Taylor v The Medical Board of South Australia - [2010] SASC 308

SUPREME COURT OF SOUTH AUSTRALIA
(Miscellaneous Appeal: Civil)
TAYLOR v THE MEDICAL BOARD OF SOUTH AUSTRALIA
[2010] SASC 308
Judgment of The Honourable Justice Anderson
9 November 2010
PROFESSIONS AND TRADES - HEALTH CARE PROFESSIONALS - MEDICAL PRACTITIONERS - LICENCES AND REGISTRATION - APPEALS AND APPLICATIONS FOR ORDER DIRECTING REGISTRATION
Appeal pursuant to s 65 of the Medical Practice Act 2004 - appeal against decision of the respondent to refuse reinstatement of the appellant's registration as a medical practitioner.

PROFESSIONS AND TRADES - HEALTH CARE PROFESSIONALS - MEDICAL PRACTITIONERS - RESTORATION TO REGISTER
Appellant was registered as a practitioner with a limited registration for the purpose of undertaking medical internship - registration required at all stages of internship - registration lapsed before internship completed - internship took longer than usual due to appellant's absences from work and requirement to repeat rotation - absences from work caused by physical and psychiatric health issues - application was made for reinstatement on register in order to complete internship - application was refused - whether decision-maker was biased - whether appellant is "medically fit" to continue internship - whether appellant suffers from Asperger's Syndrome - whether decision-maker erred in its consideration of the evidence - whether decision-maker discriminated against the appellant - whether application wrongly refused.
Held: No demonstrable error in the reasoning of the respondent - the respondent's decision was available on the evidence - appeal dismissed.
Medical Practice Act 2004 (SA) s 4, s 13(2), s 33(1), s 33(1)(c), s 33(2), s 33(2)(b), s 34, s 37, s 50, s 65 and s 77 ; Mental Health Act 2009 (SA); Health Practitioner Regulation National Law (South Australia) Act 2010 (SA); Disability Discrmination Act 1992 (Cth) s 19 and s 12(6); Equal Opportunity Act 1984 (SA) s 5(g), s 66 and s 73(2), referred to.
Carver v The Law Society of New South Wales (1998) 43 NSWLR 71, applied.

WORDS AND PHRASES CONSIDERED/DEFINED
"medically fit"

TAYLOR v THE MEDICAL BOARD OF SOUTH AUSTRALIA
[2010] SASC 308
Civil
ANDERSON J.
Introduction

The Medical Board of South Australia (“the Board”) was established pursuant to the provisions of the Medical Practice Act 2004 (SA) (“the Act”). That Act has now been repealed. It is relevant, however, for these proceedings.
This is an appeal pursuant to s 65 of the Act against the decision of the Reinstatement Committee of the Board. The Reinstatement Committee considered an application for reinstatement of registration by the appellant Dr Taylor pursuant to s 37 of the Act. The decision of the Reinstatement Committee was given, with reasons, on 14 July 2010.
The objects and powers of the Board are set out in Division 4 of the Act which deals with general functions and powers. In general terms, the Board is charged with regulating the practise of medicine in the public interest.
Section 13(2) of the Act states:
13—Functions of the Board
…
(2)The Board must perform its functions under this Act with the object of protecting the health and safety of the public by achieving and maintaining high professional standards both of competence and conduct in the provision of medical treatment in this State.
The Board controls not only medical practitioners and specialists but also medical students and interns: see s 34, s 50 and s 77, for example.
The appellant
Dr Taylor qualified as a Bachelor of Medicine and Bachelor of Surgery in 2008. Her progress as a medical student was not without incident. I will deal in more detail with her physical and psychological difficulties later in these reasons, but for present purposes she suffered from debilitating conditions which resulted in the involvement of the Board during her time as a student.
In her first year of medical school in 2003 the appellant tried to take her own life for the first time, although she has reported to various specialists that she had thoughts of not wanting to live throughout childhood and adolescence. She first consulted a psychiatrist in her second year through the Assessment & Crisis Intervention Service (“ACIS”), and that year was admitted to Glenside Hospital, Royal Adelaide Hospital (“RAH”), and the Adelaide Clinic (“TAC”) for short periods due to suicidal and self-harming behaviour. In third year, the appellant attempted suicide on multiple occasions and at that time was diagnosed with bi-polar affective disorder. She was later diagnosed with borderline personality disorder.
The appellant was prescribed various mood-stabilising medications to try and treat those disorders. She did not have great success with those medications and reported some side effects. In the report of Dr Baigent, he noted that up to September of her fourth year of medical school, the appellant had attempted suicide approximately 30 times. In her fifth year of medical school, the appellant experienced significant difficulties relating to her physical health problems. That year the appellant was diagnosed with a common variable immunodeficiency condition. As a result of health problems she spent six days in the RAH Emergency Extended Care Unit. The appellant was also admitted to the Flinders Medical Centre (“FMC”) during her fifth year. Her attempts at suicide continued into her fifth year.
During her six years at medical school, the appellant presented to emergency departments across the metropolitan area many times due to continued suicide attempts, the majority by overdosing herself. There were times when the appellant was taken to hospital by the police. I note, however, that some of the hospital admissions can be explained by an assault she suffered in December 2006 while working as a security guard at the Caledonian Hotel.
After her degree was conferred, the appellant was required to complete a period of internship. She commenced that at the Queen Elizabeth Hospital (“QEH”) in 2009 but her internship was interrupted due again to her medical conditions. At the present time Dr Taylor’s registration has not been renewed, it having lapsed during her period of internship. She is therefore required to be reinstated by the Board to enable her to complete her internship.
Agreement has not been reached on how many weeks she has left to complete her internship. She wishes to do that so that she is in a better position to obtain employment. It is only a matter of eight or ten weeks or thereabouts that she has to complete. I cannot understand why the exact period is not known and agreed.
The appellant is currently 27 years of age. She was born in Canberra and lived there prior to moving to Adelaide to attend medical school. The appellant has always done very well academically. In Year 12, she came seventh in the Australian Capital Territory (“ACT”), and was awarded the Caltex Award for the best all-rounder in the ACT.
