VICTORIAN CIVIL AND ADMINISTRATIVE TRIBUNAL
administrative DIVISION
REVIEW AND REGULATION LIST	
vcat reference No. Z235/2021	
CATCHWORDS	
Review and Regulation List – Victorian Civil and Administrative Tribunal Act 1998 (Vic), s 50(3) – Decision of Sexual Boundaries Notification Committee to take immediate action by way of suspension of doctor’s registration in relation to alleged sexual boundary violation – Whether decision should be stayed pending review – Whether any stay should be subject to conditions and, if so, what conditions are appropriate.  	

APPLICANT	Dr Sofoklis Lahanis	
RESPONDENT	Medical Board of Australia	
WHERE HELD	Melbourne	
BEFORE	R. Tang AM, Member	
HEARING TYPE	Stay hearing via video conference	
DATE OF HEARING	29 April 2021	
DATE OF ORDER and reasons	6 May 2021	
CITATION	Lahanis v Medical Board of Australia (Review and Regulation) [2021] VCAT 440	
Orders
1	Under section 50(3) of the Victorian Civil and Administrative Tribunal Act 1998 (Vic), and subject to conditions referred to in order 2, the Board’s decision of 10 March 2021 (effective from 11 March 2021) to suspend the registration of Dr Sofoklis Lahanis is stayed until final determination of this proceeding or further order. 
2	During the period of the stay, Dr Lahanis’ registration is subject to the conditions set out in Annexure 3 to the Reasons. 
3	Liberty for the parties to (jointly) apply.
4	The Tribunal has scheduled an administrative mention on 28 May 2021.
Note: You are not required to attend the Tribunal on this day but must advise the Tribunal in writing about the further conduct of this matter.

R. Tang, AM
Member			
APPEARANCES:		
For Applicant 	Mr P Lamb of Counsel	
For Respondent	Ms M Isobel of Counsel
	
ORDERS ARE IN PLACE UNDER THE OPEN COURTS ACT 2013 (VIC)
On 29 April 2021, the Tribunal made orders under section 17 of the Open Courts Act 2013 (Vic) that:
1.	Any report of the whole or part of these proceedings or information derived from this proceeding that might enable the patient the subject of these proceedings, any notifiers and the respondent’s witnesses to be identified must not be published or otherwise disclosed.
2.	This order applies throughout Australia on the basis that the Tribunal’s reasons for decision for final orders are published on AustLII and that website may be accessed throughout Australia.  The privacy of the people referred to in order 1 would be breached if persons living outside Victoria know or come to know their identity.
3.	This order operates until the later of the death of all of the people referred to in order 1.

Reasons
1	On 10 March 2021, the Sexual Boundaries Notification Committee (Committee) of the Medical Board of Australia (Board) decided to suspend the registration of Dr Sofoklis (Con) Lahanis with effect from 11 March 2021 as result of a notification by one of his patients of an alleged sexual boundary violation (Decision).
2	By application dated 31 March 2021, Dr Lahanis applied to VCAT for review of the Decision and, by ticking the relevant box on the application form, sought a stay of the Decision pending that review.
3	The Tribunal has a discretion, under section 50(3) of the Victorian Civil and Administrative Tribunal Act 1998 (Vic) (VCAT Act), to stay a decision subject of review.  The considerations relating to the exercise of that discretion are well known, based on the Tribunal’s decision in Bell and Eager v Liquor Licensing Victoria and Swapnil (Bell and Eager), namely:
•	whether refusing the stay would render the application for review nugatory (ie. of no value);
•	whether there is a serious question to be tried on the review;
•	whether the granting of the stay is in the public interest; and
•	the period that will elapse before the final hearing of the review. 
4	As indicated in Arulanantham v Medical Board of Australia (Arulanantham), the first test focuses on avoiding ‘irreparable’ damage to a person’s career before the review of the relevant decision is completed.  In Kozanoglu v Pharmacy Board of Australia (Kozanoglu), the Victorian Court of Appeal observed (in a health practitioner context) that, while ‘safety of the public must necessarily be the prime concern, that safety should be secured with as little damage to the practitioner as is consistent with its maintenance’.  Relevantly, if the Tribunal considers that a stay is appropriate, it may grant the stay subject to conditions.  
5	The allegations made against Dr Lahanis are serious and, if disciplinary proceedings are instituted and the allegations are ultimately proved, may well result in Dr Lahanis’ registration being suspended for an extended period.
6	However, the parties agree there is a serious question to be tried, given the differing accounts between the patient and Dr Lahanis as to what transpired and, while refusing the stay is unlikely to render the application for review entirely nugatory, I consider there is real potential for such a refusal to cause more damage to Dr Lahanis than is necessary to secure the safety of the public in the time that it will take to complete the review of the Decision.  
