REGULATION OF HEALTH PRACTITIONERS: TEMPTATIONS AND TRANSGRESSIONS
Dr IAN FRECKELTON 1
Life is long, the Art of Medicine long, opportunity fleeting, experiment treacherous, judgment difficult. The physician must be ready, not only to do his duty but to secure the co-operation of the patient, of the attendants and of others.
Hippocrates, Aphorisms
Recognition of the need to regulate the ethical conduct of health practitioners is not a new phenomenon.
However, translation into specific factual situations of the need to protect the public as well as the importance of upholding the integrity and standing of the professions is far from a straightforward exercise.
There are difficult balances between individual, profession and community interests.
A practical issue for health tribunals and the courts on appeal is the fundamental basis for the imposition of sanctions upon practitioners who have been found to have engaged in inappropriate conduct of a significant level of seriousness. Tribunals have traditionally been precluded from imposing sanctions with a punitive purpose but have been permitted to "protect the public" by specific and general deterrence. But, aside from this focus upon the risk posed by the individual practitioner to the community is an obligation to maintain the reputation of the professions. The coexistence of these objectives is not straightforward in the application and leads to sometimes problematically variable outcomes.
At a conceptual but practical level another related difficulty that is confronted by the health and other disciplinary tribunals is how they should respond to conduct engaged in by health practitioners which is not archetypally professional conduct - for instance conduct that is criminal, disgraceful or unethical in a practitioner's private life. Aristotle in his Nicomachean Ethics2 maintained that "it is our choice of good or evil that determines our character, not our opinion about good or evil." And it is a prerequisite of registration in all jurisdictions that a practitioner be "of good character" or "a fit and proper person". Can they be if they have seriously breached the criminal law? To what extent should disciplinary law defer to the decision-making of the criminal courts and confine itself to the likelihood of risk to the public caused by the practitioner's professional behaviour? When does a practitioner's private behaviour unacceptably detract from the standing of the profession in the eyes of the public? What if the conduct of the practitioner is adjudged unlikely to be repeated, and therefore the community does not need further protection from the person, and yet their behaviour has been very serious and such as to reduce public trust in the profession?
This paper endeavours to grapple with such difficulties in the aftermath of important recent decisions from Victoria, South Australia, the High Court and the Privy Council. It focuses upon the ethical and legal distinctions between personal and professional lives, an appropriate subject for reflection by professionals currently removed the day to day demands of practice and in a location that resonates with a history of ethical debate. It argues for a more clearly articulated role for disciplinary tribunals so as to provide greater predictability of results for medical and allied health practitioners.
The Regulatory Environment
The functioning of disciplinary tribunals in the health area is in the process of fundamental change. From an administrative law perspective, "disciplinary law" has emerged as a robust and lively field of work for lawyers. Complaint numbers have grown significantly over the last 10 years with the result that the incidence of formal and informal disciplinary hearings has also escalated3. Much arises from altering community expectations of their entitlements in terms of care, attention, respect, civility and provision of information by healthcare professionals.
In addition, it is apparent that both disciplinary tribunals and courts are imposing harsher sanctions in face of findings of unprofessional conduct. They have responded to the "consumer movement" and have become less protective and understanding of ethical transgressions by health practitioners - especially in relation to boundary violations, dishonesty, conflicts of interest, breaches of confidentiality and procedures undertaken without due provision of explanations and options to patients. This response by health boards and tribunals is reflective of changing community attitudes and expectations of professionals.
A more rigorous response by the health boards and tribunals means that, from the perspective of health practitioners, there is more to fear from hearing processes that in the past were almost exclusively providers of peer review and were relatively tolerant of professional errors and ethical breaches. In turn, first instance health board and tribunal decisions are being more fiercely, and expensively, contested; they are also increasingly often being appealed.
In addition, the accountability of medical practitioners in particular is increasingly politicised in the aftermath of the conduct of Dr Shipton and of practitioners at the Bristol Royal Infirmary4 in the United Kingdom, Dr Kevorkian in the United States and to a lesser degree Dr Edelsten and cosmetic and ophthalmic surgeons in Australia. Each in their different way has confronted the public and left anxieties about the governance of ethical conduct by medical practitioners in their professional and private lives.
