question (whether those issues were made out), and answered them based upon findings that were not properly open. That is an error of law: WRMF at [71]-[72]; Tsvetnenko v USA (2019) 269 FCR 225 at [35]. The Agency relied upon the approach to illogicality and irrationality set out by the Full Court in DAO16v Minister for Immigration and Border Protection [2018] FCAFC 2; 258 FCR 175. At [46] of its written submissions, the Agency contended the Tribunal “wrongly dismissed Ms Merran’s highly probative evidence”. It can be seen from this contention, confirmed by language used in oral submissions on the appeal, that the Agency in truth sought to impugn the merits of the decision made by the Tribunal, and its decision not to place weight on Ms Merran’s evidence. That is one of the challenges in relying on the irrationality and illogicality grounds – they can be easily transformed from the judicial supervision of legal error to an assessment of what was the correct or preferable outcome, or the correct or preferable treatment of certain evidence. See Minister for Immigration and Citizenship v SZMDS [2010] HCA 16; 240 CLR 611 at [96]; BJO18 v Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs [2020] FCAFC 189; 281 FCR 594 at [71(5)] (Murphy J), [144] (O’Callaghan J), [150] (Snaden J); DAO16 at [30(5)]. In oral submissions, the following example of the difficulty the Agency had treading that line between contentions about illogical reasoning that caused the Tribunal’s task to miscarry, and an invitation to the Court to re-visit the merits of the review, is apparent (and in effect properly recognised by counsel: transcript at p 28, ll 1-41):[MR KREMER:] We say, simply, a person hearing Ms Merran’s extensive experience and hearing her say, “You don’t need to have a nurse do this, and you don’t need to have a nurse do that, and it can be done by a support worker overseen by a nurse,” which is the way the model actually works – when one is looking at that evidence, one doesn’t jump to a finding that, well, that evidence about the tasks and the appropriateness for the individuals are somehow tainted by the fact that she has used the model or has been involved in its development or says that the model works. The disconnect again is between the model that Ms Merran has been bound up in and has gone down on with her opinions as to the tasks for the participants, and what wasn’t impugned was her expertise to be able to evaluate and assess these participants. What wasn’t in issue was whether she had the years of experience delivering services to them. What wasn’t in issue was whether her assessment of what they needed in terms of support - - -MORTIMER J: There was a debate, Mr Kremer. There was a debate before the tribunal about whether she had spent enough time with them.MR KREMER: That’s correct. And we have put it in the submissions, where she said she spent about 30 minutes with each participant, she had done thousands of those and she thought that that was all the time she needed over her almost 40 years of experience. I’m not going to get into saying that this is some sort of an error, because that would be getting into merits review, but we say it’s a signal point that that isn’t one of the two reasons that her evidence was disbelieved, or not accepted or given less weight on it. If that had been the true motivating factor and it was something that the respondents did put in submissions, if the real reason for disbelieving her evidence or relegating it to Professor Wilson is she didn’t really appreciate their needs, she hadn’t spent enough time, all of what she did was somehow fatally flawed despite her extensive experience, we say that would have been in paragraph 101 and there wouldn’t have needed to be a paragraph 102.That would have then justified, potentially, the treatment that the tribunal gave her, subject to linking that to each of the particular tasks that she talked about. In other words, was she there long enough to see that you don’t need a nurse to look at someone’s skin for 50 minutes, 48 minutes a day. That would have to be connected to a 30-minute assessment being inadequate. And on the dispositive findings, and it’s for the reasons set out in those two paragraphs that all of the statutory tests are applied with respect to, that is something that could have been done but we say wasn’t. And one can’t inject that back into the tribunal’s actual reasons. I think [Mulligan] makes that clear; one looks at the tribunal’s reasons as recording its reasoning process and its findings.