7	In all of the circumstances, and for the reasons below, I consider that a stay should be granted, subject to a stringent set of conditions on Dr Lahanis’ registration.  
Dr Lahanis’ career and the events leading to suspension of his registration
8	Dr Lahanis was registered as a medical practitioner in December 1994 and is a fellow of the Royal Australian College of General Practitioners.
9	In 2006, Dr Lahanis was reprimanded and suspended for 13 weeks as a result of a boundary violation in relation to an 18-year-old female patient.  He was found by the panel to have hugged the patient in an intimate and sexual manner and kissed her on the mouth.
10	The current notification relates to events on 1 February 2021.  At the time, Dr Lahanis worked for TLC Aged Care (TLC), an aged care provider, at various nursing homes it operates in Victoria.  He has worked with TLC for over 2 ½ years and the majority of his patients are elderly residents of those homes.
11	TLC allows its doctors to see private patients on designated days.  It was on one of these days that Dr Lahanis conducted a consultation with the patient who made the relevant notification.  The patient is a 39-year-old female, who was originally from Thailand and has difficulty in understanding English.
12	It was the first time that the patient had attended the facility at TLC and she had arranged a consultation to remove a birth control implant (Implanon).  Dr Lahanis explained that it could not be done that day, and then suggested that she have a ‘pap smear’.  He performed a vaginal examination as part of the consultation.
13	The patient’s notification raises a number of concerns about how the pap smear (and vaginal examination) was performed, including:
•	the failure of Dr Lahanis to offer for a female nurse to be present;
•	that Dr Lahanis referred to the patient as ‘very beautiful’; and
•	that he leaned in close to her, as if he was about to kiss her, and said ‘can I’.  
14	Dr Lahanis says he did offer for a female nurse to be present, directed the comment about beauty to the patient’s young daughter (who was in the room, as a means to comfort her) and that the patient misunderstood his attempts to confirm her consent to the procedures with sexual overtures.  
15	The patient’s notification to the Board was made on 3 February 2021, following discussions with her husband and another Thai friend.  The Committee convened to consider the notification ‘out of session’ and, as already mentioned, determined that Dr Lahanis should be immediately suspended.  The Committee suggested that this was the ‘minimum regulatory action’ required and that ‘gender-based restrictions’ or ‘procedure related limitations’ were not sufficient to protect the public.  
16	It is relevant to note that the material before the Committee included comments made by Dr Elena Ghergori, a doctor employed by the Australian Health Practitioner Regulation Agency (AHPRA).  That material was only disclosed in the section 49 material filed by the Board on the day prior to the stay hearing and, in order to resolve any issues regarding procedural fairness, the Board agreed that the Tribunal should not have any regard to Dr Ghergori’s comments for the purposes of the stay hearing.
Is there a serious question to be tried on the review?
17	Dr Lahanis submits that there are serious questions to be considered upon review as to:
•	whether the evidence is sufficient for a reasonable belief to be formed that he engaged in the conduct in question, having regard to the differing accounts between Dr Lahanis and the patient; 
•	if so, whether suspension was the appropriate outcome in terms of representing the ‘minimum regulatory force to be applied’ or whether ‘appropriate conditions would serve the same end’; and
•	procedural fairness in terms of the material to which the Committee had regard in making its Decision, including notes of an initial telephone discussion between Dr Lahanis and AHPRA and the comments of Dr Ghergori.
18	As already noted, the Board accepts that there is a serious question to be tried, although it suggests that Dr Lahanis only has ‘limited prospects of success’ given that ‘serious concerns about [his] practice are raised, even on his own version of events’.  
19	In oral submissions, Ms Isobel (who appeared from the Board) contended that Dr Lahanis’ reliance on procedural fairness is misplaced in the sense that, when it conducts the review, the Tribunal will need to consider all of the material and Dr Lahanis will have the opportunity to explain his early comments to AHPRA and produce any expert evidence to counter the views of Dr Ghergori.
20	I agree with the Board’s contentions concerning the procedural fairness point, but otherwise accept Dr Lahanis’ submission that there is a serious question to be tried on review.  
21	This factor points strongly in favour of the grant of a stay.  
Will the failure to grant a stay render any review nugatory?
22	On the morning of the stay hearing, Dr Lahanis filed a statement from his accountant which sets out the likely income he would ‘forgo’ if he remains suspended, and the costs that he has to continue to fund as the only person who is working in his family of four, which includes interest on a bank loan for his father’s home that is secured over Dr Lahanis’ own home.  
23	Dr Lahanis suggests that, in addition to the ‘severe financial hardship’ of ongoing suspension, there is a risk that TLC is unable to keep his position open and he would then ‘likely [face] great difficulty finding future work’.
