VICTORIAN CIVIL AND ADMINISTRATIVE TRIBUNAL
Administrative division
Review and Regulation List	
vcat reference No. Z1141/2018	
CATCHWORDS	
Review and Regulation List – Health Practitioner Regulation National Law – medical practitioner – determinations under s 196 of the National Law – limited registration improperly obtained because false Letter of Good Standing from Malaysian Medical Council provided to the Board – false statements about surgical qualification to prospective employer and to the Australian Medical Council – falsified email provided to prospective employer, purporting to be from the Australian Medical Council indicating that surgical qualification had been verified – disqualification from applying for registration – ss 196(1)(b)(iii) & (v), 196(2)(a), 196(4)(a).	

APPLICANT	Medical Board of Australia	
RESPONDENT	Dr Mohamad Faizal bin Mohamad Anwar	
WHERE HELD	Melbourne 	
BEFORE	Senior Member E Wentworth, Member R Mason (Dr) & Member A Sungaila (Dr)	
HEARING TYPE	Decision on the papers	
DATE OF ORDER (Determinations)	15 April 2020	
date of reasons	15 April 2020	
CITATION	Medical Board of Australia v Anwar (No 2) (Review and Regulation) [2020] VCAT 462	

ORDERS
1	Dr Anwar is reprimanded.
2	Dr Anwar is disqualified from applying for registration for a period of eight years from the date of these orders.

E Wentworth
Senior Member and Presiding Member	R Mason
Health Practitioner Member	A Sungaila
Health Practitioner Member	

REASONS
Background
1	In a decision published on 21 November 2019, we found three allegations proved against Dr Mohamad Faizal bin Mohamad Anwar: Medical Board of Australia v Anwar (Review and Regulation) [2019] VCAT 1803 (our Findings decision).
2	We found that:
•	Dr Anwar’s registration as a medical practitioner was improperly obtained because he or someone else gave the Medical Board of Australia (the Board) a ‘Letter of Good Standing’ purportedly from the Malaysian Medical Council dated 16 February 2015 and that document was false: finding under s 196(1)(b)(v) of the Health Practitioner Regulation National Law (National Law) (Allegation 1).
•	Dr Anwar engaged in professional misconduct by creating and relying upon a false document in support of an application for employment as a medical practitioner.  Dr Anwar falsely represented in the document that he held a Master of Surgery qualification from the Universiti Putra Malaysia (UPM) .  The document purported to be an email from the Australian Medical Council (AMC) verifying that qualification.  The AMC had not verified that qualification: finding under s 196(1)(b)(iii) of the National Law (Allegation 2).
•	Dr Anwar engaged in professional misconduct by falsely representing to the AMC, in the course of seeking to have his overseas qualifications verified, that he held a Master of Surgery qualification from UPM: finding under s 196(1)(b)(iii) of the National Law (Allegation 3).
3	The conduct in Allegations 2 and 3 was directly contrary to Good Medical Practice: A Code of Conduct for Doctors in Australia (Code), which provides that:
Doctors… must be ethical and trustworthy.
In professional life, doctors must display a standard of behaviour that warrants the trust and respect of the community.  This includes observing and practising the principles of ethical conduct.
…
When providing curriculum vitae, good medical practice involves:
8.9.1	Providing accurate, truthful and verifiable information about your experience and your medical qualifications.
8.9.2	Not misrepresenting, by misstatement or omission, your experience, qualifications or position.
4	These are our reasons for the consequential orders (determinations) we have made.
5	The facts which underlay our findings in relation to Allegations 2 and 3 are, in summary:
•	on 13 July 2016, in support of an application for employment, Dr Anwar forwarded an email to Dr Kareem Marwan, Director of Surgery at Chelsea Heights Day Surgery and Endoscopy, attaching a PDF of an email purportedly from the AMC on 23 July 2016 (the AMC email);
•	the AMC email was falsified, and Dr Anwar admits to having created and sent it;
•	on or about 20 July 2016, Dr Anwar activated his AMC Portfolio seeking verification of a Master of Surgery qualification from UPM;
•	Dr Anwar admits to having submitted false documents to the AMC in an attempt to verify a Master of Surgery degree from UPM; and 
•	UPM did not offer a Master of Surgery qualification and Dr Anwar has not received that qualification from that institution.