During her time at medical school, the appellant was awarded a number of scholarships including the Sir Charles Bright scholarship for students with a disability and financial hardship with good academic standing, the Walter and Dorothy Duncan Trust Award for students with good academic merit and financial hardship, and the Wyndham Richardson Award based on academic merit, life goals, and financial situation. She received the Australian Medical Undergraduate scholarship two years in a row. This is for rural students who have been enrolled in medical school. The appellant gave evidence before the Board that she received no financial support from her family after the mental health issues began to surface. She managed to support herself through numerous and varied part-time/casual jobs, including teaching saxophone and piano. She is clearly talented musically and enjoys a diverse range of hobbies. All in all she is a person of great talent and intellect.
This year she has completed a Post-Graduate Certificate in Clinical Toxicology through the University of Newcastle and has indicated a strong interest in this area. She is continuing her Masters in Pharmaco-Epidemiology and has started a Masters of Disability Services. She is also undertaking a diploma in counselling. She currently lives in a house that she purchased approximately a year ago in the suburb of Elizabeth Vale and rents out a room to a housemate. Her parents live in country New South Wales and she occasionally has visits from her father who stays with her.
Recent history
On 9 January 2010 the appellant was admitted to the RAH due to ongoing thoughts of self-harm and suicide. The next day the appellant took an overdose of Prazosin while still an inpatient.
On 11 January 2010 Dr Short, who was her treating psychiatrist, reviewed the appellant and recommended to her that she be admitted to TAC to help her improve her mood state, and mental health. She remained an inpatient until 23 January 2010. On that day the appellant attended Ashford Hospital for treatment of a respiratory infection. Upon returning, she had an argument with TAC staff regarding her diet and left TAC. She returned that evening and was abusive and hostile towards staff. The argument led to the appellant leaving the building and climbing on top of the roof. Dr Short placed her under a detention order and she was taken by ambulance to the RAH.
She was detained for 72 hours at the RAH under the Mental Health Act 2009 (SA) when she was released by Dr Davis. While at the RAH, she took an overdose of tricyclic antidepressant Amitriptyline which she had brought with her.
Dr Short terminated his treatment of the appellant after that incident. It is clear the appellant experienced some difficulties in dealing with Dr Short’s termination of their doctor/patient relationship. She expressed her distress during her interview with Dr Hundertmark in February this year and told him that she had contacted the ACIS team on a number of occasions since being discharged from the RAH.
On 12 February 2010 the appellant inserted a jelco into a vein in an attempt to end her life. She lost between 1½ and 2 litres of blood as a result. She was taken to the Lyell McEwin Emergency Department and was assessed and treated there.
Since that incident the appellant has not had any contact with Emergency Departments or hospitals for psychiatric problems. She informed Dr Short in September this year that she had not thought about suicide since April or May 2010.
The history set out above showing the problems Dr Taylor encountered in the early part of this year is most significant in assessing her current medical fitness to practise medicine.
The grounds of appeal
As I previously indicated, the Board published detailed reasons for its decision in refusing Dr Taylor’s application for reinstatement. Those reasons have been examined closely by counsel in this appeal.
Dr Taylor appeals to this Court on the following grounds:
1.That Dr Sexton should not have been appointed to the Reinstatement Committee of the Board for reasons of bias or apprehended bias.
2.That the Board erred in making an equivocal finding as to the diagnosis of Asperger’s Syndrome.
3.That the Board erred in ruling that the relevant criteria for assessing the appellant’s application were those in s 33(1) of the Act instead of s 33(2).
4.That the Board erred in ruling that the phrase “fit and proper” carries different standards and responsibilities depending on the type of professional authorisation sought by a person and the nature of activities to be carried on by that person, instead of having regard to s 4 of the Act.
5.That the Board erred in considering the appellant’s ability to practice medicine in the long-term.
6.That the Board did not give any or sufficient weight to the opinions of Dr Encel, Dr Nambiar, Dr Hadges, Ms Allstrom, Professor Attwood and Dr Short, and gave too much weight to the suggestion that they were not aware of the appellant’s full medical history.
7.That the Board gave undue weight to the opinion of Dr Hundertmark where he did not give oral evidence before the Board, and the Board relied on his reports and evidence before the Tribunal, evidence which was lacking partiality and objectivity.
8.That the Board gave undue weight to the opinion of Dr Davis who only reviewed the appellant on one occasion, and then only briefly for the purposes of an assessment of a detention review under the Mental Health Act 2009 (SA).
9.That the Board failed to give any or adequate consideration to the evidence of the appellant.
10.That the Board gave undue weight to the appellant’s immunodeficiency when Dr Hadges was not cross-examined on its impact on the appellant’s ability to practice, and the condition had not been previously raised as a concern.
11.That the Board did not give weight to Dr Short’s opinion on the appellant’s fitness to practice up to January 2010, and failed to consider his opinion against that of Dr Hundertmark.
12.That insufficient time was allocated by the Board in which to hear the appellant’s application, resulting in a denial of procedural fairness, particularly after ruling that it would undertake a “detailed and longitudinal assessment”.
By agreement of counsel I heard the first ground as a preliminary point. I decided, after hearing argument, that the presiding member of the Board, Dr Sexton, had played such an important part behind the scenes, and including his involvement in referring the matter to the Medical Tribunal, that on all the tests there must be an apprehended bias.
I set out brief reasons for that decision, which I repeat:
I find that there is an apprehended bias in Dr Sexton acting as the presiding member of the Reinstatement Committee of the Medical Board of South Australia.
This situation might have arisen because of the structure of the board and its role in delegating functions and also its role in making decisions to take disciplinary action and advance that action in the tribunal. I consider that any fair-minded, informed lay observer might reasonably apprehend that in the various roles he performed Dr Sexton might not be able to bring an impartial mind to resolving the question before the Reinstatement Committee. I rely particularly on Carver v The Law Society of New South Wales (1998) 43 NSWLR 71.
It is not to the point that Dr Sexton held no actual bias. I accept that it is the case that he held no actual bias. It is the apprehension of bias which is crucial in this matter.
It is useful for me to set out here some further details of Dr Sexton’s involvement.
·     Dr Sexton was present at the Board meeting on 18 March 2010. At that meeting the decision was made to lay a complaint against the appellant in the Tribunal. He did not vote on that motion, although he was present at the meeting.
·     It was alleged that Dr Sexton at all material times provided instructions to the Board’s solicitors regarding the conduct and prosecution of the Tribunal complaint. That was denied but the matter was never resolved.
·     Dr Sexton was present at the Board meeting on 10 June 2010. He was the presiding member of that meeting. At that meeting the Board discussed the Tribunal complaint and resolved to form a Reinstatement Committee to decide the appellant’s registration application.
·     Dr Sexton was then made the presiding member on the Reinstatement Committee.
