Veterinary Surgeons Investigating Committee v Williamson (No.2)
[2005] NSWADT 112
•05/20/2005
CITATION: Veterinary Surgeons Investigating Committee v Williamson (No.2) [2005] NSWADT 112 DIVISION: General Division PARTIES: APPLICANT
Veterinary Surgeons Investigating Committee
RESPONDENT
Henry Mervyn Graham WilliamsonFILE NUMBER: 043212 HEARING DATES: 01/12/2004 SUBMISSIONS CLOSED: 03/11/2005 DATE OF DECISION:
05/20/2005BEFORE: O'Connor K - DCJ (President); Carter T - Non Judicial Member; Mayo-Ramsay R - Non Judicial Member APPLICATION: MATTER FOR DECISION: Principal matter LEGISLATION CITED: Administrative Decisions Tribunal Act 1997
Drugs, Poisons and Controlled Substances Regulations 1995 (Vic)
Legal Profession Act 1987
Poisons and Therapeutic Goods Act 1996
Poisons and Therapeutic Goods Regulation 1994
Veterinary Practice Act 1997 (Vic)
Veterinary Surgeons Act 1986
Veterinary Surgeons Regulation 1995CASES CITED: Buttsworth v Walton (unreported, Court of Appeal, 19 December 1991)
Childs v Walton (Court of Appeal, 13 November 1990, unreported)
Clyne v NSW Bar Association (1960) 104 CLR 186
Gelderman v Veterinary Surgeons Investigating Committee [2001] NSWADTAP 27
Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630
Law Society of NSW v Foreman (1994) 34 NSWLR 408
Law Society of NSW v Walsh (Court of Appeal, 15 December 1997, unreported)
NSW Bar Association v Evatt (1986) 117 CLR 177
Veterinary Surgeons Investigating Committee -v- Lloyd (Inquiry 3: 'Remus' - Findings: Allegations 1 (a) to (e)) [2002] NSWADT 285
Veterinary Surgeons Investigating Committee -v- Williamson [2004] NSWADT 215REPRESENTATION: APPLICANT
M Wade, solicitor
RESPONDENT
V Bedrossian, counselORDERS: 1. The respondent is guilty of misconduct in a professional respect in relation to the conduct the subject of Allegations 1.1, 1.2, 2.1 and 2.2 of the amended complaint; 2. Pursuant to s 32 of the Veterinary Surgeons Act 1986, the Tribunal makes the following orders: (a) an order reprimanding the respondent; (b) an order imposing the condition on the registration of the respondent that he submit at his own expense to an audit of his prescribing practices (including the labelling of substances) by a registered veterinary surgeon appointed by the Veterinary Surgeons Board, the terms under which the audit is conducted being as specified at paragraph [101] of the Tribunal’s reasons for decision; and (c) an order requiring him to pay within 14 days of the date of these orders the applicant’s costs of these proceedings as agreed; and failing agreement, as assessed in accordance with Part 11 of the Legal Profession Act 1987.
1 The Veterinary Surgeons Investigating Committee has referred to the Tribunal, pursuant to s 28(1)(c) of the Veterinary Surgeons Act 1986 (the VSA) a complaint alleging misconduct in a professional respect by Dr Henry Mervyn Graham Williamson, a veterinary surgeon registered in New South Wales. (The Tribunal is constituted for present purposes as a Veterinary Disciplinary Panel of the General Division. Its membership includes a veterinary surgeon who is a member of the Veterinary Surgeons Board, and a member representing the interests of users of veterinary services: Administrative Decisions Tribunal Act 1997, Sched 2, Part 4, cl 7.)
2 The complaint relates, principally, to the activity often described as ‘distance prescribing’, i.e. prescribing drugs for administration to an animal at a remote location without making any physical examination of the condition of the animal.
3 Dr Williamson is a very experienced veterinary surgeon who has specialised for much of his career in equine medicine. At the time of the events that have given rise to this complaint he was practising in Victoria. The connection with New South Wales arises from the fact that the person to whom he sent drugs for administration was a registered horse trainer (Mr Rodney Robb) based in a remote town in rural New South Wales (Nyngan).
4 The conduct came to light incidentally to a racing stewards’ inquiry in July 2002 after a winning horse (‘Kashmir Magic’) trained by Mr Robb returned an elevated reading to a proscribed substance. The stewards conducted a general inspection of his stables. They found two vials marked ‘Femme’ and ‘Pain’. They were not connected with the elevated reading; and did not contain any substances that were prohibited under the rules of racing.
5 At their hearing the stewards interrogated Mr Robb over how he came to be in possession of the two vials, and he gave evidence as to his relationship with Dr Williamson, who he had got to know when Dr Williamson was based at Warwick Farm in Sydney.
6 That evidence became known to another veterinary surgeon, Dr Marilyn McKenzie. She made a complaint to the Committee, as she saw distance prescribing of the kind revealed by the case as contrary to acceptable standards of professional practice by veterinarians. She expressed concern as to possible breaches of standards concerning: correct labelling of vials of injectable medications; the administration of a restricted substance, progesterone, which was the vital ingredient in ‘Femme’; engaging in distance prescribing without a proper veterinarian/client relationship; adequacy of record keeping; the dispensing of unregistered or off-label stock medicines; the compounding of medications by veterinary surgeons; and the need to ensure the appropriate safeguards were adopted in the use of these medications, particularly in the case of multi-use vials.
7 Later, the chief racing steward of New South Wales, Mr Murrihy, also made a complaint to the Committee.
- Response to Matters Raised by Committee
8 In October 2003 the Committee formally advised Dr Williamson of the complaints from Dr McKenzie and Mr Murrihy, and called on him to respond. He admitted the primary facts. Through his solicitors (Smith Monti Legal), Dr Williamson engaged in an elaborate round of correspondence with the Committee contesting the suggestion that his conduct involved any departure from acceptable professional standards.
9 The Committee issued its interim report in March 2004. It then conducted an interview with Dr Williamson on 27 May 2004. Dr Williamson continued to vigorously contest the suggestion that he had, in any way, departed from professional standards. He also made a number of objections to the fairness of the process. In particular he was concerned that the complaint made by Dr McKenzie, made in May 2003, had not become known to him until October 2003.
- The Referred Complaint
10 The Committee referred a complaint to the Tribunal on 5 July 2004. Its terms were subsequently amended, by leave of the Tribunal, and came on for hearing on 1 December 2004.