There is political controversy too over the regulatory models best suited and most apt to command public confidence in relation to medical practitioners, in particular, but also in relation to the full gamut of those offering health services to the general community. Lay participation in health tribunal decision-making is increasing and, with it, the dominance of the peer review approach is coming under scrutiny5. Major changes have taken place in terms of both non-professional participation and the models for decision-making the General Medical Council in the United Kingdom, as well as in Queensland and New Zealand. They are being mooted in Victoria6 and Western Australia, while a number of matters are being reconsidered in terms of investigation of complaints against medical practitioners in New South Wales.
A new phenomenon has been a move away from the traditional preoccupation of "disciplinary boards" with professional misconduct. In the United Kingdom, New South Wales and Victoria, to name but a few jurisdictions, inquiries into concerns expressed about the quality of a medical practitioner's work can focus not only on conduct issues ("the conduct pathway") but upon the practitioner's skill levels and competence ("the performance pathway"), as well as upon health issues that may have affected either conduct or performance ("the health pathway"). This enables a reframing of the issues presented by notifiers or complainants and an assessment in the public interest of what fundamentally has given rise to consternation or what in the future might produce adverse results. Thus, the shift is away from the disciplinary to the provision of guidance, mentoring and enhancement of performance, as well as maintenance of adequate conduct and performance by virtue of therapeutic intervention.
It is in the context of these various influences that contemporary debate about the role of health practitioner boards needs to take place.
Two Victorian Cases Highlighting the Dilemma
Two difficult cases that have prompted different approaches between the Victorian Medical Practitioners Board and its appellate body, the Victorian Civil and Administrative Tribunal ("the VCAT") illustrate the problem well.
In a formal hearing the Medical Practitioners Board found a practitioner's preparedness in his private life to pay ongoing sums of money for sex to a 16 year old girl whom he had met at a casino and who was homeless and heroin dependent to raise issues of serious concern about his character7. It identified specifically issues about the practitioner's judgment and his ability to make suitable decisions in the best interests of adolescent, drug dependent patients. No complaint had been made about the practitioner's conduct of his medical practice. The VCAT overturned the Board's decision and reinstated his practising rights, finding the practitioner's personal conduct to be sufficiently removed from his professional responsibilities to justify his remaining in practice8.
In another case, the Board suspended an otherwise well-regarded forensic pathologist who had been sentenced by the County Court to a suspended gaol term for a dishonest scam to raise over $300,000 to ward off tax obligations9. It maintained that honesty in a practitioner's behaviour was an integral characteristic of the community's ability to repose trust in a contemporary medical practitioner. Again the VCAT disagreed that such an interference with a practitioner's ability to practise was necessary in order to protect the public, substituting a reprimand10.
In this regard then, two difficult issues recur for boards and, on appeal, the courts:
* What should be the bases for decision-making about sanctions when the conduct of the practitioner is adjudged unlikely to recur but is such as to impact upon the confidence that the public has in the profession?
* When should disciplinary intervention take place, with the potential for an impact upon a practitioner's registered status, when the conduct of the practitioner is removed from that of clinical practice?
A number of recent decisions in Victoria, South Australia, the High Court on appeal from New South Wales and the Privy Council have contributed to the dilemmas. What follows is a summary of the factual circumstances and the reasoning articulated in each of these cases.
The Ha Decision of the Victorian Supreme Court
In Ha v Pharmacy Board of Victoria11 Gillard J of the Victorian Supreme Court heard an appeal from a pharmacist who had been found by the Pharmacy Board to have engaged in conduct discreditable to a psychologist. He had indecently assaulted two young women aged 14 and 20 (the latter at the time on a Methadone programme) who applied for positions as a junior pharmacy assistant. In the County Court, on appeal, he was fined $1,500 without conviction and given a two year community based order without conviction with conditions that he perform unpaid community work and undergo psychological or psychiatric treatment as directed.