My ruling on Dr Sexton led to a discussion as to where the matter should go, given the fact that the legislation had changed, the Act had been repealed and a new regime had come into being as a result of the enactment of the Health Practitioner Regulation National Law (South Australia) Act 2010 (SA).
There was considerable argument as to how the matter should proceed. The choices were: send it back to a newly constituted Board in South Australia, which I was told was not possible under the new regime, or have a new Board in another State hear the matter. This, I was told, would involve most likely a hearing in Victoria. The other choice was for me to hear and determine the remaining issues raised in the appeal.
I decided, after hearing argument, that the fact that there was a finding of apprehended bias did not prevent me from proceeding and hearing the balance of the grounds of appeal. It was agreed by counsel on both sides that the appeal hearing was by way of re-hearing.
In his final submissions Mr Heywood-Smith QC for the appellant submitted that because of the finding of apprehended bias, I should discount the effect of the Board’s considerations. There seems to be no direct authority to support that.
I take a pragmatic view on this submission. If I had heard all grounds of appeal together as part of the re-hearing I would have dealt with the Board’s decision as part of that re-hearing. In the circumstances I would have reached the same conclusion that I could not interfere with the Board’s decision and that in any event I agreed with the decision. In those circumstances the re-hearing would have been complete and I may have merely stated that it was not necessary to find on bias. Alternatively, I may have said that there was an apprehended bias but that it did not matter because I had completed the re-hearing and reached a result in any event without taking into account the Board’s decision.
In any event the relevance of what the Board said in its reasons would have been fully canvassed, as it now has been. The fact that I was asked by the appellant, and not opposed by the respondent, to make a preliminary finding should make no difference to the overall disposition of the appeal. On a re-hearing it would always be necessary to review the whole of the evidence.
There was also an application made by the appellant to call fresh evidence. In the end I allowed one witness, the psychiatrist Dr Dan Short, to give evidence because he had previously been the appellant’s treating psychiatrist and his report had been tendered at the hearing before the Board as a substitute for him giving evidence because of matters of expediency. I thought it important to particularly hear from him in relation to whether there was, in his opinion, a diagnosis of Asperger’s Syndrome. Other medical practitioners had given opinions that there either was or was not evidence of such a syndrome but Dr Short had not been certain at that stage and the Board did not have the benefit of his oral evidence. On that basis he was permitted to give evidence.
The Board’s findings
I have taken the view that I should look at and examine the Board’s findings. I will therefore analyse those findings. It is important to do so because a large part of the argument advanced by Mr Heywood-Smith was to analyse all the evidence before the Board. His argument generally was directed to the weight to be given to the evidence of various experts, and in particular his submission that the Board erred in accepting and acting on the opinion of Dr Hundertmark as against all the other evidence.
The Board considered a substantial amount of expert evidence, both from doctors who gave evidence before the Board, and in some cases from doctors whose reports were tendered by consent. It is clear that the Board took particular note of the opinions of Dr James Hundertmark who was an independent psychiatrist who gave evidence to the effect that Dr Taylor had such significant risks attached to her frail psychological condition that she should not continue in a medical career.
The Board made the following significant findings:
100.The Board does not hold the view that the acquisition of a medical qualification should automatically give permission for a career in medicine to continue on that basis. Life as a student is very different to that of a clinician and evidence before the Board has clearly indicated that with new and increasing stressors, Ms Taylor has struggled to cope with the completion of her internship for a variety of reasons and has required a team of support to progress only this far. This reflects negatively on her fitness and propriety.
101.The Board is very concerned that such support will only have to increase with attempts to progress further through a medical career and that on the evidence available to it any short-term reduction in suicidality will not be sustainable.
102.The Board is very concerned that Ms Taylor’s continuation in medicine and her aspirations to progress towards a specialty are unrealistic and potentially personally hazardous and depend to a great extent on a suite of supportive personal therapists.
103.The Board is likewise concerned that the expectations of government, the public and the profession as well as medical regulators are increasing and that mandatory reporting of health professionals under the new national registration legislation will see significant barriers ahead for Ms Taylor and present her with challenges which will exceed her capacity to cope, with a high risk of adverse personal outcomes.
104.The spontaneity and unpredictability of individual patient presentations, the need to respond to all patients with skill, empathy and compassion, the need to reason and think laterally and with neither concrete thought processes nor prejudice, the uncertainty and need to work as an individual and in a co-operative team under duress for long periods are likely to exceed the capacity of Ms Taylor to cope now and into the future.
105.Her response to these may well continue to be maladaptive and hazardous with the added threat that her physical health will further imperil her choice of a medical career pathway and her ability to work in that role.
106.The Board considers that it needs to be satisfied that Ms Taylor has the ability to commit to work and be physically well enough on a daily basis to ably treat others under such conditions and that on the evidence considered it has considered this has not been achieved.
107.It is evident to Board that whilst Counsel placed considerable focus and importance on the diagnosis, it is concerned that her aberrant behaviour which is both persistent and longitudinal will require a high-maintenance approach and ongoing intensive therapy in order for her to cope with life and work as a doctor.
108.This coupled with the daily immunological illness which places her at significant risk of sino-bronchial infection and long-term lung complications, would require special precautions, restrictions and considerations at work. She is at serious risk of contracting infections from both patients and the general public.

The Board also said at 112 and 116:
112.The Board concludes that Ms Taylor has demonstrated aberrant reactions to stress over a long period which has placed her and continues to place her at high risk to herself. Concurrently she demonstrates the high need for public services and special supports at work. She has required the support of a significant number of therapists and mentors to cope with both life and work and has needed specific occupational safety strategies. She has an immune condition which impacts negatively on a daily basis and places her at risk of serious physical and psychological outcomes.
...
116.The Board is also very concerned that Ms Taylor’s medical conditions will place her at personal risk well into the future with little prospect of a cure. It has been noted that the continuation of a career in medicine may place her life at risk.
The Board’s conclusions then followed:
117.The Board is therefore not satisfied that Ms Taylor is medically fit to practise medicine.
118.The Board cannot therefore at this point in time register Ms Taylor.
119.The Board would encourage Ms Taylor to actively pursue alternative career pathways without these pressures in the hope that she will have time to learn more appropriate behavioural responses to stress and to avoid occupational hazards and professional life within a medicine profession with very high expectations of its colleagues.