11 The text of the amended complaint follows:
- The Veterinary Surgeons Investigating Committee (‘VSIC’) hereby refers a Complaint pursuant to s.28(1)(c) of the Veterinary Surgeons Act 1986 (‘the Act’) to a Veterinary Disciplinary Tribunal of the Administrative Decisions Tribunal of New South Wales.
The VSIC complains that the conduct of the respondent, Dr Williamson, particularised herein amounts to misconduct in a professional respect or serious misconduct in a professional respect as defined in s.22 and s.22A of the Act or is otherwise professional misconduct.
PARTICULAR ONE:
That on or about the dates and in the quantities described in Schedule A hereto, Dr Williamson inappropriately supplied a restricted substance labelled “Femme” and containing Progesterone to Mr Rodney Robb for administration to the animals set out in Schedule A in circumstances where:
1.1 Dr Williamson did not first examine the animal or animals to which the substance ‘Femme’ was to be administered;
In so doing, Dr Williamson’s conduct was a professional procedure performed contrary to current standards of veterinary science and amounted to a breach of Rule 5(2) of the Code.
1.2 The animals to which the substance ‘Femme’ was to be administered were not under Dr Williamson’s care at the relevant times in that Dr Williamson did not have a veterinarian-client-patient relationship with those animals;
In so doing, Dr Williamson’s conduct was a professional procedure performed contrary to current standards of veterinary science and amounted to a breach of Rule 5(2) of the Code.
1.3 The substance ‘Femme’ was contained in bottles the details of the labels of which are described in Schedule B, hereto;
In so doing, Dr Williamson did not ensure that a substance included in Schedule 4 of the Poisons List was correctly labelled and his conduct amounted to a breach of Rule 6(3) of the Code.
Further Particulars:
1(a) Professional standards of veterinary science at the relevant times referred to in Schedule A hereto required that a Veterinary Surgeon examine an animal before diagnosing its condition and prescribing treatment. Dr Williamson breached this standard;
1(b) Professional standards of veterinary science at the relevant times referred to in Schedule A hereto required that, where treatment is provided to an animal for an ongoing condition and examination of the animal to be treated on each occasion is not practicable or necessary, there should be an ongoing veterinarian-client-patient relationship. An ongoing veterinarian-client-patient relationship requires at a minimum that the veterinarian treating the animal has a satisfactory knowledge of the animal, its circumstances and its current condition, including that the veterinarian has examined the animal sufficiently recently to professionally manage the animal’s treatment. Dr Williamson breached this standard;
1(c) The labelling of restricted substances supplied in NSW prior to 1 September 2002 was governed by the Poisons and Therapeutic Goods Regulation 1994 (repealed and replaced on 1 September 2002). The Dictionary to that regulation defines ‘dealer’ as including, inter alia, a veterinary surgeon in his capacity as a supplier of the substance. Part 3 of the Regulation relates to restricted substances. Sub-clause 27(3) requires, inter alia, that where the quantity of a restricted substance supplied is more than that required for three days’ treatment, a veterinary surgeon must label the substance in accordance with the requirements of Appendix A. ‘Supply’ is defined broadly in s.4 of the Poisons and Therapeutic Goods Act 1966. ‘Label’ is defined to include any tag, brand, mark or statement in writing on or attached to or used in connection with any container or package containing any poison, restricted substance or drug of addiction. Appendix A to the Regulation requires, inter alia, that the label of a therapeutic substance to which the Appendix applies carry “… if the substance is intended for the treatment of an animal, the species of the animal and the name of the animal’s owner”. Dr Williamson did not comply with this requirement.
PARTICULAR TWO:
That on or about the date and in the quantity described in Schedule A hereto, Dr Williamson inappropriately supplied a substance labelled “Pain” to Mr Rodney Robb in circumstances where:
2.1 Dr Williamson did not first examine the animal or animals to which the substance ‘Pain’ was to be administered;
In so doing, Dr Williamson’s conduct was a professional procedure performed contrary to current standards of veterinary science and amounted to a breach of Rule 5(2) of the Code.
2.2 The animals to which the substance ‘Pain’ was to be administered were not under Dr Williamson’s care at the relevant times in that Dr Williamson did not have a veterinarian-client-patient relationship with those animals;
In so doing, Dr Williamson’s conduct was a professional procedure performed contrary to current standards of veterinary science and amounted to a breach of Rule 5(2) of the Code.
Further Particulars:
2(a) Professional standards of veterinary science at the relevant times referred to in Schedule A required that a Veterinary Surgeon examine an animal before diagnosing its condition and prescribing treatment. Dr Williamson breached this standard;
2(b) Professional standards of veterinary science at the relevant times referred to in Schedule A required that, where treatment is provided to an animal for an ongoing condition and examination of the animal to be treated on each occasion is not practicable or necessary, there should be an ongoing veterinarian-client-patient relationship. An ongoing veterinarian-client-patient relationship requires at a minimum that the veterinarian treating the animal has a satisfactory knowledge of the animal, its circumstances and its current condition, including that the veterinarian has examined the animal sufficiently recently to professionally manage the animal’s treatment. Dr Williamson breached this standard.
- Relevant Law
12 The key provisions of the Act are ss 22 and 22A.
13 Section 22 provides, as relevant to this case:
- ‘ 22 Misconduct in a professional respect
Without limiting the meaning of the expression “misconduct in a professional respect”, a registered veterinary surgeon shall be deemed to be guilty of misconduct in a professional respect if the veterinary surgeon: …
(c) breaches any provision, prescribed for the purposes of this paragraph, of the veterinary surgeons’ code of professional conduct established under section 23.’
14 The effect of the opening words of s 22 is that the common law meaning of professional misconduct is preserved: see generally, Veterinary Surgeons Investigating Committee -v- Lloyd (Inquiry 3: 'Remus' - Findings: Allegations 1 (a) to (e)) [2002] NSWADT 285 at [25]-[29].
15 Section 22A provides, as relevant to this case:
- ‘ 22A Serious misconduct in a professional respect
(1) Without limiting the meaning of the expression serious misconduct in a professional respect, a registered veterinary surgeon is taken to be guilty of serious misconduct in a professional respect if the veterinary surgeon:
…(d) breaches any provision, prescribed for the purposes of this paragraph, of the veterinary surgeons’ code of professional conduct established under section 23.’