Justice Gillard acknowledged that where issues coming before a court on appeal relate to the practice of a health professional "the standard that one would expect of the reasonable competent pharmacist or the good character and reputation expected of a pharmacist, the members of the Board are usually in a better position than this Court to make an assessment of those matters, and in those circumstances, the Court should attach substantial weight to their findings." However, he held that where the issues before an appeal court "involve matters that do not depend upon the practice of pharmacy, then the Court is in as good a position as the Board to make its own assessment of the penalty."12
Justice Gillard futher observed that the inappropriate behaviour of the appellant "was not confined to the practice of pharmacy ... However, his conduct does have a connection with the practice of pharmacy in that he was able, by reason of his position as a pharmacist, to deceitfully induce the potential employees to go along with his investigation because, as a pharmacist, he was concerned about the theft of drugs."13 He classified the "prime purpose" of the inquiry of a disciplinary tribunal as "to ensure that a member of the profession ... adheres to the high standards expected of a member of the profession."14 In doing so, he acknowledged that the function of boards "is not to uphold the law or punish those who may transgress any law in this State." He observed that the pharmacist had been "severely punished for his stupidity and serious misconduct. His reputation has been tainted. What he had experienced to date should be a constant reminder to him of what he had risked by his stupidity, namely, the permanent loss of reputation, position in the community and his business."15 By contrast, he stressed that the focus of the Pharmacy Board and then the Supreme Court on appeal should be on the "protection of the public and to protect the reputation of the profession itself."16
Thus he postulated a joint focus. He noted that the New South Wales Court of Appeal in Health Care Complaints Commission v Litchfield17 held that "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."
Justice Gillard held that members of the public dealing with pharmacists must be able to do so confident that the pharmacist is an honest, reliable, careful and responsible person. He noted that the pharmacist before him had been working extremely long hours, had become increasingly stressed, his wife had had post-natal complications and he had had sleeping difficulties, as well as stresses in coping with the introduction of the Goods and Services Tax. He continued to be anxious and guilty about his behaviour. There was a report from a psychiatrist that there was a low likelihood that he would repeat his behaviour. A psychologist too opined that it was unlikely that the pharmacist would indulge in inappropriate behaviour as an answer to stress again.
Justice Gillard accepted that it was highly unlikely that he would reoffend and decided that the punishment already meted out was a sufficient reminder of what would follow if he repeated his behaviour. He took into account the consequences of a suspension of the pharmacist's practice and concluded that a suspension was not necessary to protect the public and maintain the integrity and standing of the profession.
The Re A Solicitor Decision of the High Court
In A Solicitor v The Council of the Law Society of New South Wales18 a similar set of circumstances arose. The New South Wales Court of Appeal found a legal practitioner guilty of professional misconduct and not a fit and proper person to be on the roll of practitioners. The two matters which had earned the ire of the Court of Appeal were that the solicitor had been found guilty by the Local Court of four counts of aggravated indecent assault of a person under the age of 16 and that he had failed to disclose to the Law Society that he had been guilty of further similar charges.
The High Court reflected upon its own decision in Ziems v The Prothonotary of the Supreme Court of NSW19 when a barrister had been convicted of manslaughter and sentenced to two years' imprisonment. The High Court had concluded that the conviction and sentence themselves did not constitute grounds to disbar the barrister. Instead it looked at the particular circumstances of the case. He had been drinking at a hotel, been attacked and beaten, with the result that he was seriously injured. He was advised by police to go to a hospital. He asked the police to drive him there but they did not do so. Then he set out to drive himself to hospital and in the course of the journey was involved in a fatal collision. The court differentiated between cases of personal as against professional misconduct holding that "the whole approach of a court to a case of personal misconduct must surely be very different from its approach to a case of professional misconduct. Generally speaking the latter must have a much more direct bearing on the question of a man's fitness to practice than the former."20 Justice Kitto in Ziems commented:
"It is not difficult to see in some forms of conduct, or in convictions of some kinds of offences, instant demonstration of unfitness for the Bar. Conduct may show a defect of character incompatible with membership of a self-respecting profession; or, short of that, it may show unfitness to be joined with the Bench and the Bar in the daily co-operation which the satisfactory working of the courts demands. A conviction may of its own force carry such a stigma that judges and members of the profession may be expected to find it too much for their self-respect to share with the person convicted the kind and degree of association which membership of the Bar entails. But it will be generally agreed that there are many kinds of conduct deserving of disapproval, and many kinds of convictions of breaches of the law, which do not spell unfitness for the Bar; and to draw the dividing line is by no means always an easy task."
The Court in Re A Solicitor reaffirmed its approach in Ziems and confirmed that it is important to consider the "detailed subjective and objective circumstances of offending behaviour."21 It proceeded to do so, noting that the solicitor before it had been involved for some years in a relationship with a woman to whom he was by then married. She had four children, including two daughters aged 12 and 10. In 1997 the solicitor suffered two major personal setbacks, he and a number of other employees being made redundant and his father being diagnosed with mesothelioma. He suffered exhaustion and depression and at some point removed the girls' clothing, rubbed them on the back, buttocks and stomach and touched one of them on the outside of her vagina.