120.The Board could not look favourably on any attempted future application for registration as a medical practitioner without at least clear evidence of a prolonged and sustained period of several years of mental stability and improvement with reports from both treating and independent psychiatrists, full compliance over that period with the regular and appropriate psychotherapy recommended by independent and treating psychiatrists, a demonstrated honesty of character in dealings with all treating health professionals and compliance in full with treatment. In addition, Ms Taylor would need to demonstrate those characteristics which would leave in no doubt in the minds of her colleagues and the Board that she is both fit and proper and medically fit.
The expert evidence
The Board relied on the expert opinion evidence of the following doctors and treating specialists from the tendered reports: Professor Tony Attwood, Dr Short, Dr Hundertmark, Ms Kate King and Ms Angela Davis, Dr Steven Hadges, Dr Paul Davis, Dr Narain Nambiar, Ms Mary Allstrom, Dr Conrad Wareham, Dr Nicola Encel, and Dr Adrian Anthony. Oral evidence was given to the Board by Dr Wareham, Dr Encel, Ms Allstrom, Dr Hadges, Dr Nambiar and Dr Anthony.
I have reviewed that evidence. I will summarise briefly the written and/or oral evidence given.
Professor Attwood
Professor Attwood is a psychologist and a noted expert in Asperger’s Syndrome. He used the Ritvo Austism Asperger’s Diagnostic Scale (RAADS) to assess the appellant and affirmed the diagnosis of Asperger’s. In his opinion, in light of that diagnosis, the appellant should be able to practice as a proficient medical specialist, with special provisions. Flexibility with degree of social contact with medical peers and preferred working style would assist. He wrote that “people with Asperger’s are often natural experts in specific areas” and “the medical profession and patients in particular, will eventually benefit from her expertise and natural talents in the area of toxicology”.
Professor Attwood described the appellant as being prone to episodic depression triggered by relatively minor events, or a “depression attack” in his words. He recommended that the appellant have a support person physically with her during her episodes, whether they last hours or days. This would be to prevent suicide and eventually to minimise the frequency and duration of the intense depressive episodes.
The Board thought that such high-level support, which based on her history could be required frequently, would be difficult to achieve and unrealistic. The Board considered Professor Attwood’s recommendations to be based on a limited understanding of the appellant’s internship requirements and her full clinical picture.
Dr Short
Dr Short was the appellant’s treating psychiatrist from 2006 to January 2010. The Board had a number of written reports before them from Dr Short, spanning the period in which he treated her, as well as one subsequent report dated 24 February 2010. The reports described various incidents and hospital admissions. Dr Short expressed differing diagnostic opinions during that period but finally settled on Asperger’s. Along the way, Dr Short gave the Board recommendations as to whether the appellant was fit to continue her studies, and generally that she was fit but he was unable to express an opinion as to her fitness in his February 2010 report.
He raised concerns about the appellant’s impulsive and antagonistic behaviour, particularly towards authority, and her inability to develop appropriate therapeutic relationships with previous treating doctors. Dr Short considered long-term psychotherapy was fundamentally necessary to the appellant’s ability to function as a medical student and a doctor. His opinion was that her ability to complete her internship was affected by her ongoing poor physical health, her social dysfunction related to Asperger’s, other stressors, anxiety, and incidences of bullying.
Dr Short provided a more recent report dated 15 September 2010, after interviewing the appellant and referring to the expert reports of the appellant’s other treating specialists. In it, he expressed the opinion that the appellant is currently fit, both medically and psychiatrically, to return to her internship. He was “almost surprised” at the appellant’s progress over the previous six months. He stated that she had made significant efforts to improve her condition with her attendances on two clinical psychologists and with Dr Nambiar who was then her treating psychiatrist. He stated that she was making excellent progress under psychological treatment using models established for Asperger’s, and strategies specifically tailored for her. Dr Short noticed a marked decrease in the personality traits that might be associated with borderline personality disorder.
Dr Short also gave evidence before this Court. In cross-examination, he confirmed that the appellant, while in his care, had a long period of stability from April 2007 to March 2009. She subsequently relapsed into self-harming and suicidal behaviour as a result of frustration from both her physical health and work stressors.
Dr Short disagreed that the reason for the appellant’s period of stability over the past approximately six months was her absence from her internship and consequent reduction of work stress. He stated that she was still under stress from the legal proceedings, financial difficulties, and a road-rage incident in which she was the victim.
Dr Short stated in cross-examination that “simply having anxiety or depression shouldn’t stop one from practising as a doctor”. He expressed the opinion that the appellant should be allowed to continue with her internship, with a proper support system in place.
Dr Hundertmark
Dr Hundertmark was an independent psychiatrist whose opinion was sought by the Board in 2007. At that time Dr Hundertmark expressed the opinion that the appellant was “medically unfit to provide treatment both as a medical student and as a medical practitioner”. He noted that she had been diagnosed with bi-polar and borderline personality disorder but he felt there was little value in distinguishing between the appellant’s various diagnoses. He explained that her significant affective instability and deliberate self-harm had severely impaired her functioning over a prolonged period.
Dr Hundertmark wrote “[a]ll indications from the [appellant’s] clinical history are that she has a longstanding disturbance which will continue on into the future for many years … this clinical instability will make the practice of medicine an extremely difficult one for her and perhaps put the patient’s safety at risk as a result of her personal mental health problems.”
His consistent opinion was that there was significant personal risk should the appellant continue in her medical career. He recommended long-term one-to-one psychotherapy linked to dialectic behaviour therapy, including group therapy. Dr Hundertmark gave his opinions based on what he considered significant affective instability, her behaviour, marked animosity and anger towards authority figures, anger management problems, identity issues, difficulty in establishing appropriate boundaries, difficulty in sustaining relationships with others, and her “splitting” tendencies. He excluded the diagnosis of Asperger’s and preferred the diagnostic label of borderline personality disorder. He considered that she had a long-term unsuitability to a medical career.
Dr Hundertmark also gave an updated report dated 4 March 2010 after re-interviewing the appellant. In that report he confirmed his opinion that she did not suffer from Asperger’s and his opinion that the diagnosis was not the critical issue but the repeated and high lethality suicidal behaviour and its eventual impact, which is not within the appellant’s control. His opinion was that the appellant was not fit to practise medicine. He wrote that “her difficulty managing her mood state may overwhelm her on occasions … this could impair her clinical practice”. Dr Hundertmark also wrote that “the public may be at risk due to [the appellant’s] issues with decompensating when under stress”.