24	The Board says there is ‘no evidence that Dr Lahanis would be put out of business’ and ‘unable ultimately to return to the profession’ if the stay were not granted.  In her oral submissions, Ms Isobel pointed to a letter from TLC dated 4 March 2021 which suggested, to the contrary, that they would welcome Dr Lahanis back.
25	There is insufficient evidence before me to suggest that the failure to grant a stay would render the review nugatory.  If Dr Lahanis is successful in having the Decision set aside or varied, there is no reason to suppose that he cannot return to practice, whether with TLC, another aged care provider or to general practice.
26	However, I do accept that Dr Lahanis does face financial hardship which could, on the material produced by his accountant, potentially be severe if it results in the need to sell either his own home or his father’s home.
27	I consider that this points (moderately) in favour of the grant of a stay.  
Likely period of time that will elapse before the hearing of the review?
28	Dr Lahanis estimates a period of six to 12 months before the review would proceed to final hearing.
29	The Board does not proffer a view as to timing, but requests that the final hearing be listed at the Tribunal’s earliest convenience.
30	The Tribunal will be able to set the matter down for final hearing relatively quickly after the parties produce a joint Tribunal Book containing all of the information on which they seek to rely, as well as information on the number of witnesses to be called, the expected duration of the hearing and the availability of the parties, their witnesses and legal representatives.  
31	The parties have yet to agree on a timetable for exchange of information between themselves to enable the joint Tribunal Book to be produced and so there remains uncertainty as to when the matter will have the matter ready to be listed.
32	I consider this points (moderately) in favour of the grant of a stay.
Is the grant of a stay in the public interest?
33	While Dr Lahanis accepts that the protection of the public is paramount, it is submitted that ‘there is no public benefit or community interest in a denial of the stay’ in circumstances where the ‘alternative is a suitable undertaking or conditions’. 
34	Dr Lahanis goes on to contend that there is a ‘strong public benefit’ in allowing him to continue to practice given his capability and experience and the impact that ongoing suspension will have on his employer and aged care patients, particularly as TLC seeks to conduct a COVID-19 vaccination program for residents and staff of its nursing homes.
35	The Board notes the comments of the Committee that a breach of sexual boundaries involves a serious breach of trust, poses a serious risk of causing emotional and/or psychological harm and jeopardises the safe and effective provision of medical care.  In this case, the Board contends that there was a ‘clear power imbalance’ between Dr Lahanis and his patient, by virtue of her limited English language skills.  The Board goes on to suggest that the notification ‘raises the possibility that Dr Lahanis used the offer of a “pap smear”, perhaps opportunistically, for the purposes of his own gratification, sexual or otherwise’.
36	The Board submits that, even on Dr Lahanis’ own version of events, his conduct ‘raises serious questions about his understanding of key medical principles relating to examinations of this nature and the nature of informed consent’, given his own recognition that the patient was nervous, ‘freaking out’ and ‘not understanding’.
37	The Board concludes that Dr Lahanis’ alleged conduct is ‘sufficiently serious that the public may not be assured that [he] will make decisions consistent with safe and appropriate care of his patients’.  It suggests that, given the gravity of the allegations against him, the public would be ‘alarmed’ and ‘public confidence in the medical profession and its regulation are likely to be undermined’ if a stay were granted to allow Dr Lahanis to continue in practice.  
38	The Board says the risk to public confidence is more so ‘in circumstances where Dr Lahanis has a clear history of similarly unprofessional behaviour in relation to another especially vulnerable patient’.  It points to similarities between the current notification and the events that lead to Dr Lahanis’ suspension in 2006, including that both cases involve(d):
•	patient vulnerability (by reason of age in the earlier case, and limited English for the current notification);
•	alleged breaches of sexual boundaries;
•	alleged conduct that is non-consensual in the context of medical treatment; 
•	limited record-keeping by Dr Lahanis; and
•	attempts to undermine the credibility of the patient and suggest a misunderstanding.  
39	The question of whether a stay should be granted in this case clearly turns on the issue of public interest, and there is obviously a balance to be drawn when considering such matters.
40	The community will rightly have concerns about a doctor, who is proved to have seriously breached sexual boundaries, continuing to practice.  On the other hand, the community will recognise that the decision to take immediate action is a decision taken quickly, based on limited evidence, and the underlying allegations may not ultimately be proved.  As was stated in Milky v Medical Board of Australia (Milky), the ‘presumption of innocence, must be given weight in this context’, which the public ‘must be taken to understand’.  