16 The Veterinary Surgeons Code of Conduct is Schedule 1 to the Veterinary Surgeons Regulation 1995 (VSR). The VSR lists in cl 10(2) the rule-breaches that fall under s 22 and those that fall under s 22A.
- Issue as to Jurisdiction
17 Following the referral by the Committee of its complaint to the Tribunal, Dr Williamson objected to the Tribunal’s jurisdiction. In line with the objections previously made to the Committee, he contended that failures of procedure on the part of the Committee were such that pre-conditions to the Tribunal’s jurisdiction had not been satisfied. That objection was dismissed: Veterinary Surgeons Investigating Committee -v- Williamson [2004] NSWADT 215 (decision delivered 28 September 2004).
- Allegation 1.3
18 At hearing, the Committee advised that it was not pressing Allegation 1.3, the labelling allegation. The Allegation refers to the Code, Rule 6(3) which provides:
- A veterinary surgeon must not supply, issue or dispense to a client any substance that is included in Schedule 1, 3 or 4 to the Poisons List without ensuring that the substance is correctly labelled.
19 Breach of this rule constitutes ‘serious misconduct in a professional respect’ within the meaning of s 22A: see VSR cl 10(3). There was no dispute that the drug ‘Femme’ contained a restricted substance (progesterone).
20 The Committee’s decision not to proceed with Allegation 1.3 was a significant one, as, if accepted by the Tribunal, it removed the possibility of Dr Williamson being the subject of a finding of ‘serious misconduct in a professional respect’.
21 In contrast, breach of the other Rule referred to in the complaint, Rule 5(2) (‘Professional procedures should always be carried out in accordance with current standards of veterinary science’) belongs to the lesser category of ‘misconduct in a professional respect’: see VSR cl 10(2).
- Admissions
22 At the opening of the hearing, counsel for Dr Williamson, Mr Bedrossian, advised that his client no longer contested the charges. Dr Williamson submitted a reply to the allegations admitting all the facts relevant to these allegations and agreed that:
- 1. the facts gave rise to a breach of Rule 5(2) of the Code; and
2. consequently, they constitute misconduct in a professional respect.
23 Consequently Dr Williamson, in effect, acknowledged that he had contravened professional standards in the way alleged by Allegations 1.1, 1.2, 2.1 and 2.3.
24 In support of a further submission that no order for suspension or deregistration be imposed, he asked the Tribunal to take account of the following circumstances:
- ‘2.1 at all times I had the health and welfare of the animals in question as my foremost concern and, despite the geographic distance between the animals and myself, I attempted to provide an appropriate treatment for them;
2.2 there is no evidence that the treatment provided by me for the animals in question was inappropriate or negligent;
2.3 although the animals in question were not under my direct care nor had they been inspected personally by me, I had, prior to providing the treatment for the animals, obtained blood samples of those animals, from which samples I undertook a profiling of the animal’s health condition; and
3. it is in the public interest that I should be allowed to continue to practise veterinary science:
3.1 I am a very experienced veterinarian with a specialisation in equine veterinary;
3.2 many of my clients in Victoria would be disadvantaged by needing to find an alternative equine veterinarian if my services were not available to them;
3.3 I have a strong professional reputation and participate in the equine veterinary profession and the horse racing industry so as to make a positive contribution thereto.’
- Disciplinary Orders: Proposals
25 The parties have put forward different options as to the disciplinary orders that the Tribunal should make. It is helpful, we think, to have these proposals in mind before turning to the examination of the evidence in support of the complaint, and entering findings in respect of those allegations.
26 The range of disciplinary orders available to the Tribunal are set out in s 32 of the VSA which provides:
- ‘ 32 Tribunal’s powers when complaint proved
(1) If the matter of a complaint against a registered veterinary surgeon has been proved to the satisfaction of the Tribunal, the Tribunal may make any one or more of the following orders:
(a) an order reprimanding or cautioning the veterinary surgeon,
(b) an order suspending the veterinary surgeon from practice for a period not exceeding 12 months,
(c) an order directing that the name of the veterinary surgeon be removed from the register of veterinary surgeons or the register of specialists,
(d) an order imposing a fine on the veterinary surgeon of an amount not exceeding $10,000,
(e) an order imposing conditions on the registration of the veterinary surgeon with respect to the practice of veterinary science,
(f) an order requiring the veterinary surgeon to pay specified costs relating to the hearing.
(2) Even though the matter of a complaint against a registered veterinary surgeon may have been proved to the satisfaction of the Tribunal, the Tribunal must not make an order of the kind referred to in subsection (1) (b) or (c) if the Tribunal is of the opinion that:
(a) because the matter of the complaint is of a trivial nature, or
(b) because of the circumstances in which that matter occurred, or
(c) for any other reason, it is in the public interest that the veterinary surgeon should be allowed to continue to practise veterinary science.
(3) If the Tribunal considers that the matter of a complaint against a registered veterinary surgeon has not been proved to the satisfaction of the Tribunal, but the Tribunal nevertheless considers that the conduct of the veterinary surgeon was sufficiently unacceptable to warrant the making of the complaint, the Tribunal may make an order against the veterinary surgeon under subsection (1) (a) or (f), or both.
(4) On directing the name of a person to be removed from a register, the Tribunal may fix a time after which the person may apply for restoration of the person’s name to the register.
(5) While an order under this section suspending a person from practice remains in force, the person is taken not to be a registered veterinary surgeon.
(6) An order under this section does not take effect until 21 days after notice of the order is given to the veterinary surgeon by the Registrar, subject to any decision of an Appeal Panel of the Tribunal on appeal under section 34.’
27 As is conventional, s 32 has a hierarchy of possible sanctions divisible into two groups – those that do not constrain, in any way, future practice (caution, reprimand, fine); and those that constrain future practice (conditions on registration, suspension, deregistration).
28 Not surprisingly, Dr Williamson suggested in the submissions handed up to the Tribunal on 1 December 2004 that the sanctions appropriate should be of a kind that do not constrain future practice. He submitted that he should be cautioned in respect of the conduct (non-examination of animals) the subject of Allegation 1.1 and Allegation 2.1; and cautioned in respect of the conduct (supplying substances for administration to animals not under his care) the subject of Allegation 2.1 and 2.2. He also submitted that a condition of these orders be that he supply to the Committee a written undertaking to the effect that he will not supply or prescribe any substance for any animal which he has not physically examined within the 12 month period immediately preceding the proposed supply or prescription.