In his opinion, the appellant cannot deliver the high standards of practice required of practitioners. His recommendation was for weekly, or more frequent, sessions of psychotherapy over several years.
The Board considered Dr Hundertmark’s reports and transcript of his evidence before the Tribunal. It played a significant role in the considerations of the Board.
Ms King and Ms Davis
Ms King and Ms Davis provided a joint Diagnostic Assessment Report after being self-referred by the appellant. Ms Davis is a psychologist and Ms King is a speech pathologist. The appellant was interviewed and an assessment of Asperger’s Syndrome was made using the criteria in the Diagnostic and Statistical Manual, 4^th ed (“DSM-IV”) of the American Psychiatric Association. The report states that it is based solely on information provided by the appellant and with some assistance from her friend Yelena. They concluded that the appellant does present as a person with Asperger’s.
The Board had concerns regarding their report as it was contradictory with respect to repetitive behaviours.
Dr Hadges
Dr Hadges had been the appellant’s general practitioner in the three years before the Board hearing. He saw her monthly and sometimes weekly. Dr Hadges managed some of the appellant’s physical problems resulting from her immunodeficiency condition and described daily fevers, fatigue, propensity to infection and a requirement for prophylactic inhalational and intermittent antibiotic treatment. He also offered some psychological support (or counselling) to the appellant.
Dr Hadges wrote a letter for the Board dated 10 May 2010 stating his opinion that the appellant was “medically fit to complete her internship under appropriate supervision”.
The evidence of the GP Dr Hadges was relevant due to the appellant’s insistence that her physical condition and not her mental illness was the cause of her repeated absences from work. The Board noted in its reasons that both Dr Nambiar and the appellant herself made a link between her daily physical sickness and resulting frustration and her mental state. The appellant told Dr Hundertmark that she does not attend hospital as a student when feeling hypomanic and instead takes the day off. Dr Short also made this link in his report dated 8 November 2006, as did Dr Davis.
The Board stated in its reasons that Dr Hadges “lacked an appreciation of [her] full mental history especially prior to 2008” and that it was clear he was unaware of the full details of her mental illness. His letter and oral evidence was therefore given reduced weight by the Board. This was one area where Mr Heywood-Smith criticised the Board. He submitted that GPs have the ability to better understand the make-up of their patients than do the specialists.
Dr Paul Davis
Dr Davis provided a report as requested by the Board, having interviewed the appellant to review her detention at the RAH under the Mental Health Act 2009 (SA). He observed she had a restricted range of affect but this was appropriate, given their conversation.
In his opinion the appellant had a long-term pattern of emotional dysfunction with a tendency to externally project responsibility for her misfortunes on others, particularly those who purportedly misunderstood her and frustrated her needs. Dr Davis expressed concern regarding the appellant’s inability to take responsibility for her actions. He noted a history of intense anger and a recurrent theme of “not coping” with coping skills regularly stretched past her limit. He considered the appellant had a tendency to act impulsively without consideration for the consequences and that she had a serious prognosis which is difficult to treat.
His opinion was that the appellant had a long way to go before she achieved emotional stability. Dr Davis stated that the appellant clearly struggled with ill-health which had a continuing negative impact on her emotional state. He felt that, at that time, she was not in a fit mental or emotional state to practise medicine by providing treatment to others. His opinion was that, into the future, the appellant is not fit to practise medicine based on her pattern of reacting to stress, as the practice of medicine is a demanding and stressful one.
Dr Nambiar
At the time of the Board’s hearing, Dr Nambiar had been the appellant’s treating psychiatrist for roughly three months. He cited his role as assessing her need for antidepressants and her suicidality. In his opinion, the appellant’s behaviour was partially consistent with both borderline personality disorder and Asperger’s Syndrome, but he deferred to psychologists’ opinions where the Asperger’s diagnosis was concerned. He also believed she suffered from episodic depression, partly related to her immunodeficiency condition and the resulting health problems.
Dr Nambiar told the Board at the hearing that a long-term approach was required in the appellant’s case and that her response to stress was “maladaptive”. He stated that she needed regular psychological therapy providing coping strategies and that her progress and application of such strategies should be monitored. In his report, Dr Nambiar suggested that she may benefit from cognitive behavioural therapy.
Dr Nambiar suggested that in returning to the QEH the appellant would require fully informed supervisors and supports, to be briefed in conjunction with her treating psychologists, and that be a condition of her limited registration. He recommended that a further condition be imposed that she agree to comply with a treatment regime.
His opinion per his report dated 29 April 2010 was that the appellant was fit, from a psychiatric viewpoint, to complete her internship and attempt to complete her last rotation.
Dr Nambiar accepted that the appellant’s prognosis was “guarded”. He accepted that any potential progress would only occur in the long-term, over two or more years, and that there would be no significant change in the short-term.
The Board said in its reasons that up to the time of giving evidence, Dr Nambiar had only been provided with an incomplete medical history by the appellant, and he had not had the opportunity to gather all relevant clinical information. This was of some concern to the Board and they noted that this was a common theme amongst the appellant’s treatment team. They noted that Dr Nambiar expected to have an ongoing role in treating the appellant as one member of her “team of professional support” but had only had limited contact with the rest of the team to that date.
Ms Allstrom
Ms Allstrom is a mental health advocate and is the Consumer Advisor for the Mental Health Directorate. She was referred to the appellant by Dr Short and she assisted the appellant through the Board proceedings. She provided a report dated 24 March 2010 and a letter dated 21 February 2010 in which she described “working with” the appellant using similar techniques as with her own son, who has Asperger’s. She had some success with these techniques and stated that “when her environment was such that her stressors reduced … she was then able to problem solve her issues with some calm and sensible assistance”.
In her report Ms Allstrom expressed the opinion that the appellant should not be stopped in her pursuit of a medical career. She based this opinion on her belief that the appellant had now been correctly diagnosed and was receiving intensive treatment for Asperger’s.
The Board considered that she lacked objectivity and gave her evidence and written documentation little weight.
Dr Wareham
Dr Wareham was the Acting Director of Medical Services at the QEH. He had never met with the appellant but had access to her intern reports. He admitted to having a personal interest in Asperger’s Syndrome with a family member having the condition, and this motivated him to take a favourable view of the appellant’s circumstances.