Complaint about two of the matters was made by the children. The appellant admitted the offences, and also told the police of two other offences involving the same children. He sought professional help from a psychiatrist. In February 1998, the four charges came before a Local Court. The appellant pleaded guilty and was sentenced to three months imprisonment. He appealed to the District Court against the severity of the sentence. In May 1998, the appeal was allowed and the sentence quashed, the sentence in each case on condition that the appellant entered into a recognizance to be of good behaviour for three years.
In due course he was forgiven by the children's mother. A senior psychologist said that he had a full awareness of the situations that had led to his offending behaviour and the risk of his re-offending was "minimal" A report from the founder director of the Child Abuse Protection Centre suggested that he was a man of "basically good character who was not a future risk."
In July 1998, the Council of the Law Society resolved to institute disciplinary proceedings against the solicitor based on his four convictions for indecent assault. Problematically, in May 2000, one of the daughters of the woman who by then was his wife made further allegations of a similar nature against the solicitor. He denied the allegations but was charged, convicted and sentenced to imprisonment for two years. He successfully appealed to the District Court with the result that in 2001 his convictions and sentences were quashed. The appellant at all times maintained that the charges were false. However, throughout matters being traversed with the Law Society the solicitor did not communicate that he had been found guilty in the Local Court of the additional matters.
The High Court observed that the solicitor's indecent conduct did not occur in the course of the practice of his profession and that it had no connection with his practice, even though it constituted an abuse of trust. The decision of Gillard J in Ha v Pharmacy Board of Victoria was not referred to by the judges. It took a similar approach, however, The High Court overturned the decision of the New South Wales Court of Appeal, concluding that it had given "insufficient weight to the isolated nature of the 1997 offences and the powerful subjective case made on behalf of the appellant." While Justice Sheller in the Court of Appeal found the solicitor's 1997 conduct to manifest qualities of character which were incompatible with the conduct of legal practice, in particular being a very serious breach of trust on his part given the paternal like role he had with the victims, the High Court unanimously disagreed: "It is true that the conduct involved a form of breach of trust, being the trust reposed in the appellant by the mother of the children (who later forgave, and married, him) and the children themselves. However, the nature of the trust, and the circumstances of the breach, were so remote from anything to do with professional practice that the characterisation of the appellant's personal misconduct as professional misconduct was erroneous."
Likewise the High Court found the solicitor's lack of candour to have occurred in "extraordinary circumstances" and concluded that it was not such as to demonstrate him to be unfit for practice.
The Craig Decision of the South Australian Full Court
A contrasting receipt decision is that of the Full Court of the South Australian Supreme Court in Craig v Medical Board of South Australia22 which had occasion to consider at length the considerations appropriate to dealing with serious misconduct by a medical practitioner. At first instance it was found, on admissions by Dr Craig, a psychiatrist, that he had engaged in an intimate (though allegedly non-sexual) relationship with a current patient who required treatment for an eating disorder.
The Court held that:
"The purpose of disciplinary proceedings is to protect the public, not to punish a practitioner in the sense in which punishment is administered pursuant to the criminal law. A disciplinary tribunal protects the public by making orders which will prevent persons who are unfit to practise from practising, or by making orders which will secure the maintenance of proper professional standards. A disciplinary tribunal will also consider the protection of the public, and of the relevant profession, by making orders which will assure the public that appropriate standards are being maintained within the relevant profession."23
It specifically followed the decision of the High Court in New South Wales Bar Association v Evatt24 in its much cited judgment:
"The Supreme Court thought, moreover, that as the exercise of its disciplinary powers was, to some extent, a punishment for wrongdoing, mercy might be shown towards a young man who had not understood the error of his ways. The power of the Court to discipline a barrister is, however, entirely protective, and, notwithstanding that its exercise may involve a great deprivation to the person disciplined, there is no element of punishment involved. This has already been pointed out by this Court in Clyne v NSW Bar Association (1960) 104 CRL 186, at 201, 202. The respondent's failure to understand the error of his ways of itself demonstrates his unfitness to belong to a profession where, in practice, the client must depend upon the standards as well as the skill of his professional adviser."