6	Dr Anwar did not participate in the Tribunal proceedings.  
7	His registration was suspended by way of immediate action on 16 August 2016. 
8	His visa, which depended on his registration, was revoked, and he had left Australia by September 2018.  By then he had also been struck off the register in Malaysia.  We say more about the reasons for that below.
9	At an early stage in the proceedings, however, he had legal representation, and those legal representatives had provided his formal response to the Board during the investigation.  As our Findings decision notes, Dr Anwar admitted much of the conduct, including that:
•	he made the false document purporting to be from the AMC and provided it to his prospective employer;
•	he made and submitted a false document claiming he held a Master of Surgery degree from UPM to his prospective employer; and
•	he submitted a false document to the AMC in an attempt to have the fictitious Master of Surgery degree verified.
10	We were satisfied that Dr Anwar had received all the relevant documents and correspondence in the proceedings by email, including the Board’s submissions on determinations.  
11	Nevertheless, we provided an opportunity for him to make submissions by our 21 November 2019 orders, allowing him until 31 January 2020 to provide submissions and any supporting material.  
12	Our orders also set out the determinations the Board asked for, namely a reprimand and a period of disqualification between three to five years, together with our indication that we considered a longer period of disqualification might be appropriate.
13	Dr Anwar did not send any submissions.
14	Our decision on determinations follows after the next section, which sets out for convenience the allegations we found proved.
Allegations found proved
Allegation 1
1.	That Dr Anwar’s limited registration granted by the Board on 23 March 2015 was improperly obtained because he or someone else gave the Board information or a document that was false or misleading in a material particular.
PARTICULARS
The particulars include, but are not limited to:
(i)	on or about 26 January 2015, the Australian Health Practitioner Regulation Agency (AHPRA) received a completed Application for Limited Registration for Postgraduate Training or Supervised Practice (Form ALPS-3), signed by Dr Anwar on 22 January 2015;
(ii)	on 27 February 2015, AHPRA wrote to Dr Anwar noting the following outstanding documents:
(A)	a Certificate of Good Standing (COGS) from the Malaysian Medical Council (MMC) to be forwarded directly to the Board; and
(B)	evidence of internship;
(iii)	on 27 February 2015, AHPRA received a ‘Letter of Good Standing’ dated 16 February 2015, purportedly signed by Dr Muhammad Yazuran Sallij Muhd Yasin (Dr Yasin) Deputy Secretary of the MMC (purported Letter of Good Standing) stating that:
(A)	Dr Anwar had fully completed his Internship under the Malaysian Medical Act 1971;
(B)	Dr Anwar had no past history of any disciplinary action taken against him or any current ongoing cases/medical board inquiries on ethical, conduct or professional responsibility against him; and
(C)	there was no disciplinary action pending against him under the Malaysian Medical Act 1971;
(iv)	on 19 August 2016, AHPRA received an email from Dr Yasin to the effect that:
(A)	the purported Letter of Good Standing was not produced or sent by the MMC; and
(B)	Dr Yasin did not sign the purported Letter of Good Standing;
(v)	on 11 August 2017, AHPRA received a letter from Associate Professor Shireen Sumita Mahalingam of the MMC, which contained an assertion to the effect that the Letter of Good Standing was not issued by the MMC.
Allegation 2
2.	That Dr Anwar engaged in:
(a)	professional misconduct within the meaning of the definition of professional misconduct in paragraph (a) and/or (b) and/or (c) of section 5 of the National Law;
and/or
(b)	unprofessional conduct within the meaning of the definition of unprofessional conduct in section 5 of the National Law;
in that, on or about 13 July 2016 and 14 July 2016, Dr Anwar, in support of an application for employment at Chelsea Heights Day Surgery and Endoscopy (CHDSE):
1.	submitted to Dr Kareem Marwan (Dr Marwan), CHDSE’s Director of Surgery and a member of its Medical Advisory Committee, a false and/or misleading document purportedly from the Australian Medical Council (AMC); and/or
2.	made a false and/or misleading representation to Dr Marwan to the effect that he held a Master of Surgery degree from the Universiti Putra Malaysia (UPM).