41	It will also be relevant to consider the community’s need for the services of the doctor, having regard to his or her place within the medical system and the impact on the doctor’s other patients.  Thus, in Katz v Medical Board of Australia, it was recognised that the public interest in not leaving the practitioner’s patients without specialist psychiatric care, at a time when COVID-19 was at its peak and mental health issues in the community were exacerbated, ‘tipped the balance in favour of a stay, although with rigorous conditions’. 
42	The decision in Milky concerned a doctor who was working as a general practitioner in a regional area.  Reports had been received from 12 women that, during consultations, he had engaged in serious sexual boundary violations.  The Board initially imposed a gender-based restriction on Dr Milky’s practice, preventing him from having contact with female patients.  Subsequently, the Board decided to suspend his registration by way of immediate action.  It seems the notifications were the subject of ongoing police investigations, although no criminal charges had been laid at the time of the stay hearing.  The Tribunal was persuaded that a stay of the suspension decision should be granted, which had the effect of leaving the gender-based restriction in place.  In so doing, the Tribunal criticised the ‘leap of logic’ of the Board to equate the matters the subject of the notifications with any threat to the physical safety of non-female patients which would justify a complete suspension.
43	Likewise, in the present case, it seems to me that the Board has jumped from:
•	the fact that Dr Lahanis has been found to have breached sexual boundaries with one young female patient in the past; and 
•	is alleged to have done so again recently with a middle-aged female patient who has limited English skills, 
to a conclusion that he represents a serious risk to all patients, irrespective of their age or gender or other specific vulnerabilities.  
44	It may be that the contention that Dr Lahanis poses a serious risk to all patients is found to be established when the review proceeds, or after investigation, if any disciplinary proceedings are brought.  However, in my view, it does not provide a sound basis for restricting Dr Lahanis from any practice in the meanwhile, particularly where he has a supportive employer who attests to his care for the elderly and the absence of any complaints having been made about him.  
45	In my view, on balance, it is in the public interest for a stay to be granted, pending review, provided his ability to practice is subject to conditions to protect that class of patient to whom he appears to pose a risk.
Conditions on practice
46	As part of the material filed with his submissions, Dr Lahanis provided a further statement dated 29 April 2021 indicating a willingness to provide an undertaking, or consent to conditions, to the effect that he only:
•	provide care to aged care residents and staff of TLC (facility and patient restriction); and
•	consult with any female resident while another TLC staff member (eg. a nurse or patient care attendant) is present (chaperone condition),
with the Board permitted to take steps to ensure that these conditions are complied with, such as provision of records of attendances by chaperones.
47	Dr Lahanis provided the form of conditions to which he would consent under cover of an email dated 30 April 2021 (which is set out in Annexure 1).
48	Ms Isobel indicated that the Board strongly opposed a chaperone condition, pointing to the findings made by Professor Ron Paterson, who conducted a review of the use of chaperones in 2017, that chaperones are of limited effectiveness in protecting patients, and that chaperone conditions can be evaded where there is a power imbalance between the doctor and chaperone.  Dr Paterson went on to conclude that ‘[i]t is time to abandon chaperone conditions as an interim restriction’, which ‘should be replaced by gender-based prohibitions and suspensions’. 
49	The Board contended that, if the Tribunal were minded to grant a stay subject to conditions on practice, they should take the form of gender-based restrictions.  The Board provided the form of conditions that it considers appropriate under cover of an email dated 30 April 2021 (which are set out in Annexure 2).
50	While I accept that chaperone conditions can be problematic and, in light of Dr Paterson’s report, should not generally be relied on as an interim measure in and of themselves, I consider the broad tenor of the conditions proposed by Dr Lahanis are appropriate because the combination of the chaperone condition and facility and patient restriction will, in my view, protect public safety, having regard to the identified risks that Dr Lahanis poses, particularly to young to middle-aged women, while doing so with ‘as little damage to the practitioner as is consistent with its maintenance’.  
51	By contrast, it seems to me that a gender-based restriction would severely curtail Dr Lahanis’ ability to work in the aged care environment, given the likelihood that at least half of residents would be female.  Indeed, it would potentially be impracticable for him to continue to work in that environment, particularly if he was the only doctor at a given TLC facility on a given day or night.  
52	As observed by Deputy President Macnamara in Arulanantham, the Tribunal (and, I would interpolate, the public generally):
can be comforted in the knowledge that the public interest in the meantime will be catered for by the thought that a practitioner … if given a stay [will] have the strongest possible motives to refrain from anything that might be inappropriate, [and] to use extra care, to ensure there is no [further] failure to meet proper standards …
53	This is all the more so in circumstances where it appears that the patient has made statements to the police which could potentially lead to criminal charges.
