When the Health Practitioners Disciplinary Tribunal chose not to strike off Dr Nalendra Appanna after he completed an STI test on his date and recorded himself performing sex acts on her at his clinic, the woman was “dumbfounded”.
But Appanna’s penalty, largely consisting of a three-month suspension, censure, supervision and an order to pay costs, does not appear to be out of step with the dozens of other rulings handed down to doctors by the regulatory body in the past five years.
Many patients may also never know if their doctor has been reprimanded for bad behaviour as nearly half of those with tribunal charges upheld against them during the period were granted name suppression.
Auckland Women’s Health Council’s Sue Claridge doesn’t believe any doctor who has committed sexual misconduct or physical offending should be allowed to practise again.
“I know we really struggle with doctors, we’re short of doctors, but we shouldn’t accept doctors whose behaviour is that bad.”
“The bar needs to be higher for doctors than for many other professions, in the same way is if an accountant had been convicted of a financial, a theft crime, a dishonesty crime, you wouldn’t want to go to an accountant who had that sort of background.”
Claridge said at the “very least” doctors who continue practising should have to disclose the charge to patients, with a caveat that a line could be drawn with conduct that doesn’t directly impact patients, such as drink-driving.
Dr Kate Taylor, who filed the complaint against Appanna on the woman’s behalf, was also dismayed by his penalty.
“If you fully trust someone, you trust that they will do the right thing. Which enables them to do almost anything.”
Although Appanna was never struck off in New Zealand, he recently appealed a decision not to renew his practising certificate, which was dismissed.
Appanna’s lawyer Harry Waalkens, KC, said the suggestion that the penalty was inadequate was misplaced and overlooked in particular the context in which the conduct occurred.
“It had nothing to do with the practice of medicine,” he told the Herald.
Taylor thought it was inappropriate that doctors who have committed sexual misconduct were often allowed to continue practising under special conditions - like needing a chaperone.
She pointed to the case in the US, which involved a predatory gymnastics doctor, and how parents were sometimes in the room when children were being abused.
”The idea that having a chaperone protects patients against sexual misconduct is misguided.”
Claridge told the Herald that legislation must be strengthened to allow the tribunal to remove doctors from the register permanently.
“Theyshould have clear direction that certain doctors who have committed certain crimes or are guilty of certain types of misconduct should not be allowed to practice.”
Medical Council of New Zealand chair Dr Rachelle Love said there was no mechanism under the Health Practitioners Competence Assurance Act 2003 (the Act) to permanently cancel a doctor’s registration.
“Even if a doctor can reapply for registration following cancellation, they must still satisfy the council that they are competent to practise. The decision to approve a doctor’s application for registration or re-registration is made based on comprehensive criteria set out in the act and is enhanced by our standards.”
Love said a doctor may be excluded from registration if they failed to meet the required standards, which included professional behaviour, competence, and the presence of criminal convictions that impacted their suitability to practice medicine.
“When council receives concerns about a doctor’s conduct, it can refer those concerns to a Professional Conduct Committee (PCC) for investigation. At the end of its investigation, the PCC may determine to bring a charge against the doctor before the tribunal.”
On whether the council believed those who have committed sex offences should be allowed to practise as doctors, Love said it adhered to a zero-tolerance policy regarding sexual misconduct between doctors and patients, and treated notifications about sexual misconduct very seriously.
“The question of whether a doctor will ever be permitted to return to medical practice must be assessed on a case-by-case basis, having reference to the nature and seriousness of the offending, the time lapsed and the individual’s personal circumstances.”
She said trust was at the essence of the doctor-patient relationship, and the council considered it was never appropriate for a doctor to engage in a sexual relationship with a patient.
“The Health Practitioners Competence Assurance Act (HPCAA) specifies that no applicant for registration may be registered by council if they have a conviction in respect of an offence punishable by imprisonment for a term of three months or longer, and council is not satisfied that the conviction does not reflect adversely on their fitness to practise.”
The tribunal, which is a separate entity to the council, declined to provide a separate response.
Health Minister Dr Shane Reti confirmed that, under the act, people who had been struck off a register by the Tribunal could later apply for re-registration, but he understood the bar for acceptance was high.
“I understand The Ministry of Health is currently conducting a review of health workforce regulatory settings, which includes the HPCA Act, to ensure they are enabling a flexible, sustainable and safe workforce. I look forward to seeing the outcome of this review, which will consider whether current disciplinary processes and settings are appropriate.”
Labour health spokesperson Ayesha Verrall declined to comment.
Katie Harris is an Auckland-based journalist who covers social issues including sexual assault, workplace misconduct, crime and justice. She joined the Herald in 2020.
They were paid to target a woman embroiled in an alleged international pyramid scheme.