PARTICULARS
The particulars include, but are not limited to:
(i)	on or about 13 July 2016, Dr Anwar sent to Dr Marwan an email, which included a representation that Dr Anwar had obtained a Master of Surgery;
(ii)	on or about 14 July 2016, Dr Anwar forwarded to Dr Marwan an email dated 23 May 2016 purportedly from the AMC, which indicated that a Master of Surgery qualification obtained from UPM in 2007 had been successfully verified;
(iii)	the email referred to in (ii) was not authored or sent by any officer of the AMC;
(iv)	UPM did not offer a Master of Surgery in 2007 or at any time and Dr Anwar did not obtain any such degree from UPM;
(v)	the representation referred to in (i) above was false or misleading because of the matters in (ii), (iii) and (iv) above;
(vi)	the email referred to in (ii) above was false or misleading because of the matters in (iii) and (iv) above;
(vii)	at all material times, the Board’s Good Medical Practice: A Code of Conduct for Doctors in Australia (Code) provided that:
Doctors… must be ethical and trustworthy.
In professional life, doctors must display a standard of behaviour that warrants the trust and respect of the community.  This includes observing and practising the principles of ethical conduct.
…
When providing curriculum vitae, good medical practice involves:
8.9.1	Providing accurate, truthful and verifiable information about your experience and your medical qualifications.
8.9.2	Not misrepresenting, by misstatement or omission, your experience, qualifications or position.
Allegation 3
3.	That Dr Anwar engaged in:
(a)	professional misconduct within the meaning of the definition of professional misconduct in paragraph (a) and/or (b) and/or (c) of section 5 of the National Law;
and/or
(c)	unprofessional conduct within the meaning of the definition of unprofessional conduct in section 5 of the National Law;
in that, on or about 20 July 2016, Dr Anwar made a false and/or misleading representation regarding his qualifications to the AMC.
PARTICULARS
The particulars include, but are not limited to:
(i)	on or about 20 July 2016, Dr Anwar created an AMC Candidate Portfolio via the AMC’s Candidate Account Service, located online at account.amc.org.au;
(ii)	on or about 20 July 2016, Dr Anwar updated his qualifications page on his AMC Candidate Portfolio to include reference to a Master of Surgery qualification obtained from UPM in 2007;
(iii)	UPM did not offer a Master of Surgery in 2007 or at any time and Dr Anwar did not obtain any such degree from UPM;
(iv)	at all material times, the Board’s Good Medical Practice: A Code of Conduct for Doctors in Australia (Code) provided that:
Doctors… must be ethical and trustworthy.
In professional life, doctors must display a standard of behaviour that warrants the trust and respect of the community.  This includes observing and practising the principles of ethical conduct.
…
When providing curriculum vitae, good medical practice involves:
8.9.1	Providing accurate, truthful and verifiable information about your experience and your medical qualifications.
8.9.2	Not misrepresenting, by misstatement or omission, your experience, qualifications or position.
Determinations under the National Law: General Principles
15	The applicable principles are well-established.  
16	The primary purpose of determinations is to protect the public, not to punish the practitioner.  
17	That primary purpose, together with protection of the reputation of the particular health profession in the eyes of the public, is achieved by ensuring that proper ethical and professional standards are maintained. 
18	As the Tribunal observed in Honey v Medical Practitioners Board of Victoria (Occupational and Business Regulation) [2007] VCAT 526 (Honey), at [14] and [16]: 
It is of prime importance in assessing the appropriate sanction that we bear in mind that the purpose of the determination is not to punish …
…
Our aim must be to protect the public, and we achieve that aim by imposing sanctions aimed at regulating professional performance of the particular individual under consideration and also by way of general deterrence to the profession as a whole.