54	Accordingly, I will order that the stay is subject to the conditions set out in Annexure 3, being a modified version of the conditions proposed by Dr Lahanis, incorporating certain aspects of the Board’s proposed orders.  
55	I note that when the Board filed its proposed conditions, it indicated that it ‘maintains its opposition to any form of “chaperone condition” being imposed [and has] particular concerns about the detail and practicalities of the Applicant’s Proposed Orders’.  The Board indicated that it sought to be heard if the Tribunal was minded to impose the conditions proposed by Dr Lahanis.  
56	At the end of the hearing, I made it clear that it would be undesirable for the parties to leave it to the Tribunal to craft proposed conditions, and suggested (but did not order) that each party propose the form of conditions it considered appropriate, depending on the type of condition that the Tribunal was minded to impose.  
57	It was clear, at that time, the applicant was proposing a chaperone condition (together with the facility and patient restriction) and it was open for the Board to submit its own form of chaperone condition for the Tribunal’s consideration.  
58	Further, it can be assumed that Dr Lahanis (in consultation with TLC) has considered the detail and practicalities of the chaperone condition to be imposed in putting forward his proposal.
59	In these circumstances, and noting that I have made some changes to the form of condition proposed by Dr Lahanis in any event, I do not consider it necessary or appropriate to have a further hearing on the form of the conditions.  However, I will grant liberty for the parties to jointly apply in the event any refinement of the conditions is required and can be agreed between them.

R. Tang, AM
Member			

Annexure 1 – Dr Lahanis’ proposed conditions (facility and patient restriction and chaperone condition)
A.	The Applicant only be permitted to provide care to the staff of the TLC Aged Care group of companies and the residents in the various aged care homes owned by it, being:
a)	TLC Aged Care – Clifton Views;
b)	TLC Aged Care – Forest Lodge;
c)	TLC Aged Care – Homestead Estate;
d)	TLC Aged Care – Homewood;
e)	TLC Aged Care – Marina;
f)	TLC Aged Care – Noble Gardens;
g)	TLC Aged Care – Noble Manor;
h)	TLC Aged Care – Sunlight;
i)	TLC Aged Care – The Belmont;
j)	TLC Aged Care – The Heights;  
k)	TLC Aged Care – Warralily Gardens.
B.	Chaperones are required to be physically present and directly observe all contact between the Applicant and any patient (as defined).  
‘Contact’ means any in-person interview, examination, assessment, prescribing for, advising, treating or otherwise seeing a patient in person.
‘Patient’ means any female individual awaiting, requiring, and/or receiving the professional services of the registered health practitioner or a registered health practitioner within the same place of practice of the practitioner. 
C.	Prior to any contact with a patient, the Applicant or an appropriate staff member will inform each and every patient of the necessity for a chaperone to be present and directly observing any contact between the Applicant and the patient at all times.  
D.	The patient must be offered either: 
a)	The use of a chaperone of their choice;
b)	A chaperone approved by AHPRA in advance; 
c)	An appointment with another practitioner.  
F.	Where a patient refuses or demonstrates any reluctance to have a chaperone present the contact must not go ahead or, if commenced, must cease immediately.  Where practical the patient must then be offered an appointment with another practitioner.
G.	Where a patient chooses to use a chaperone of their own choice, that chaperone must be at least 18 years of age and acceptable to the patient and may be a spouse, partner, parent, other family member, or a guardian/carer of the patient.  All chaperones chosen by the patient must be given the information sheet on the role of a chaperone (the information sheet) prior to the contact commencing and must confirm their agreement to continue in the role after receiving the information sheet.  This must occur prior to any contact between the patient and the Applicant occurring.
H.	The Applicant is required to nominate individuals to be approved to act as chaperones, where a chaperone of the patient’s choice is not available Any nominations for potential chaperones are to be submitted on the AHPRA approved form and the nominated person meets the following criteria, in addition to that outlined in the restriction:
a)	The nominated chaperone(s) are staff of the TLC Aged Care group of companies;
b)	The nominated chaperone(s) are not the Applicant’s relatives or friends or direct employees or otherwise persons in a direct contractual or financial relationship with the Applicant;
c)	The nominated chaperone(s) are registered health practitioners without restrictions on their registration;
d)	The nominated chaperone(s) are at least 18 years of age.