29 On the other hand at the hearing the Committee sought a tougher set of orders, including some which involved some constraints on future practice. The orders sought were:
- 1. reprimand.
2. maintain a register of all of his prescribing of all or certain drugs in a format approved by the Veterinary Surgeons Board.
3. submit to an audit or audits of his prescribing practices (including his labelling of substances supplied by him or by any organisation under his control) at his own expense by a registered veterinary surgeon appointed by the Board at a frequency not less than 3 or 6 monthly. The first of such audits to be within 3 months of the date of the Tribunal’s order.
4. to make available to the auditor all records relating to the examination, diagnosis, treatment and on-going management of his patients and ordering and supply of substances whether on his own account or through any company or business in which he has a controlling interest.
5. to make himself available to discuss with the auditor his prescribing practices, the clinical circumstances of each case considered by the auditor and his supplying, prescribing and labelling of substances.
6. to authorise the auditor to report the results of his/her audit to the Board.
7. such audits to continue at the discretion of the Board and at least until three sequential satisfactory audit reports have been completed.
30 At the conclusion of the hearing, the Tribunal indicated to the parties that it did not have in mind imposing a suspension or deregistration order, but would appreciate any further submissions that might give rise to an agreed approach and a supervisory role for the Board.
31 On 9 December 2004 the applicant’s solicitors submitted that the following orders be made:
- 1. as previously, caution in respect of Allegations 1.1 and 2.1;
2. as previously, caution in respect of Allegations 1.2 and 2.2;
3. a written undertaking within 7 days of the order being made of the kind previously suggested;
4. that he submit to an audit of his prescribing practices (including his labelling of substances) at his own expense by a registered veterinary surgeon appointed by the Committee as follows:
- a. the veterinary surgeon selected to undertake the audit is to be one located in Victoria
b. the first audit is to take place within 3 months of these orders
c. the audits are to take place no more frequently than once every 6 months
d. the last audit will occur upon the third successive audit in which there have been no identified breaches of rules, regulations or standards of practice by him during the period since the previous audit
e. he is to take all reasonable steps to make himself available to discuss with the auditor his prescribing practices, the clinical circumstances of each case considered by the auditor, and his practice relating to the supply, prescribing and labelling of circumstances
f. he is to authorise the auditor to report the results of his/her audit to the Board, except that the names and identities of clients and patients are not to be revealed except in circumstances in which the auditor has identified a breach of a rule, regulation or standard of practice by him
g. each audit is to be completed no later than close of business on the first working day after the commencement of the audit, provided that he has made himself available to the auditor on each day of the audit
h. any audit is not to extend beyond the hours between 8.00 am and 6.00 pm on any working day of the week during the duration of the audit
i. the Committee is, at least 14 days prior to the occasion of each audit, to provide written notice to him of the date and time of commencement of the audit and the identity of the veterinary surgeon conducting the audit.
32 The proposed orders sought in addition that both parties be granted liberty to apply to the Tribunal with respect to any issue relating to the orders relating to audit.
33 The proposed orders also included a term that Dr Williamson pay the Committee’s costs of these proceedings as agreed (whether in relation to a specific quantum or the basis of assessment) in writing within 14 days of these orders. If no such agreement is reached, the parties to be at liberty to have the matter re-listed before the Tribunal for the making of submissions on costs.
34 The Committee replied to this submission by further submissions filed 15 March 2005.
35 The Committee opposed, giving reasons, imposition merely of cautions, as proposed in items 1 and 2 above. It also opposed, giving reasons, the mere giving of an undertaking of the kind proposed. As to the particulars of item 4, the Committee indicated that (b), (d), (e) and (f) were consistent with its previous submission; and as to (h) and (i) said that they were reasonable. The Committee joined issue in respect of (a), (c) and (g), giving reasons.
36 The question of the appropriate order will be returned to later in these reasons. We now turn to the conduct under notice.
- Evidence
37 In support of the complaint, the Committee filed a two-volume bundle of documents comprising an affidavit from the Secretary to the Committee and numerous annexures, and two further letters (see Exhibits D and E); together with a Victorian guideline on supply and use of drugs in veterinary practice (Exhibit I).
38 In support of his case, Dr Williamson filed a bundle of documents (Exhibit F), some of which duplicated material found in Exhibit D; an article, ‘Australian veterinarians who work with horses: an analysis’ by T J Heath, Australian Veterinary Journal Volume 82, No 6, June 2004 (Exhibit G); and testimonials from an experienced veterinary surgeon, a leading farrier, a leading breeder and a leading harness racing trainer (Exhibit H).
39 Dr Williamson referred to his long career in equine medicine involving both thoroughbred race horses and standard bred race horses. He had first been registered as a veterinary surgeon in 1957, and was (as at December 2004) 73 years old. Dr Williamson stated that he was on the board of a number of standard bred racing bodies, as well as having once been a committee member of the Standard Bred Sub Committee of the New Zealand Veterinary Association; that he had given a paper at a world conference for which he had received a commendation; that he had held appointment as in the extra curricular program of the Sydney University Veterinary School; and that he held honorary registration with the New South Wales Branch.
40 Practice and Procedures: He explained why he had thought it acceptable to deal with horse trainers in the way revealed by this case. Mr Robb was a trainer of thoroughbred race horses in a remote country town. He did not have easy access to veterinarians familiar with the needs of race horses. He had confidence in Dr Williamson, as a result of dealings he had with him when he had brought horses to race in Sydney in the time when Dr Williamson was based at Warwick Farm race course.
41 Dr Williamson said that he had never prescribed treatment for a horse without either having done a physical examination or undertaking a blood test. In his evidence in chief, he outlined the type of questions he asked about the horses when Mr Robb telephoned him, the notes he took, the request he made for Mr Robb to supply blood samples, the laboratory tests that were run on the blood samples after being received by Dr Williamson, the assessment made of those results in combination with the information supplied by Mr Robb and the advice then given to Mr Robb. This would be followed by the sending of appropriate drugs, in this instance ‘Femme’ and ‘Pain’. He filed letters from Mr Robb to similar effect.
42 As to this case, Dr Williamson said that he had discussed with Mr Robb the possibility of him getting assistance locally from an equine specialist, but had learnt that the closest practitioner to Nyngan was located at a town about 200 miles away, named Dr Ross Padrana. It was not, he considered, practical, having regard to distance and cost, for Mr Robb to rely on the specialist at Nyngan. Mr Robb also told him that he often raced his horses at remote towns such as Birdsville and in outback Queensland. He considered that it would be uneconomic for Mr Robb to bring a vet to his stables, given the costs involved and having regard to the fact that he raced for very low prize money stakes. His general assessment was that the horses may have been suffering from overtraining.