19	With that protective focus in mind, the Tribunal considers a range of factors including the nature and seriousness of the conduct, any plea of guilty, the relative importance in the case of specific deterrence and general deterrence, past disciplinary history, evidence of character, and other mitigating factors such as medical or psychological evidence.  
20	Personal matters such as shame, personal ordeal and financial difficulty are of little relevance save insofar as they contribute to the specific deterrence of the practitioner.
21	In considering the importance of specific deterrence in any case – whether there is a need to deter the individual practitioner from repeating the conduct – the Tribunal assesses any ongoing risk posed by the practitioner taking into account factors such as: 
•	whether they have demonstrated insight into the seriousness of the conduct and how and why it occurred; 
•	whether they have shown genuine remorse and have taken independent steps to reduce the risk of repetition; and 
•	whether they have any past disciplinary history, which in turn may suggest that stronger penalties may be required to deter them in future.
22	Recognising that practitioners are entitled to put the Board to proof of the allegations made, credit will nevertheless be given for cooperation in the investigation and the proceedings, and any appropriate admissions.  
23	Where, as here, the practitioner does not participate in the proceedings at all, it is more difficult for the Tribunal to decide factors such as insight and remorse in their favour and to consider mitigating factors such as personal circumstances at the time of the conduct, including any mental health issues. 
24	We acknowledge there may be many reasons for not participating but it is almost always to the practitioner’s advantage to do so. 
25	In considering the importance of general deterrence, the Tribunal looks at:
•	the nature and seriousness of the conduct and the risk it poses to the public if engaged in by others; and
•	whether there is therefore a need to deter other members of the profession from engaging in the same conduct by signalling that adverse consequences will follow such conduct.

26	In Honey at [42]-[45], the Tribunal discussed the difference between the determinations of suspension and cancellation:
The major difference between a suspension and cancellation is that once the doctor’s registration is cancelled, he must reapply after the period specified.  He is not guaranteed that he will be so re-registered.  He must satisfy the Board that registration is appropriate and that he fulfils the qualifications for general registration …
Cancellation of registration sends a clear message of unsuitability to practice.  Suspension may be thought to indicate confidence in the doctor’s future ability to practice once the period of suspension is served. 
There are some cases in which it is abundantly clear that deregistration is the only option available to protect the public from a miscreant doctor.
This is apparent in situations in which the practitioner does not accept the inappropriateness of his conduct, or has been shown to be a serial offender.
27	A reprimand may be appropriate even where more serious sanctions are imposed.  A reprimand is a professional rebuke and indicates that the conduct is condemned.
28	We note here that Dr Anwar no longer holds registration in Australia.  Under s 196(4)(a) of the National Law, the Tribunal may nevertheless order that a practitioner who is not registered be disqualified from applying for registration for a specified period.
29	Whilst the Tribunal may be assisted by submissions as to the appropriate sanction, it is ultimately in the discretion of the Tribunal as to the appropriate sanction in any given case.
30	Determinations in other cases of similar or analogous conduct will provide useful guidance.  Consistency and proportionality are important.  But every case is different, with its own combination of facts and relevant factors, including the degree of seriousness of the conduct, the length of time the practitioner engaged in the conduct, the number of patients or others impacted by the conduct, and the circumstances involved. 
31	As we discuss below, the Board was not able to identify a case where a Tribunal had made a finding under s 196(1)(b)(v) of the National Law – that the practitioner’s registration was improperly obtained because he or she or someone else gave the Board information or a document that was false or misleading in a material particular.
Consideration of Determinations
General deterrence: nature and gravity of the conduct
32	The following features of Dr Anwar’s conduct indicate its gravity and the commensurate importance of general deterrence:
•	Dr Anwar’s registration in Australia was obtained by the provision of a false document purporting to be from his home country’s regulator.  Certificates or Letters of Good Standing, required for registration of overseas practitioners in Australia and elsewhere, are most important documents.  They tell a regulator that the person does not have any restrictions on their practice or any fitness to practise issues arising from their practice in their home country.
•	Dr Anwar attempted to deceive both a regulatory body and a potential employer.