I.	Each chaperone nomination is to be accompanied by the following:
a)	Contact details, photographic identification and sample signatures of each and every nominated chaperone(s);
b)	Written confirmation, on the approved form, from each and every nominated chaperone(s) that they have received a copy of the information sheet for chaperones and they: 
i.	Are aware of the nomination, consent to the nomination and are willing to act as chaperones; 
ii.	Are not in a social or familial relationship with the Applicant and are not in a direct employment or contractual relationship with the Applicant;
iii.	Are aware of the meaning of the meaning of the word ‘patient’ and ‘contact’ for the purposes of this restriction;
iv.	Are aware that, should a patient refuse or demonstrate reluctance to have a chaperone present and directly observing all contact, the contact must not proceed or, if commenced, should immediately cease and the patient should be offered an appointment with an alternate practitioner; 
v.	Are aware of the Board’s expectations of you in compliance with this restriction, and in particular, the need for prior discussion with the patient and the requirements of the chaperone log, signed at the end of each patient contact (not pre-signed); 
vi.	Are aware they may contact AHPRA in order to discuss any concerns or queries they may have in relation to this requirement or if they feel personally vulnerable, intimidated or threatened while acting as a chaperone; 
vii.	Are aware that they may be contacted by AHPRA in order to monitor the Applicant’s compliance with this restriction.  
J.	Within 5 days of this order being made, the Applicant must provide acknowledgement to AHPRA, on the approved form, that he is are aware that, for the purposes of monitoring his compliance with the restriction on his registration, AHPRA may: 
a)	Contact, communicate with and obtain information from Medicare Australia; 
b)	Conduct random practice inspections;
c)	Contact and communicate with patients, chaperones, staff or employers; 
d)	Contact private health insurers, where relevant, and access practice billing data (both public and private) for the purpose of monitoring compliance with this restriction;
e)	Access, copy or retrieve appointment diaries, patient booking schedules and the like.  The Applicant is further required to provide evidence, where relevant, that he has notified any private health insurers of the conditions on his registration.
K.	The Applicant must maintain a chaperone log (the log), on a template provided by AHPRA, detailing every case where contact is had with a patient, confirming the presence and direct observation of a chaperone for the entire contact.  The log must be completed in indelible ink at the end of the contact, be co-signed by the chaperone at that time and must detail: 
a)	The full name of the patient and their date of birth; 
b)	The date and time of the consultation; 
c)	The full name of the chaperone;
d)	The chaperone’s contact address and telephone number;
e)	The chaperone’s signature.  
L.	Where chaperones are individuals chosen by the patient the log must also detail: 
a)	Acknowledgement by the chaperone that they received a copy of the information sheet for chaperones prior to the patient contact; 
b)	The chaperone’s authorisation for AHPRA to contact them for the purposes of monitoring compliance with this restriction; 
c)	The relationship of the chaperone to the patient.  
M.	Blank templates for chaperone logs will be provided by AHPRA.  To comply with privacy laws, where patients select their own chaperone, the previously completed details on the log are to be temporarily obscured at the time the chaperone signs the log.  
N.	The Applicant must provide a copy of the chaperone log to AHPRA at such times as requested by AHPRA.
O.	The Applicant must place the template sign, setting out the requirement for the presence and direct observation of a chaperone in a clearly visible location in the patient treatment area or equivalent of each and every place of practice.  The template provided by AHPRA must be used.

Annexure 2 – the Board’s proposed gender-based restriction
I.	The practitioner must not practise as a medical practitioner until approved practice locations are published below:
The following are approved practice locations: [No practice locations approved to date]
II.	After publication of approved practice locations the practitioner must not have any contact with female patients and must only practise at approved practice locations.
For the purposes of this condition, the following definitions apply:
‘Practise’ is defined as any role, whether remunerated or not, in which the individual uses their skills and knowledge as a medical practitioner in their profession.  It is not restricted to the provision of direct clinical care and includes using the knowledge and skills of a medical practitioner in a direct non-clinical relationship with a client, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that impact on safe, effective delivery of services in the medical practitioner.
‘Practice location’ means any location where the practitioner practises the profession including any place where the practitioner:
(a)	is self-employed
(b)	shares premises with other registered health practitioners
(c)	is engaged by one or more entities under a contract of employment, contract for services or any other arrangement or agreement
(d)	provides services for or on the behalf of one or more entities, whether in an honorary capacity, as a volunteer or otherwise, whether or not the practitioner receives payment from an entity for the services, or
(e)	provides professional services at the residential premises of a patient.
‘Patient’ is defined as any individual awaiting, requiring, or receiving the professional services of the practitioner or a registered health practitioner within the same place of practice as the practitioner and any spouse, partner, parent, family member or guardian/carer of this individual.
‘Contact with a patient’ includes consultation, interview, examination, assessment, prescribing for, advising, or otherwise treating a patient, whether it is in person or on a communication device.
‘Male’ is defined as any individual whose biological sex is that of a male, as well as all individuals whose gender identity or gender expression is that of a male.
‘Female’ is defined as any individual whose biological sex is that of a female, as well as all individuals whose gender identity or gender expression is that of a female.