43 He noted that Mr Robb had, in the past, found Femme and Pain effective. He said that they were both private formulas of his which at that time could only be obtained from him.
44 In cross-examination, he described more specifically the procedure he followed when he received a call from a trainer in circumstances like Mr Robb’s:
- (i) Make a record of matters that he regarded as relevant in a consultation record in the name of the horse.
(ii) Request the trainer to take two blood samples and forward them.
(iii) Give the samples to a laboratory for testing, with its report to cover 36 or 38 criteria specified in a standard form supplied by Dr Williamson (the metabolic profile).
The purpose of this test, he said, was to provide information, for example, as to whether the animal is anaemic or dehydrated; to obtain white cell counts which might indicate whether the horses were suffering from viral bacterial infections; to indicate if there was inflammation; an to assess electrolyte balances, liver function and muscle function.
(iv) Make an assessment of the test report in conjunction with the information committed to the consultation record.
(v) Call the trainer and provide a diagnosis and advice.
(vi) Prescribe medications, if appropriate.
45 He was closely cross-examined as to the adequacy of these practices in reaching a reliable conclusion as to the problems a horse might have.
46 He was questioned as to the dangers of recommending treatments and prescribing medicines without ever having examined the horses in question, or having visited the stables. As had occurred here, Dr Williamson often supplied treatments formulated by him and compounded by him.
47 He said that ‘Femme’ contained progesterone and oestrogen; and that ‘Pain’ was a homeopathic remedy, made to a formula that included Devil’s Claw and arnica.
48 He said that ‘Femme’ promotes muscle building and the ingredients have some effect on the adrenal gland to reduce the release of cortisol under stress. He said that he also prescribed ‘Femme’ for horses who were eating poorly. He said that the alternative treatment would be to give the horse anabolic steroids, but that would have meant under the rules of racing that they would have to be kept away from the track for 140 days. He acknowledged that progesterone was a restricted drug. He said that if this drug was used without supervision there was a likelihood of some upset in the hormonal balance, especially in mares, such that the oestrogen could cause cyst and persistent oestriol behaviour.
49 The Committee obtained advice in relation to ‘Pain’ from a medical herbalist (Robert McDowell, letter 26 February 2004). He advised that ‘Pain’ is a combination of most commonly used homeopathic anti-inflammatory remedies. He questioned the desirability of the practice followed by Dr Williamson of having this medication administered intravenously. He felt it was safer to administer such a medication orally. Alluding to the alcoholic element of the medication, he said that he would never recommend injecting alcohol in any concentration, especially into the bloodstream of a herbivore. He also raised concern about the maintenance of sterility in circumstances like these where the medication is formulated by practitioners in their clinics.
50 He was unable to refer to any independent studies or trials that had been done as to the effectiveness of these medications. He acknowledged that the drugs were not prescribed because the horses were, to any degree, suffering ill health. They were aimed at lifting their performance in a legitimate way that did not breach the rules of racing. He conceded that in his formal reply to the complaint he had said that the medications were administered to relieve pain and suffering.
51 He acknowledged that his method of diagnosis would be more satisfactory if he were to undertake a physical examination of the horse. He acknowledged that the work he was doing as not connected with ‘ill health’ but rather ‘sub optimal health’. He considered it reasonable to take account of a horse trainer’s observations as to a horse’s condition, as they had expertise to offer.
52 Dr Williamson was asked why veterinary surgeons were permitted to engage in the use and supply of restricted drugs. He said: ‘Because they have the qualification and the experience – because they have the training and the experience to be able to assess the risks.’
53 He acknowledged that it was also because they have the knowledge to supervise satisfactorily their use. He did not consider it essential that the veterinary surgeon actually administer the drug, and noted that it was permitted by veterinary standards for the administration to be done by someone else under the supervision of the veterinarian. He felt that he had observed that standard in the present cases, with Mr Robb undertaking the administration.
54 The issue of the adequacy of his record-keeping practices was raised. Dr Williamson acknowledged the importance of keeping proper, accurate records, and the importance of that in ensuring that an animal’s therapeutic needs were met.
55 He accepted that the records kept by him in relation to the three race horses relevant to this case (‘Nazeem’, ‘Quiet Ways’, ‘Heza Bandit’) were less than adequate. He acknowledged as an example of inadequacy the recording of an opinion conveyed by the trainer that a horse had a damaged shoulder muscle. He was shown various consultation sheets. He explained that the ‘metabolic profile’ he recorded on the sheet was determined by him following analysis of blood samples provided by the trainer. He said that he always recorded whatever relevant information the trainer had given him in the initial phone call.
56 He was cross-examined in relation to the record kept in relation to a test done on the horse ‘Heza Bandit’ around 20 January 2002. He explained how he concluded that the horse was suffering from stress having regard to the neutrophils count. He said a fit horse would score in the 60 to 65 range, whereas this horse had scored 67 indicating that it may be suffering from overtraining. He rejected the possibility of an alternative diagnosis, namely bacterial infection, on the basis that no problem was disclosed by the white blood cell count. He acknowledged that, as far as he was concerned, there is only one diagnosis open to be made on the results obtained from the blood test. He believed his professional colleagues involved in equine medicine would have come to the same conclusion, though they might have used different terms such as ‘not muscling’.
57 On the same day he made the same diagnoses in relation to the other two horses for which Mr Robb had sought advice – ‘Nazeem’ and ‘Quiet Ways’.
58 The issue of delay in receipt and analysis of the sample was raised. Dr Williamson acknowledged that allowing for express post mail times the blood test would occur about three days or so after the initial phone call. He referred to the methods he advises the trainer to use in order to minimise the possibility of deterioration of the sample during the delivery process. He explained that he had a standing arrangement with the testing lab that he used which does a standard test that he has devised.
59 As to his billing practices, he said that there was no separate charge for the consultation; it was included in the price of the blood test (about $55). While his internal computer system contained a separate charge for the medications, he would usually send out a bill that combined the service, the test and the medication into one fee.
60 Change of Attitude: In light of the vigour with which he had contested the Committee’s views up until the announcement made at the hearing that he would plead guilty, understandably Dr Williamson was closely cross-examined as to a his reasons for changing his mind about the allegations; the extent of his recognition that he had erred; and his commitment to not repeating his error.