•	The deceptions, both separately and taken together, were premediated and deliberately orchestrated.
•	The deception constituting Allegation 2 involved the elaborate manufacturing of a fraudulent document purporting to be from a regulatory body.
•	The deception about the fictitious degree was as to a matter directly relevant to his ability to practice safely as a medical practitioner in a particular field, namely, whether or not he possessed a tertiary qualification in surgery.
•	A deception as to a person’s qualifications is a particularly egregious form of dishonesty by a medical practitioner, specifically proscribed by the Code.
•	There was a direct connection between the dishonesty and risk to the public.  Dr Anwar’s false representation as to his qualifications was intended to enhance his prospects of obtaining employment.  It was only astuteness by Dr Marwan and good fortune that resulted in the discovery of the dishonesty.
•	The allegations were not isolated but formed part of a series of events involving dishonesty:
o	there was an impropriety in the manner of Dr Anwar’s registration involving a fraudulent document;
o	Dr Anwar provided false documents in support of an application for employment; and
o	subsequently made misrepresentations to the regulator compounding the earlier dishonesty.
33	As we noted in our Findings decision, in the case of Medical Board of Australia v Win, the practitioner made misrepresentations and provided false documents to the Board in support of her application for registration.  The Tribunal found that the conduct constituted professional misconduct and made the following comments regarding the honesty of medical practitioners: 
The honesty and reliability of health practitioners is essential to ensuring that patients receive proper care and that patients and other practitioners may place trust in the expertise of those providing health care.  It is also essential when practitioners are dealing with the Board and other regulatory agencies – those bodies rely on practitioners honestly providing information which is important to decisions regarding registration and other matters.
It is often the case that medical practitioners are asked to provide certificates or opinions in respect of patient’s Medicare claims, their capacity to attend work, study or undertake other activities and in connection with workers’ compensation and transport accident claims.  Medical practitioners are also asked to witness statutory declarations.  Medical practitioners are relied upon by various organisations and the community at large to undertake these tasks honestly, mindful of their seriousness, and responsibly given the reliance that will be placed on their professional obligations and their word.
34	We agree with those observations.
35	As the Board submitted, unlike other cases this was a case where the risks presented by improper registration or deception as to qualifications directly related to the practitioner’s skill or competence.  Dr Anwar sought employment in areas requiring higher surgical qualifications, which he lacked.  
36	This was not a theoretical risk.  Between April 2016 and August 2017, the Board received notifications that related to Dr Anwar’s clinical performance, including in relation to:
•	a labiaplasty;
•	a bilateral breast augmentation and abdominoplasty;
•	liposculpture;
•	a “tummy tuck” procedure;
•	blepharoplasty; and
•	a “suture lift”.
37	Those investigations were discontinued after his registration renewal was refused, and he left Australia.  Nevertheless, they strongly suggest that Dr Anwar was practising above his qualifications, skill and competence.  There was an unacceptable risk to the patients concerned.
38	We agree with the Board’s submission that general deterrence is of paramount concern in this case.  The conduct strikes at the heart of public safety and confidence in the medical profession.
39	It is imperative that the medical profession, including those who seek to rely on qualifications obtained elsewhere, understands that this conduct, with its various aggravating features and in the absence of any mitigating circumstances, will be met with the most serious consequences.
Specific deterrence
40	Dr Anwar’s registration was suspended by way of immediate action on 16 August 2016. 
41	At that time, he had a pending application to renew his registration.  On 1 September 2016, the Registration Committee of the Board (Committee) proposed not to renew his registration (based on the immediate action that had been taken) and invited him to make submissions about that issue.  He made no further submissions. 
42	On 14 October 2016, the Committee decided to refuse to renew his registration.
43	Dr Anwar subsequently committed criminal offences under the National Law.
44	In the weeks after his registration was suspended in August 2016, Dr Anwar continued to practise as a medical practitioner performing procedures at the Victorian Cosmetic and Laser Clinic. 
45	He was then charged with four counts of ‘holding out’ under the National Law, in other words, holding himself out as a registered medical practitioner when he was not registered.  