III.	The practitioner must comply with the Gender-based restriction protocol in force at the date these conditions are imposed and then as amended from time to time.
IV.	Within 21 days of notice of these conditions being imposed the practitioner is to provide acknowledgement, on the approved form (GBR-1)) that:
(a)	they have read and understood the Gender-based restriction protocol
(b)	they are aware that they are not permitted to practise until such time as approved practice locations are published
(c)	they understand the definition of ‘patient’, ‘practise’, ‘practice location’, ‘male’, ‘female’, and ‘contact’ as detailed in this condition, and
(d)	they are aware of the actions AHPRA may take for the purposes of monitoring compliance with the gender-based restriction.
V.	Within 21 days notice of the imposition of these conditions the Practitioner must provide to AHPRA, on the approved form (HPC), the contact details of a senior person, such as the Director of Medical Services, Director of Nursing, Senior Practice Manager, Senior Manager, Senior Partner, Proprietor, Owner, or equivalent (the senior person) at each place he is approved to practice.  In providing this form, the practitioner acknowledges that:
(a)	AHPRA will contact the senior person and provide them with a copy of the conditions on the Practitioners registration or confirm that the senior person has received a copy of the conditions from the Practitioner, and
(b)	The Practitioner will be required to provide the same form:
i.	within seven days of the commencement of practice at each and every subsequent place he is approved to practice, and
ii.	within seven days of each and every notice of any subsequent alteration of these conditions.
VI.	All costs associated with compliance with the conditions on their registration are at the Practitioner’s own expense.

Annexure 3 – Conditions imposed on Dr Lahanis’ registration (order 2)
A.	The following definitions apply in these conditions.
‘AHPRA’ means the Australian Health Practitioner Regulation Agency.
‘Approved Practice Location’ means each of:
a)	TLC Aged Care – Clifton Views;
b)	TLC Aged Care – Forest Lodge;
c)	TLC Aged Care – Homestead Estate;
d)	TLC Aged Care – Homewood;
e)	TLC Aged Care – Marina;
f)	TLC Aged Care – Noble Gardens;
g)	TLC Aged Care – Noble Manor;
h)	TLC Aged Care – Sunlight;
i)	TLC Aged Care – The Belmont;
j)	TLC Aged Care – The Heights;  
k)	TLC Aged Care – Warralily Gardens.
‘Board’ means the Medical Board of Australia.
‘Chaperone’ means a person chosen by a Female Patient in accordance with conditions C to F.
‘Chaperone Log’ means the log required to be maintained by the practitioner as specified in condition K.
‘Contact’ includes consultation, interview, examination, assessment, prescribing for, advising, or otherwise treating a patient, whether it is in person or on a communication device.
‘Female Patient’ means any Patient whose biological sex is that of a female, as well as all individuals whose gender identity or gender expression is that of a female.
‘Information Sheet’ means an information sheet on the role of a chaperone in such form as may be approved by AHPRA from time to time.
‘Patient’ means any individual awaiting, requiring, and/or receiving the professional services of the registered health practitioner or a registered health practitioner within the same place of practice of the practitioner.  
‘Practise’ is defined as any role, whether remunerated or not, in which the individual uses their skills and knowledge as a medical practitioner in their profession.  It is not restricted to the provision of direct clinical care and includes using the knowledge and skills of a medical practitioner in a direct non-clinical relationship with a client, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that impact on safe, effective delivery of services by the medical practitioner.
B.	The practitioner must not:
a)	Practise as a medical practitioner except at an Approved Practice Location;
b)	have Contact with any Patient (including any Female Patient) that is not a resident of the facility at an Approved Practice Location or a staff member of the TLC Aged Care group of companies; or
c)	have Contact with a Female Patient except in the presence of a Chaperone who is able to directly observe any Contact between the practitioner and the Female Patient.  
C.	Prior to any contact with a Female Patient, the practitioner or an appropriate staff member must inform each and every Female Patient of the necessity for a chaperone to be present and directly observe any contact between the practitioner and the patient at all times.  
D.	The Female Patient must be offered the choice of: 
a)	the use of a chaperone of their choice;
b)	a chaperone approved by AHPRA in advance; and
c)	an appointment with another practitioner.  
E.	Where a Female Patient refuses or demonstrates any reluctance to have a chaperone present the Contact must not go ahead or, if commenced, must cease immediately.  Where practical the Female Patient must then be offered an appointment with another practitioner.
F.	Where a Female Patient chooses to use a chaperone of their own choice, that chaperone must be at least 18 years of age and acceptable to the Patient and may be a spouse, partner, parent, other family member, or a guardian/carer of the Patient.  All chaperones chosen by the Female Patient must be given an Information Sheet by the practitioner or an appropriate staff member prior to any Contact commencing and must confirm their agreement to continue in the role after receiving the Information Sheet.  