Dr Wareham was not aware of the appellant’s complete medical history but conceded that multiple serious suicide attempts, hospital admissions and significant reliance on ACIS were relevant and concerning. In Dr Wareham’s view, it was not the appellant’s performance that was preventing her from completing her internship but rather her frequent absences. He gave evidence before the Board that the QEH was prepared to put sufficient supports in place to assist her, though this had not been done for any QEH intern before. No specifics of the kind of support was given. After being informed of the appellant’s suicidality, Dr Wareham was unable to confirm that the QEH would take her back as an intern without further enquiry.
Dr Encel
Dr Encel was one of the appellant’s two treating clinical psychologists. She has specific expertise in Asperger’s Syndrome. Her opinion was that the appellant suffered from Asperger’s Syndrome. Her opinion was based on subjective observation as well as the diagnostic concurrence from her colleagues. Dr Encel stated that the diagnosis of Asperger’s was subjective and that the diagnosis of borderline personality disorder was possible, although she had limited expertise in this condition. She acknowledged that when there is an alternative explanation of “cognitive maladaption” then that diagnosis takes precedence over the Asperger’s diagnosis.
Dr Encel gave evidence before the Board that the appellant was responding to her cognitive behaviour therapy and affective training. She stated that the appellant was motivated to improve her social functioning and change her behaviour, and that her progress should continue to improve over the next 12 months.
Dr Anthony
Dr Anthony is the Director of Clinical Training at the QEH. He was not aware of all the events concerning the appellant. He gave evidence to the Board regarding the appellant’s intern placement reports. Dr Anthony, in consultation with Dr Peter Satterthwaite (Director of Medical Services a the QEH), offered support to the appellant, in principle, in continuing her internship but this is conditional on the appellant being registered and any conditions of registration being disclosed to the QEH; the QEH receiving an updated written report from the appellant’s treating psychologist and psychiatrist indicating her fitness to return to work; the report articulating the supports and conditions that are deemed necessary to enable the appellant to work and train effectively and to maintain her in good health; the hospital being able to provide reasonable supports and conditions within its existing resources; and that prior to an offer of employment the hospital is able to meet with the appellant to discuss and agree upon expectations of performance, supervision, assessment and supports.

He did not provide a clear, individualised plan of support for the appellant. Before the Board, Dr Anthony estimated that the appellant had eight weeks of her internship to complete.
He provided information by email which was tendered in this matter. He said that the QEH was in principle willing to offer Dr Taylor the opportunity of completing her internship.
That offer was qualified, however, because the QEH required updated reports on her fitness to return, confirmation that the hospital could provide the necessary support, and it was subject to Dr Taylor agreeing to terms and conditions. He, of course, was not in a position of finally deciding because that decision would be negotiated by others in the medical administration section of the hospital. It was therefore a very qualified answer to the question of whether she had an offer to complete her internship.
Asperger’s Syndrome
According to the report of Ms King and Ms Davis:
Asperger syndrome is a pervasive developmental disorder, which is considered to be part of the autistic spectrum. The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) of the American Psychiatric Association specifies that people diagnosed with Asperger syndrome must present with a qualitative impairment in social interaction and with restricted, repetitive patterns of interests, activities or behaviours. Additionally, there is often impairment in the use of language for social discourse, and difficulties with the processing of sensory information. Diagnostic criteria stipulate that there must be no clinically significant general delay in language or cognitive development.
At this time there are no medical or psychological tests to diagnose Asperger syndrome, so diagnosis is based on the presence of a cluster of the common behavioural characteristics of the syndrome. Diagnosis requires that significant deficits in the areas mentioned above exist for each individual, however, people present differently and are affected in each area to varying degrees. The behaviours associated with Asperger syndrome can vary within individuals as they grow and develop and respond to various situations and environments in their daily lives.
According to Dr Hundertmark’s report dated 4 March 2010:
The diagnostic criteria in the DSM include a number of groups. The first refers to a qualitative impairment in social interaction as manifested by at least two or the listed features.
…
The second diagnostic group on the DSM involves restricted, repetitive and stereotype patterns of behaviour, interests and activities manifested by at least one of the four symptom areas listed in the DSM… A preoccupation or a restricted pattern of interest is noted in Asperger’s Syndrome.
…
Criterion C in the DSM notes that the disturbance needs to cause clinically significant impairment in social, occupational and other important areas of functioning.
The Board at [96] of its reasons concluded that symptoms of Asperger’s in the appellant were not addressed to the Board’s satisfaction. The Board was criticised by the appellant for making an equivocal finding.
I conclude on the basis of the evidence before me that on the balance of probabilities the appellant does suffer from Asperger’s Syndrome.
My conclusion is based on the fact that since being diagnosed with Asperger’s, the treatment for Dr Taylor has been designed to treat that condition. The treatment has been effective. I bear in mind that Dr Taylor has a very detailed knowledge of the condition and its symptoms. She may be reacting in a way consistent with her knowledge of what the symptoms should be. Overall, however, I am convinced that the evidence as a whole supports the diagnosis of Asperger’s.
As Mr Walsh QC for the Board submitted, it probably does not matter in the final analysis which label is put on Dr Taylor’s condition. The symptoms, her reaction to those symptoms and her ability to work as a medical practitioner with whatever condition she has are the relevant considerations.
Purely as a logical legal exercise, in my view the analysis of all of the evidence before the Board leads to the conclusion, as I have stated, that on the balance of probabilities Dr Taylor does suffer from Asperger’s. That diagnosis is important from the point of view of future treatment and how Dr Taylor is likely to respond to that treatment in the future.
As can be seen from the review of the medical evidence, there are opinions both ways. Even those opinions favouring Dr Taylor completing her internship are guarded and subject to several precautionary measures being put in place. This is relevant to the submission of Mr Heywood-Smith as to the weight of all the evidence. I deal with that shortly in these reasons.
Submissions of the appellant
Mr Heywood-Smith submitted that grounds 2, 6 to 9 and 11 of the Notice of Appeal raise “a weight of evidence argument” effectively. He argued that the doctors supporting the appellant’s registration have had a longer treating relationship with her, and have spent more time assessing her fitness and stability. In this way it is submitted their evidence should be given greater weight, particularly that of Dr Hadges as her treating GP. He submitted that those against the appellant’s registration, for example Dr Hundertmark and Dr Davis, have spent less time with the appellant, may have a closed mind, and may be taking a paternalistic view. Counsel submitted that upon balancing the evidence before the Board, and now before me, the appellant is, according to expert opinion, medically fit to continue her internship and to be registered accordingly.