46	On 1 February 2018, he pleaded guilty to all four charges, was convicted, fined $100,000 in total and ordered to pay costs of $14,884.56.  That is, the Board advised, the largest single fine against an individual under the National Law, reflective of the seriousness with which the Court regarded his conduct.
47	On 19 December 2017, Dr Anwar was struck off the register of medical practitioners in Malaysia for conduct entailing:
•	carrying out a cosmetic surgical procedure for which he was not trained;
•	failing to refer the patient appropriately for treatment; and
•	permitting an untrained nurse to perform a procedure on the patient.
48	Beyond the information contained in the press release tendered in this proceeding, the Board was unable to provide any further details about those matters.  
49	What is noteworthy, however, is that the information suggests that that Dr Anwar was practising beyond his qualifications, skill or competence in more than one jurisdiction.  
50	Dr Anwar’s visa to remain in Australia was revoked on 6 September 2018 at which time he had already departed Australia.  
51	We have not heard from Dr Anwar about his future plans.  It is unclear what, if any prospects, Dr Anwar has to return to Australia or whether he will ever seek to practise medicine again.  
52	Thus, while there is not presently a specific risk to the Australian public presented by Dr Anwar, specific deterrence is not irrelevant.  
53	We agree with the Board’s submissions that the determination ought to reflect the sternest discouragement directed towards Dr Anwar having regard to the seriousness of his conduct and an attitude indicative of complete disdain for health practitioner regulation in Australia. 
Comparable cases
54	The Tribunal’s recent decision of Occupational Therapy Board of Australia v Cornelio (Cornelio), refers to a range of cases relating to medical practitioner dishonesty.  We quote directly from the decision, at [48]-[52] including the footnoted citations:
48	The Board’s counsel, Mr Stoller, took us to decisions where this Tribunal and its other state counterparts had considered practitioners who had engaged in dishonest conduct of a similar kind.  He distinguished between cases where the practitioner had fabricated documents or forged signatures to obtain a benefit or entitlement and cases where the conduct did not produce a benefit or entitlement different to what would have flowed in the natural course.  
49	He also distinguished between cases where the practitioner was registered at the time of hearing and so the Tribunal could consider sanctions such as registration and conditions.  As Mr Cornelio was not registered at the time of the hearing, those somewhat more flexible options were not available to us. 
50	Mr Stoller referred us to two cases where a practitioner’s registration was cancelled and they were disqualified from re-applying for registration for two years.  The first was in circumstances where the practitioner provided false information in her curriculum vitae and about the extent of her experience in Indian clinics.  The second was where the practitioner made false declarations and produced false documents in respect of her eligibility to undertake a diploma course.  The practitioner had also been convicted of four counts of fraud on Centrelink by obtaining about $10,000 in the form of a Newstart allowance to which she was not entitled.  The two year disqualification period applied to that practitioner was in respect of all of the conduct including the criminal matters. 
51	In two other cases, the practitioners’ registration was not suspended or cancelled and instead they were reprimanded for falsifying documents.  In one, the relevant board found that the practitioner had not been advantaged by his conduct and that it would not have altered his eligibility for registration.  In another, the practitioner produced a false declaration and a false document as to her training and experience in Burma in order to become registered in circumstances where she had been declared to be a refugee and was unable to obtain legitimate documents as a consequence.  In addition to imposing a reprimand, the Tribunal required her to undertake education including in respect of ethical medical practice and decision-making and requirements to make and witness statutory declarations.
52.	Mr Stoller referred us to two cases where the relevant practitioner forged documents and/or altered clinical records in such a way that there was a risk of patient harm.  One practitioner’s registration was cancelled for three years, and another had a six month suspension imposed with conditions to be applied to his registration when he was re-registered.
55	The period of disqualification proposed by the Board – between three and five years – was arrived at by reference to other cases involving allegations of dishonesty, including those referred to above.  
56	However, as also submitted, those cases did not involve a finding, under s 196(1)(b)(v) of the National Law, that registration had been improperly obtained.  