The Full Court commented:
"The protection of the public or the public interest may justify an order intended to bring home to the practitioner the seriousness of the practitioner's departure from professional standards, and intended to deter the practitioner from any further departure. A fine might well be imposed with this object. An order imposing a fine might look like a punishment imposed by a court exercising criminal jurisdiction, but in professional disciplinary proceedings it is imposed on a different basis. An order might also be made in professional disciplinary proceedings to emphasise to other members of the profession, or to reassure the public, that a certain type of conduct is not acceptable professional conduct. In the latter case the order is made in part to protect the profession, by demonstrating that the profession does not allow certain conduct. This, in the end, is also in the public interest.
I make these points merely to emphasise that the protection of the public has various aspects. The public may be protected by preventing a person from practising a profession, by limiting the right of practise, or by making it clear that certain conduct is not acceptable. These are merely illustrations of the sort of order that may be called for."25 The Court upheld the suspension and imposition of supervision as a condition on Dr Craig's practice, holding that his conduct was of a kind that might well shake the public confidence in the profession of psychiatry, were it not dealt with firmly: "It was conduct which called for an emphatic indication of the Tribunal's disapproval, and of the profession's disapproval. Although Dr Craig's acknowledgment of wrongdoing was accepted as genuine, and there was no need to deter him from repeating his conduct, it was appropriate for the Tribunal to emphasise to Dr Craig the seriousness of his conduct."26
The Roylance Decision of the Privy Council
The Privy Council had occasion to grapple with a number of the same issues in the complex case of Roylance v General Medical Council27.
The principal issue concerned the responsibility of the chief executive officer, a registered medical practitioner, of the Bristol Royal Infirmary, to take action over the years when concerns were being raised about the excessive mortality of infants and his failure to take any steps in a particular case to prevent an operation from proceeding.
Their Lordships acknowledged that when misconduct is engaged in by a doctor which has a clear relevance to the practice of medicine, namely that it affects the practitioner's patients or professional colleagues, it falls squarely within the purview of a medical board and can be found to constitute professional misconduct28.
However, on the more difficult issue involving the extended parameters of such conduct, their Lordships stated:
"...serious professional misconduct may arise where the conduct is quite removed from the practice of medicine, but is of a sufficiently immoral or outrageous or disgraceful character. An example can be found in A County Council v W (Disclosure) [1997] 1 FLR 574, where a question arose whether the alleged sexual abuse by a father of his daughter, the father being a medical practitioner, could constitute serious professional misconduct. It was argued that any sexual abuse was too remote from the father's occupation as a doctor since it was outwith any medical treatment of a child. But Cazalet J held (at 581) that "it seems to me that this doctor can be said, if he has sexually abused his daughter, to have demonstrated conduct disgraceful to him as reflecting on his profession and/or indeed conduct disgraceful to him as a practising doctor". What is important here is not only the fact that disgraceful behaviour remote from the carrying on of a professional practice may constitute serious professional misconduct, but also that the duty of a doctor to himself, if not to his profession, exists outwith the course of his professional practice. One particular concern in such cases of moral turpitude is that the public reputation of the profession may suffer and public confidence in it may be prejudiced."29
The Issues Remaining
For tribunals, appellate courts and healthcare practitioners, the legal principles governing the imposition of disciplinary sanctions are unclear after the recent judicial determinations. On the one hand, it is accepted that disciplinary tribunals must not punish. However, they can dispense sanctions (including substantial fines) that are perceived by practitioners as punishment so long as they do so avowedly to protect the public by deterring the practitioner from like conduct or to deter other practitioners from comparable conduct.
It appears that in most circumstances disciplinary tribunals should pay significant heed to the punishment dispensed by the criminal courts where the practitioner has engaged in behaviour that has broken the law: this is a common issue when medical practitioners have supplied themselves with drugs of addiction because of a pethidine or other dependency which they or a person close to them has developed. Criminal court sentencing also has the potential to accomplish a large measure of the deterrent effect which otherwise might be the bailiwick of a disciplinary determination. If such measures are considered likely to result in a low likelihood of recidivism by the practitioner, it would seem that serious sanctions might be inappropriate as they are not required to protect the public. The focus may then shift toward educative and supervisory arrangements which might enable ongoing monitoring.