In relation to ground 3, counsel submitted that the relevant criteria for assessing the appellant’s application for reinstatement is s 33(2) of the Act, instead of s 33(1). Section 33(1) provides for registration on the general register whereas s 33(2) relates to registration on a particular register. Mr Heywood-Smith submitted that an intern is not registered on the general register and that an intern’s registration is limited. He submitted that the test is “medically fit to provide medical treatment of the kind authorised by registration” under s 33(2)(b), the kind authorised being that of an intern. He submitted that the fitness test is lower for an intern than for a practitioner due to the supervision interns receive when providing medical treatment in the student environment.
Mr Heywood-Smith submitted that in respect of ground 4 on the appeal the only consideration for the court is whether the appellant is medically fit to provide medical treatment as an intern, as per s 4 and s 33(2)(b) of the Act. He submitted that there is not sufficient evidence for either the Board or the Court to be able to assess the risk that the appellant might endanger a patient’s health or safety.
It was submitted that the Board was in error by taking a paternalistic approach to the appellant’s case, in effect saying that it made its decision with her best interests in mind. This was said to be based on its concerns that she could eventually complete suicide should she be allowed to continue and should the stress of her internship prove too much to bear. Mr Heywood-Smith argued that this was the approach taken by Dr Hundertmark. He submitted that this approach was incorrect and should not have any bearing on the assessment of medical fitness.
Mr Heywood-Smith submitted that the appellant’s long history of self-harm must be considered in light of her current diagnosis and her positive response to the treatment for that. Counsel submitted that since being diagnosed with Asperger’s Syndrome and receiving proper treatment for the condition, the appellant’s psychiatric state has stabilised. Counsel pointed to Dr Short’s report in which it was noted that the appellant is no longer taking medication and has not contacted the ACIS or Lifeline help lines since March 2010. It was submitted that there is evidence of substantial improvement. This relates to ground 2 on the appeal.
Mr Heywood-Smith pointed to the fact that the past seven months have passed without incident. He submitted that at the time of the Board hearing the appellant had been mentally stable for four months, and that has continued to date. Counsel noted the number of doctors and specialists who continue to treat and support the appellant, to continue should she be allowed to continue her internship. Mr Heywood-Smith submitted that during the appellant’s period of instability she was incorrectly diagnosed and was not being treated properly.
Further, under ground 4 Mr Heywood-Smith relied on the Disability Discrimination Act 1992 (Cth) and the Equal Opportunity Act 1984 (SA). Reliance was placed on s 19 of the Commonwealth Act which provides that it is unlawful for a qualifying body to discriminate against a person on the ground of the person’s disability in conferring or renewing a qualification needed for the practice of a profession. Mr Walsh QC, counsel for the respondent, submitted that s 12(6) of the Commonwealth Act stipulates that s 19 of that Act only applies to discrimination in the exercise of power under a Commonwealth law and therefore it does not apply in this case.
Mr Heywood-Smith submitted that s 5(g) of the South Australian Act gives the definition of disability and s 66 of that Act provides the criteria for establishing discrimination on the basis of disability. Section 73 deals with discrimination by a qualifying body. It was submitted that the Board is included in the definition of a qualifying body. Mr Heywood-Smith submitted that the appellant suffers from a disability, and were the Board or the Court to take into account her disability in assessing her medical fitness, that would infringe both discrimination Acts.
In relation to ground 5 counsel submitted that the appellant’s long-term fitness to practise is irrelevant. He submitted that this application is for registration as an intern merely to complete her internship. Mr Heywood-Smith submitted that once the internship is completed, the appellant is required to apply for registration as a practitioner and that her long-term fitness may be considered at that stage.
In relation to ground 10 Mr Heywood-Smith submitted that the Board unfairly considered the appellant’s immunodeficiency condition. He argued that the immunodeficiency and its effect on her physical health had never been raised as an issue by the Board and that the appellant was not aware it would be of such concern. It was submitted that Dr Hadges was not cross-examined on this issue, and he may not have given as fulsome an account of her condition as he could have.
Mr Heywood-Smith submitted in relation to ground 12 that insufficient time was allocated by the Board in which to hear the application, resulting in a denial of procedural fairness. This was said to be as a result of the change in legislation, and the fact that the Board considered it was required to complete the hearing before 30 June 2010. Counsel submitted that oral evidence was therefore limited and that the Board denied itself of the opportunity to see Dr Hundertmark and Dr Davis in person.
Submissions of the respondent
Mr Walsh submitted that the appellant’s current period of stability has to be looked at with reference to a previous period of stability from 2007 to 2009. He submitted that her subsequent relapse was of concern to the Board but that the Board allowed the appellant to continue and indeed granted her a number of extensions. Mr Walsh accepted that the appellant has been relatively stable since March this year, but he noted that in Dr Hundertmark’s report Dr Hundertmark took account of Associate Professor Baigent’s comment that the appellant should demonstrate a period of at least twelve months stability.
Mr Walsh submitted that the 2009 relapse may have been triggered in part by work stress at the QEH and that such work stress was usual in the life of an intern and of a practitioner. He submitted that the appellant by her own admissions could not handle the everyday pressures of her internship, physically or mentally. He pointed to the appellant’s statement that when she was feeling hypomanic she would not attend for work, and her statements to doctors that her body could not physically handle the long working hours. Mr Walsh submitted that her behaviour demonstrated an inability to cope.
Mr Walsh agreed that there are differing diagnoses of the appellant. He noted that Dr Hundertmark said a diagnosis is important in relation to medication and treatment. However, he submitted that no definitive diagnosis needs to be made in these proceedings. He submitted that whether the cause is Asperger’s Syndrome or any other diagnosis, it is the appellant’s behaviour which is of concern, and that behaviour which leads to the conclusion that the appellant is not medically fit. As I have said, the diagnosis is important, however, in relation to making predictions for the future.
In relation to potential discrimination under the Disability Discrimination Act 1992 (Cth) and the Equal Opportunity Act 1984 (SA) Mr Walsh made three points. He submitted first that s 19 of the Commonwealth Act does not apply due to s 12(6). I accept that. He then submitted that no discrimination has occurred as per the definition in s 66 of the South Australian Act. Mr Walsh argued that the Board did not make its decision merely by reference to the appellant’s physical and psychiatric conditions, but by reference to her aberrant behaviour. Mr Walsh’s third point was that even if discrimination is found by the Court, s 73(2) of the South Australian Act operates such that the Board’s decision does not infringe the Act as it was open to the Board to find that the appellant is not able to practise medicine adequately or safely due to her disability. Mr Walsh emphasised that the respondent primarily relies on his second point. Mr Walsh stated that this discrimination argument is not covered by ground 4 of the appeal and was not raised before the Board.