57	Further, the practitioners in most of those cases engaged in the disciplinary proceedings, made relevant admissions, and expressed remorse for or otherwise demonstrated insight into their conduct.  We agree, save that Dr Anwar did make admissions (except in relation to the Letter of Good Standing) during the Board’s investigations. 
58	As the Board also submitted, it is ultimately a matter for the Tribunal what orders are made, and it is open to impose a longer period of disqualification taking into account all the circumstances.
59	We think there are some important distinctions between this case and those referred to, that in combination warrant a period of disqualification longer than that proposed by the Board.  
60	First, Dr Anwar sought to obtain a direct benefit from the deceptive conduct and the false documents, and the deception was deliberate. 
61	Second, on our reading of the cases summarised in Cornelio, no actual harm was done in most cases.  
62	Dr Anwar’s deception, however, related to his qualifications in respect of surgery, the most invasive area of medical practice, and one with an obvious risk of harm from incompetence.  
63	We are mindful that the Board’s investigations into the multiple notifications were discontinued but as noted above, we consider there are real concerns that patient outcomes may have been compromised. 
64	Third, the false Letter of Good Standing was directly relevant to Dr Anwar’s his eligibility for limited registration and was fundamental to the Board’s assessment of his fitness to practise.  The conduct tainted his registration from the outset.
65	We found some additional cases useful, provided by the Board in further submissions, where lengthy periods of disqualification were ordered, although for different conduct:
•	Health Care Complaints Commission v Black (No 3) [2015] NSWCATOD 72 (Black), where an osteopath’s disregard of authority and lack of insight or remorse led the Tribunal to conclude that rehabilitation would be unlikely in any shorter period: disqualification for 10 years;
•	Medical Board of Australia v Hung Phan (Review and Regulation) [2018] VCAT 1324 (Phan), which related to an extended and significant fraud on Medicare: disqualification for six years; and
•	Health Care Complaints Commission v Karunaratne (No 2) [2018] NSWCATOD 201, where the Board was put to proof, and the Tribunal had to consider determinations in the absence of evidence from the dental practitioner including evidence of any mitigating factors: disqualification for 10 years.
66	In Phan, at [83], the Tribunal made the following observation, which we think is apposite here:
83	The nature and gravity of such conduct, and its implications if engaged in by others, require a clear message to be sent to other practitioners that if they engage in such conduct, they are likely to forfeit the privilege of practising medicine for a substantial period of time.  As the counsel for each party conceded, this is the kind of case where it would be open to the Tribunal to permanently disqualify a practitioner from applying for re-registration.
67	In Black, at [15]-[16], the NSW Tribunal referred to Health Care Complaints Commission v Do [2014] NSWCA 307, where the NSW Court of Appeal referred to the objectives of the National Law at [34], and at [35] made the following remarks, with which we respectfully agree:
35	The objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct operates both as a deterrent to the individual concerned, as well as to the general body of practitioners. It also maintains public confidence by signalling that those whose conduct does not meet the required standards will not be permitted to practise.
68	Although for different conduct, we consider those additional cases to be relevant here. 
69	We consider that Dr Anwar’s conduct is such that other practitioners need to know that if they engage in it, they are likely to forfeit the right to practise medicine for a considerable period of time, if not permanently; and public confidence must be maintained by signalling that those who engage in it will not be permitted to practise.
Conclusion
70	For the above reasons, our view is that Dr Anwar ought to be disqualified from applying for registration for a period of eight years.
71	We are not to be taken as expressing a view that he will be suitable to be registered after the period of disqualification expires. 
72	In setting a disqualification period of eight years we have had regard to the fact that Dr Anwar has already been out of practice in Australia since August 2016.
73	We acknowledge that such a lengthy period out of practice – over 11 years – means that it is unlikely he will ever practise medicine again in Australia. 
74	Should he apply in the future for registration, it will be entirely a matter for the Board to consider and assess any application, taking into account the Board’s role in providing for the protection of the public and the requirements for registration under the National Law. 

E Wentworth
Senior Member and Presiding Member	R Mason
Health Practitioner Member	A Sungaila
Health Practitioner Member