61 Dr Williamson was evasive as to how long he had been engaging in the kind of practices that had placed in issue. He stated that as a result of these proceedings he had discontinued engaging in distance prescribing. He said: ‘if I'm not practising to current standards then I have to change my standards and it's a matter of personal pride to me that I should’ (ts 8:22).
62 He said his change of heart had resulted from a family discussion with his son two or three months earlier. He said that he had regarded distance prescribing based on blood test information as acceptable, in circumstances where large distances between veterinarians existed or there were significant numbers of animals in proportion to the number of veterinarians.
63 He said that his acceptance now that distance prescribing was unacceptable arose simply from the fact of this proceeding. He had not seen it as wrong in the past.
64 He acknowledged that his change of attitude had only occurred very recently. He denied the suggestion that his change of attitude was one designed simply to assist in having a lighter punishment imposed by the Tribunal.
65 In our view it is most likely that practices and procedures identified by this case have been a component of Dr Williamson’s practice for a very long time. It is plain from the history of the proceedings that, until very soon before the hearing was due to commence, he had seen nothing wrong with a practice of this kind.
- FINDINGS AS TO ALLEGATIONS
Professional Standards
66 In this decision we need do no more than assess the particular facts of Dr Williamson’s conduct.
67 The usual standards of veterinary practice, as Dr Williamson acknowledges, require that a veterinary surgeon examine an animal before making a diagnosis or prescribing treatment or medicines.
68 There may be circumstances when this standard is not able to be observed and a lesser standard can be tolerated. We have in mind situations of urgency or isolation where a veterinary surgeon may be compelled to give advice as to how to deal with an animal that is apparently injured or sick to a client by remote means, such as email or telephone.
69 In our view contemporary standards of veterinary practice require in such circumstances that the veterinary surgeon have an established prior relationship with the client in respect of that animal; or, in the case of herd animals, a prior relationship with the client in respect of the herd. It is not necessary in this case to reach a firm view of what may be the limits of appropriate practice in relation to herd animals. This is not a herd case.
70 Dr Williamson did not have an established professional relationship with the trainer in respect of the three horses. Moreover, had he had a prior relationship, we would not have regarded the circumstances as involving a degree of urgency or isolation sufficient to justify remote advice and prescription.
71 The law governing veterinary surgeons makes it clear that special standards are to be observed in the administration of restricted substances such as progesterone. A restricted substance may only be supplied ‘upon the written prescription of medical practitioner, nurse practitioner authorised to prescribe the substance …dentist or veterinary surgeon’: Poisons and Therapeutic Goods Act 1966, s 8(2), now repealed but the legislation in force at the time of the events in issue in this case).
72 Dr Williamson, in our view, did not see any problem in distance-prescribing a restricted substance for administration without supervision and intravenously to an animal he had never seen, let alone examined. This is a worse form of misconduct than occurred in respect of the administration of ‘Pain’, a kind of herbal remedy.
73 Dr Williamson’s conduct is also of special concern because it involves racing animals. The racing industry and the massive gambling activities (and income stream to government) that surround it are tightly regulated. Public confidence in the operation of racing depends heavily on licensed persons observing the rules of racing and behaving with integrity. Equally, professionals with a close involvement in the industry must act in a way which upholds that public confidence. While animal welfare considerations are the paramount ones, the nature of this industry provides an important additional reason for ensuring that veterinary surgeons only deal directly with these animals.
74 A factor which stands, to an extent, in mitigation is that there is no evidence before the Tribunal as to any attempts at information as to acceptable standards in connection with distance-prescribing by the New South Wales bodies responsible for regulation of the veterinary profession. In contrast their Victorian counterparts have issued guidelines: see Ex I, Guideline 6 dated July 2002 issued by Veterinary Practitioners Regulation Board of Victoria, Supply and Use of Drugs in Veterinary Practice referred to by the Committee. Dr Williamson drew attention, also, to Guideline 17 issued by the Victorian Board.
75 The Victorian standards are consistent with the observations we have made in this decision, but have a much greater degree of refinement and detail. Most importantly, they reflect in Guideline 6.2.1 the necessity of having a prior professional relationship with the client that involves familiarity with the current management and health status of the client’s animals. This guideline also refers to the need to have physically examined the animal or herd immediately prior to dispensing. The document then deals with such matters as storage and handling requirements, documentation and communication of instructions in respect of the administration of the drugs where the client has that responsibility. There are recommendations in relation to labelling, and detailed references to the requirements connected with scheduled medicines.
76 There is a special part dealing with Drug Supply for the Treatment of Racing Animals (Guideline 6.10). The following passage is directly relevant to this case:
- ‘The dispensing of drugs by registered veterinary practitioners for racing animals, i.e. horses and greyhounds, needs to be undertaken with care to ensure that the requirements by racing animals for animals to race ‘drug free’ are met.
Under the Rules of Racing for most Codes, registered trainers must not have in their possession S4 drugs unless these have been lawfully dispensed by a registered veterinary practitioner. This places an enhanced obligation on practitioners to ensure that any drugs dispensed for racing animals are clearly and properly labelled, and quantities supplied should be strictly limited to that required to meet therapeutic need. Checks of drugs held at racing stables and kennels are undertaken by Stewards.’
77 We are satisfied that Dr Williamson is guilty of misconduct in a professional respect, in that he contravened Rule 5(2) of the Code by engaging in professional procedures which were contrary to current standards of veterinary science, being that:
- (i) He did not first examine the animal or animals to which the substance ‘Femme’ was to be administered.
(ii) The animals to which the substance ‘Femme’ was to be administered were not under his care at the relevant times in that he did not have a veterinarian-client-patient relationship with those animals.
(iii) He did not first examine the animal or animals to which the substance ‘Pain’ was to be administered.
(iv) The animals to which the substance ‘Pain’ was to be administered were not under his care at the relevant times in that he did not have a veterinarian-client-patient relationship with those animals.
- Allegation 1.3
78 In our view the documentation filed by the Committee contained substantial evidence that might have supported a finding adverse to Dr Williamson in respect of this charge. The Tribunal has, in our view, the power, once seized of the charge and relevant evidence not to accede to a decision not to press a charge. The Committee did not dispute this proposition. We will not on this occasion require any detailed explanation from the Committee for its decision not to press this charge. The disciplinary orders which follow are, we believe, adequate to deal with the problems revealed by this case; and would not we think have been significantly different had Allegation 1.3 been pursued, and been the subject of an adverse finding.