However, this sits uncomfortably with statements in decisions like that of the Full Court of the South Australian Supreme Court in Craig that decisions should be made which factor into account the need for there to be denunciation of behaviour unacceptable to a profession and in order to "reassure the public, that a certain type of conduct is not acceptable professional conduct". Justice Gillard in Ha, too, held that a further purpose for the imposition of sanctions upon a practitioner is to "protect the reputation of the profession". How, though, does this come into the intuitive synthesis of factors to be reflected upon in arriving at a justice decision? It appears from the decisions of Gillard J in Ha and of the High Court in Re A Solicitor that the potential for public anxiety and mistrust of a profession because of the adverse conduct of its practitioners is a consideration that, in practice, is considered secondary to the need of the public for ongoing protection from a practitioner.
It would appear that in principle there are transgressions in private life that would be considered incompatible with registration as a practitioner of an honourable profession. So much has been clear since the High Court's decision in Ziems although Ziems' culpable driving was found not to fall into such a category. Significant ongoing dishonesty might be an example of precluding conduct. However, the Victorian Supreme Court and then the High Court have found, respectively, that sexual interference with a prospective staff member and with a practitioner's daughters are not defects of character incompatible with membership of a self-respecting profession. It is difficult in such circumstances to identify which flaws of character exhibited outside or even bordering on professional behaviour would arouse sufficient curial concern to be regarded as incompatible with a professional maintaining their registered status.
The issues identified in this paper are complex. They go to the heart of the contemporary functioning of disciplinary tribunals and the distinctions between private life and professional life. They are not amenable to easy resolution or reconciliation.
While it is apparent that more and sophisticated guidance needs to be provided by the superior courts, it is also the case that the role of health boards and tribunals is changing in conformity with community expectations of both them and professionals. There is a growing recognition within professions that it is often not effective to deal with individual instances of unacceptable conduct from a disciplinary perspective. Frequently, such instances are indicative of broader-based performance or health issues. Clearly, where a practitioner, in whose training the community is likely to have expended significant sums of money, is reclaimable without posing an undue risk to the public, this is a preferable course to draconian interference with registered status. However, such an approach does not always meet the anxieties fanned by the media or the need to uphold the reputation and standards of the profession.
NOTES
1 Barrister, Melbourne; Lawyer Member, Medical Practitioners Board of Victoria and Psychologists Registration Board of Victoria. The views expressed in this paper, however, should not be imputed to any body or organisation with which the author is associated.
2 III, ii, 11.
3 In Victoria this is the explicit division between types of hearings under the Medical Practice Act 1994 (Vic).
4 See eg Roylance v The General Medical Council [1999} UKPC 16.
5 See D Thomas, "The Co-regulation of Medical Discipline: Challenging Medical Peer Review (2004) 11 Journal of Law and Medicine 382
6 http://www.google.com.au/search?q=Regulation+of+the+Health+Professions+in+Victoria&ie=UTF-8&oe=UTF-8&hl=en&btnG=Google+Search&meta=
7 Re Sze-Tho [2002] MPBD (Vic).
8 Sze-Tho v Medical Practitioners Board, unreported, VCAT, 22 March 2002.
9 Re Collins [2002] MPBD (Vic) ; http://medicalboardvic.org.au/levelTwo.php?art=27&uid=4
10 Collins v Medical Practitioners Board [2003] 1755.
11 [2002] VSC 322.
12 Ibid at [84].
13 Ibid, at [86].
14 Ibid
15 Ibid, at [99].
16 Ibid, at [91], referring to Clyne v New South Wales Bar Association (1960) at 201: "Although it is sometimes referred to as the 'penalty of disbarment' it must be emphasized that a disbarring order is in no sense punitive in character. When such an order is made, it is made, from the public point of view, for the protection of those who require protection, and from the professional point of view in order that abuse of privilege may not lead to loss of privilege." See too New South Wales Bar Association v Evatt (1968) at 183.
17 (1997) 41 NSWLR 630 at 637.
18 [2004] HCA 1.
19 (1957) 97 CLR 279.
20 At [24].
21 At [22].
22 [2001] SASCR 169.
23 At [41].
24 (1968) 117 CRL 177, at 183-184.
25 At [43]-[44].
26 At [64].
27 Council [1999} UKPC 16.
28 See eg Allinson v. General Council of Medical Education and Registration [1894] 1 QB 750at 761.
29 At [42].
Copyright 2004. Greek Legal and Medical Conference