G.	The practitioner may nominate individuals to be approved to act as chaperones, where a chaperone of the patient’s choice is not available.  Any nominations for potential chaperones are to be submitted on the AHPRA approved form, and each nominated person must:
a)	be an employee of the TLC Aged Care group of companies;
b)	be a registered health practitioner without restrictions on their registration;
c)	be at least 18 years of age; and
d)	not be a relative or friend or direct employee or otherwise a person in a direct contractual or financial relationship with the practitioner.
H.	Each chaperone nomination is to be accompanied by the following:
a)	contact details, photographic identification and sample signatures of each and every nominated chaperone(s); and
b)	written confirmation, on the approved form, from each and every nominated chaperone(s) that they have received a copy of the Information Sheet for chaperones and they: 
i.	are aware of the nomination, consent to the nomination and are willing to act as chaperones; 
ii.	are not in a social or familial relationship with the practitioner and are not in a direct employment or contractual relationship with the practitioner;
iii.	are aware of the meaning of the meaning of the phrases ‘Female Patient’ and ‘Contact’ for the purposes of this condition;
iv.	are aware that, should a Female Patient refuse or demonstrate reluctance to have a chaperone present and directly observing all Contact, the Contact must not proceed or, if commenced, should immediately cease and the patient should be offered an appointment with an alternate practitioner; 
v.	are aware of the Board’s expectations of their compliance with these conditions and, in particular, the need for prior discussion with the Patient and the requirement to maintain a Chaperone Log, which is signed by the chaperone at the end of each Contact by the practitioner with a Female Patient (and which must not be pre-signed); 
vi.	are aware they may contact AHPRA in order to discuss any concerns or queries they may have in relation to these conditions or if they feel personally vulnerable, intimidated or threatened while acting as a chaperone; and
vii.	are aware that they may be contacted by AHPRA in order to monitor the practitioner’s compliance with these conditions.  
I.	Within 5 days of this order being made, the practitioner must provide acknowledgement to AHPRA, on the approved form, that he is are aware that, for the purposes of monitoring his compliance with the restriction on his registration, AHPRA may: 
a)	contact, communicate with and obtain information from Medicare Australia; 
b)	conduct random practice inspections;
c)	contact and communicate with any Patient (including any Female Patient), Chaperone, and any employee or director of the TLC Aged Care group of companies; 
d)	contact private health insurers, where relevant, and access practice billing data (both public and private) for the purpose of monitoring compliance with these conditions; and
e)	access, copy or retrieve appointment diaries, patient booking schedules and the like.
J.	Within 30 days of these conditions, the practitioner is required to provide evidence to AHPRA that he has notified any private health insurers of the conditions on his registration.
K.	The practitioner must maintain a Chaperone Log using the template provided by AHPRA, detailing every case where Contact is had with a Female Patient, confirming the presence and direct observation of a Chaperone for the entire Contact.  The Chaperone Log must be completed in indelible ink at the end of the Contact, be co-signed by the Chaperone at that time and must include: 
a)	the full name of the Female Patient and their date of birth; 
b)	the date and time of the consultation; 
c)	the full name of the Chaperone;
d)	the Chaperone’s contact address and telephone number; and
e)	the Chaperone’s signature.  
L.	Where Chaperones are individuals chosen by the Female Patient the Chaperone Log must also detail: 
a)	acknowledgement by the Chaperone that they received a copy of the Information Sheet prior to the Contact between the practitioner and Female Patient; 
b)	the Chaperone’s authorisation for AHPRA to contact them for the purposes of monitoring compliance with these conditions; and
c)	the relationship of the Chaperone to the Female Patient.  
M.	Blank templates for Chaperone Logs will be provided by AHPRA.  To comply with privacy laws, where a Female Patient selects their own Chaperone, the previously completed details on the log are to be temporarily obscured at the time the Chaperone signs the log.  
N.	The practitioner must provide a copy of the Chaperone Log to AHPRA at such times as requested by AHPRA.
O.	Within 21 days of the imposition of these conditions, the practitioner must provide to AHPRA, on the approved form (HPC), the contact details of a senior person, such as the Director of Medical Services, Director of Nursing, Senior Practice Manager, Senior Manager, Senior Partner, Proprietor, Owner, or equivalent (the senior person) at each Approved Practice Location.  In providing this form, the practitioner acknowledges that AHPRA will contact the senior person and provide them with a copy of the conditions on the practitioner’s registration or confirm that the senior person has received a copy of the conditions from the practitioner.
P.	All costs associated with compliance with the conditions on their registration are at the practitioner’s own expense.