Mr Walsh submitted that the test of “medical fitness” under s 4 of the Act relates to “medically fit” under s 33 of the Act and that it makes no practical difference that the Board considered s 33(1) as the criteria for the appellant’s application instead of s 33(2), being the correct section relating to such registration. He submitted that s 33(1)(c) is exactly the same as s 33(2)(b).
Consideration of submissions
I do not accept the argument advanced by Mr Heywood-Smith as to the weight of evidence. It is simply not a matter of numbers. The Board is quite entitled to reject all evidence supporting one point of view and accept a minority view, the same as a court does when assessing competing evidence. That is so, provided that there is evidence capable of supporting the particular point of view. In this case there is that evidence.
The Board may have confused the relevant tests and considered s 33(1) rather than s 33(2). Section 33(2) provides the relevant test for considering Dr Taylor’s application for reinstatement. The question is whether she is “medically fit to provide medical treatment of the kind authorised by registration”? Looking at the Board’s reasoning overall, I cannot find any error which has led the Board to any incorrect considerations. The relevant question has been answered, in my view, at least indirectly if not directly, regardless of what section was used.
I agree with Mr Heywood-Smith that there is some element of “paternalism” in the Board’s reasoning, but such comments are in the overall context of the Board considering the overall position of the applicant and making the appropriate assessment as to whether she is medically fit to practise medicine.
In my view there is no relevance in the claim that the Board has acted contrary to both the Commonwealth and South Australian legislation relating to discrimination. I do not consider that the Commonwealth legislation applies. The Board is not exercising any power under any Commonwealth law: see s 12(6) of the Disability Discrimination Act 1992 (Cth). I agree with Mr Walsh that under the Equal Opportunity Act 1984 (SA) there is no discrimination. The Board’s decision is not based on the appellant’s physical or psychiatric conditions but upon her behaviour and likely ability to be able to practise medicine in an appropriate manner and in the public interest.
In relation to Mr Heywood-Smith’s point about lack of procedural fairness at the Board hearing, I have reviewed the relevant transcript. Although there were time constraints, and although it is clear that the Board wished to finalise the matter before the new legislation took effect, I do not consider that as a result any injustice to the appellant has resulted.
Dr Taylor was represented by counsel before the Board. Counsel was able to make full and detailed submissions. Although some doctors were not called to give evidence before the Board, their evidence was before the Board by way of their detailed reports, and full submissions were made on the basis of the whole of the evidence, including the medical reports and the oral evidence.
Conclusion
I have decided that even though there was an apprehended bias because of the involvement of Dr Sexton with matters relating to Dr Taylor outside the hearing, I should take account of the reasons of the Board. I have said earlier that it would be impractical and unrealistic in a re-hearing to not consider the Board’s reasons when the bias argument is but one of twelve grounds of appeal.
I have proceeded on the basis of a re-hearing and taken account of all the evidence before the Board. In addition I have heard the further evidence of Dr Short.
Upon my review of the reasons of the Board, I cannot find that the Board has made findings which were not available on the evidence before it. This is a case where although different minds might come to different conclusions, it cannot be said that there is any demonstrable error in the reasoning of the Board. There was certainly evidence against the conclusions of the Board but that is not the test.
I take into account that the Board is a specialised tribunal specifically charged in the public interest with the overall control of medical practice, including students and interns: see s 13(2) of the Act set out at [4]. A court is always reluctant to interfere with the views expressed by an expert tribunal unless demonstrable error can be shown. I can find no demonstrable error. It is simply a conclusion based on the Board’s assessment of the evidence, which conclusion was available on the evidence.
If I am wrong in taking into account the reasons of the Board then upon my own assessment of the whole of the medical evidence, I would reach a similar conclusion. That is because it is my view that it is premature to grant reinstatement to Dr Taylor. She has demonstrated in a period of a few months that she is coping to a much better extent than she did when she was employed as an intern at the Queen Elizabeth Hospital. But she has shown in the past long periods of coping, only to unfortunately relapse, the last time being the significant events of January this year.
The problem is that the pressure of work as an intern may have been the reason for her difficulty encountered at that time. Of course she is now relieved from the pressure of work. Against that is the fact that she might be under more pressure because she does not have employment. However, my view is that the removal of the pressure of work as an intern has been significant in her improvement and absence of symptoms. She just needs more time to ensure that she is not a risk to the public in the carrying out of her profession.
Counsel for the Board submitted that a significantly longer time should be allowed to monitor the progress of Dr Taylor. I agree that some delay is preferable to ensure that Dr Taylor continues to progress as she has done already. I would suggest that a period of a further twelve months should clarify the position. I do not agree with the Board’s suggestion of “several years”. That is unreasonable, given that she has all but completed her internship and such a long delay may require re-training.

My decision, as was the Board’s, is a very harsh result for Dr Taylor. She has only eight weeks or so to complete her internship. I am sure that any judge in my position would strive to do whatever was possible to assist Dr Taylor in getting across the line, as it were. However, the matters raised by the Board are of extreme significance in the public interest, and after reflection I share those views. I cannot exclude the extreme behaviour of Dr Taylor early this year in forming my overall view that it would be premature to order reinstatement.
I would hope that Dr Taylor can find suitable employment in the interim with her medical degree and expertise in toxicology. Subject to demonstrating to the Board at a later stage that she has been able to cope, she should then be permitted to resume and complete her internship. What happens after that, of course, is another matter altogether. She could, in say 12 months time, make a further application for reinstatement. If she has shown continued improvement, and there is an absence of any of her aberrant behaviour from the past, I would hope that she may be regarded as a suitable candidate to complete her internship. In my view, it all depends on the progress made at that time.
I have taken the view, contrary to the view taken by the Board, that there should be a shorter rather than a longer time before a further application for reinstatement can be considered. I have done this because of the resilience and pure determination which Dr Taylor has shown throughout her troubled student days and for most of the time of her internship. It shows that she possesses the inner strengths required to deal with all her problems in times of adversity. I consider that it would be unfair for her to have to wait several years before even being considered again for reinstatement. Once again it is up to her to demonstrate how she can cope with her latest adversity, but given her background in coping in the past, I am confident that she will once again be able to overcome her difficulties and demonstrate to the Board that she is a proper candidate for reinstatement.
For all these reasons I dismiss the appeal.