- The Question of the Appropriate Order
79 The power to make disciplinary orders has as its objective the upholding of the public interest in the proper practice of a profession, and, has often been stated, the purpose is not punitive but the protection of the public. We reiterate the observations of the Appeal Panel in Gelderman v Veterinary Surgeons Investigating Committee [2001] NSWADTAP 27:
- ‘16 It is well established that disciplinary proceedings are concerned with the protection of the public; their purpose is entirely protective, it is not punitive: Clyne v NSW Bar Association (1960) 104 CLR 186 at 201-202; NSW Bar Association v Evatt (1986) 117 CLR 177 at 183-184; Law Society of NSW v Foreman (1994) 34 NSWLR 408 at 440-441; Childs v Walton (Court of Appeal, 13 November 1990, unreported) at 13; Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637-638. The impact of any order on the practitioner, the subject of the disciplinary proceedings, is irrelevant: Clyne v NSW Bar Association at 201-202; Health Care Complaints Commission v Litchfield at 637-638.
17 In determining whether a practitioner found guilty of misconduct should be permitted to continue to practice [sic], the Tribunal must, amongst other things, balance the public interest in allowing competent practitioners to practice [sic], against the likelihood of a repetition of the offence. “The public interest in allowing the practitioner to continue to practice [sic] must be weighed against the public interest in protecting patients from any repetition of the conduct exhibited in the case”: Buttsworth v Walton (unreported, Court of Appeal, 19 December 1991) at 15….
22 However it is clear from the authorities that an assessment of the likelihood of a repeat of the offending behaviour is not the sole issue before the Disciplinary Panel in its determination as to whether it is the public interest to make an order to suspend (or remove) a veterinary surgeon from practice. While the purpose of orders made in disciplinary proceedings is the protection of the public, protection of the public is not confined to the protection of the public from similar defaults by the practitioner the subject of the disciplinary proceedings, but extends to the protection of the public against similar defaults by other practitioners: Law Society of NSW v Foreman at 441 . “ In this sense any penalty has an element of general deterrence, publicly marking the seriousness of what the instant solicitor has done”: Law Society of NSW v Foreman per Mahoney JA at 441, referred to in Law Society of NSW v Walsh (Court of Appeal, 15 December 1997, unreported) per Beazley JA at 3.
23 Indeed, in determining appropriate orders, protection of the public against further misconduct by the offending practitioner , “is not the sole, and in some cases may not be the determining factor”: Law Society of NSW v Foreman per Mahoney JA at 440
24 In Health Care Commissioner v Litchfield at 637 the Court of Appeal referred to the relevance of disciplinary proceedings to the maintenance of professional standards:
- Disciplinary proceedings against members of a profession are intended to maintain proper ethical and professional standards, primarily for the protection of the public, but also for the protection of the profession.
26 While this is a protective jurisdiction, if any sanctions at all are imposed upon the practitioner, they “will inescapably have a punitive consequence for the practitioner.” (Foreman per Kirby P at 413.) If, in order to secure the protection of the community, it is necessary in the public interest to impose sanctions upon a practitioner, it is an unfortunate collateral effect that the practitioner is, in effect, punished. But the person ultimately responsible for his or her misfortune is, of course, the practitioner in question.’
80 In this instance, an experienced practitioner of standing in the field of equine treatment has been the subject of adverse findings of misconduct. We accept that the findings are not so serious as to justify removal of his right to practise, either temporarily or permanently. On the other hand there are aspects of the case which do cause concern, and raise some doubts in our mind as to whether the public can be confident that he will, in the future, adhere to current standards of veterinary practice and not re-offend.
81 We note also that Dr Williamson was found guilty in the Melbourne Magistrates’ Court on 15 February 2000 of an offence under reg. 26(1) of the Drugs, Poisons and Controlled Substances Regulations 1995 (Vic.), in that being a registered veterinary surgeon he sold or supplied Schedule 4 drugs in containers to which labels as required by the regulation were not affixed. He was discharged without conviction, on a good behaviour bond.
82 In addition, on 4 December 2002, the Veterinary Practitioners Registration Board of Victoria found that Dr Williamson had ‘engaged in unprofessional conduct of a serious nature’ within the meaning of the Veterinary Practice Act 1997 (Vic.). It made the following determination:
- ‘The Panel made its finding based on a clear position that the labelling of registered drugs by registered veterinary practitioners is a serious element of a system by which the supply and use of controlled and registered drugs is regulated in the State of Victoria under the Drugs Poisons and Controlled Substances Regulations 1995.
…
The Panel determined that Dr Henry Mervyn Graham Williamson:
(c) be reprimanded with respect to the unprofessional conduct which was the subject of this formal hearing
(d) be required to undertake to provide to the Board within 28 days, a copy of a new label which he undertakes to use with the supply of all Schedule 4, 8 and 9 drugs, and which label is compliant in full with Regulation 26(1) (a)(b)(c)(d)(e) of the Drugs Poisons and Controlled Substances Regulations 1995, this being a label which will be affixed as required by Regulation 26 to all containers of these restricted drugs
(e) be required to complete a written assessment in the form of a document which will be provided to him by the Board for him to complete and return. This document will seek to allow Dr Williamson to demonstrate his knowledge and understanding of Guideline 6, which is the guideline issued by the Veterinary Practitioners Registration Board of Victoria pursuant to the Veterinary Practice Act 1997 in relation to the supply and use of restricted drugs by registered veterinarians
(h) be required to pay the reasonable costs of and incidental to this hearing being the sum of $5,000’
83 In favour of Dr Williamson, we have given some weight to the fact that he did, belatedly, plead guilty thereby saving the Committee and the Tribunal the time, effort and costs of three further days of hearing.
84 As noted earlier, Dr Williamson’s proposal was that a caution be recorded, that he give an undertaking, and that he submit to supervision by way of regular audits - the terms of the undertaking and the audit to be as proposed in the further submission dated 9 December 2004. The Committee’s proposal was that the misconduct be the subject of a reprimand, that an undertaking in the terms proposed was not acceptable and that there be supervision by way of audit, with some of the terms being different to those suggested by Dr Williamson. Most importantly, the Committee proposed that the audit requirements operate as a condition on registration.
85 In our view the Committee’s proposals come closer to what is required in this case.
86 A caution lies at the bottom of the hierarchy of sanctions. It is appropriate to minor cases of misconduct, especially ones involving an isolated relatively minor error or such factors as youth and inexperience. While the findings in this case relate to one set of events, they involve three horses, and for the reasons we have given, there is substantial material to suggest that Dr Williamson was following long-established practices and procedures. This is not a case of isolated error. Dr Williamson is a practitioner of great experience, and of some standing in the racing industry.
87 We do not think that Dr Williamson had any real contrition or remorse for his behaviour. In our view, he continues to believe that what he did was acceptable, at least at the time it occurred. We do not discern any real commitment on his part to avoid repeating the misconduct identified in this case if circumstances presented themselves which he regarded as pressing and deserving of a response.
88 This attitude is, we consider, reflected in the terms of the undertaking offered in clause 3 of his proposed orders. He proposes to promise not to supply or prescribe a substance for ‘any animal’ which he ‘has not physically examined within the 12 months period immediately preceding the proposed supply or prescription’. This is a lax standard. It fails to address the principal demand, that the veterinarian have an up-to-date, current knowledge of the animal; nor does it address the special position that must apply to dealings with racing animals. In some instances not having seen the animal for several months may not be a bar to recommending a treatment or prescribing a medication. In some circumstances any gap in time might not be acceptable. The approach proposed by Dr Williamson does not reflect these considerations. His proposal on this matter tends to strengthen our doubt as to his commitment to current standards of practice in relation to the matters raised by this case.
89 Moreover, this is the third proceeding in recent years where Dr Williamson’s professional conduct has been the subject of an adverse finding. We note that the events the subject of these proceedings belong, broadly, to the same time period as the matters that arose in Victoria. None the less, he is nearing the point where his continued fitness to practise may become an issue.
90 His misconduct should, in our view, be the subject of a reprimand.
91 The significance of the misconduct also warrants the imposition of a condition on his registration. If there is any breach of the condition, that will provide a basis in its own right for further disciplinary action.
92 The condition should be one that involves a period of direct supervision of his practice at his cost.
93 He should, as proposed by the Committee, be required to submit to a continuing audit of his prescribing practices (including the labelling of substances) at his expense by a veterinarian appointed by the Veterinary Surgeons Board of New South Wales.
94 Dr Williamson proposed term (a) [requiring that the veterinary surgeon selected as auditor be one located in Victoria] is not acceptable. The Board must be left free to chose an appropriate auditor. Obviously, the Board should keep in mind the expense for Dr Williamson that might be involved in sending someone down from New South Wales to Victoria. It may be possible to find a suitable dual-registered veterinarian in Victoria. This is a matter for the Board. Dr Williamson chose to practise veterinary science in New South Wales, relying on his New South Wales registration, when he dealt with Mr Robb. He can not complain if he thereby falls subject to discipline which includes costs connected with New South Wales.
95 The next matters are the timing of the first audit, the frequency of the audit, the overall period of auditing, the availability of the auditee to the auditor and the mode of reporting of the results of the audit to the Board. There is no dispute between the parties on these matters, and the proposals made by Dr Williamson are acceptable.
96 The next term in dispute is Dr Williamson’s proposed term (g), which seeks to place a restriction on the length of time of the audit – essentially that it not be more than two days. This is unnecessary. The key to this procedure working is that there be appointed a competent auditor sensitive to the nature of the task and the cost considerations affecting the auditee, and a co-operative approach, promoted especially by Dr Williamson. The length of time of the audit ought not be long in these circumstances. We doubt that would be anything like two days – at least once the first audit is done, parameters for the future are established and there is co-operation by Dr Williamson.
97 The other matters raised by Dr Williamson are not the source of contention.
98 Dr Williamson’s proposal contemplates the possibility of disputes over the implementation of the orders being brought back to the Tribunal. We agree with the Committee’s submission that this is not appropriate. The appropriate body to which to take any complaints about the way the audit process is conducted is the Board.
99 The costs order proposed by Dr Williamson is acceptable to the Committee. In the orders which follow, we have varied the proposed terms to a form which reflects the usual practice in this Tribunal.
100 We should indicate, finally, that we see the auditor’s principal task (audit of ‘prescribing practices’) as one to be interpreted widely not narrowly. The cross-examination of Dr Williamson in this case revealed, in our view, a number of matters that could properly give rise to concern. We have in mind his approach to collection and storage of blood samples, his interpretation of laboratory test results, his record-keeping practices and the extent of the instructions he gives to clients. The auditor’s other specified task is to audit the ‘labelling of substances’. The main issue here, we think, is the labelling of restricted substances.
101 The terms of the audit condition will be as follows:
- (a) the first audit is to be conducted within 3 months of these orders
(b) the next and subsequent audits are to take place no more frequently than once every 6 months
(c) the last audit will occur upon the third successive audit in which there have been no identified breaches of rules, regulations or standards of practice by the respondent during the period since the previous audit
(d) the respondent is to take all reasonable steps to make himself available to discuss with the auditor his prescribing practices, the clinical circumstances of each case considered by the auditor, and his practice relating to the supply, prescribing and labelling of circumstances
(e) the respondent is to authorise the auditor to report the results of his/her audit to the Board, except that the names and identities of clients and patients are not to be revealed except in circumstances in which the auditor has identified a breach of a rule, regulation or standard of practice by him
(f) any audit is not to extend beyond the hours between 8.00 am and 6.00 pm on any working day of the week during the duration of the audit
(g) the Committee is, at least 14 days prior to the occasion of each audit, to provide written notice to him of the date and time of commencement of the audit and the identity of the veterinary surgeon conducting the audit.
- 1. The respondent is guilty of misconduct in a professional respect in relation to the conduct the subject of Allegations 1.1, 1.2, 2.1 and 2.2 of the amended complaint.
2. Pursuant to s 32 of the Veterinary Surgeons Act 1986, the Tribunal makes the following orders:
- (a) an order reprimanding the respondent;
(b) an order imposing the condition on the registration of the respondent that he submit at his own expense to an audit of his prescribing practices (including the labelling of substances) by a registered veterinary surgeon appointed by the Veterinary Surgeons Board, the terms under which the audit is conducted being as specified at paragraph [101] of the Tribunal’s reasons for decision; and
(c) an order requiring him to pay within 14 days of the date of these orders the applicant’s costs of these proceedings as agreed; and failing agreement, as assessed in accordance with Part 11 of the Legal Profession Act 1987.
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