SUBRAMANI v A PROFESSIONAL CONDUCT COMMITTEE APPOINTED BY THE DENTAL COUNCIL OF NEW ZEALAND [2023] NZHC 189

SUBRAMANI v A PROFESSIONAL CONDUCT COMMITTEE APPOINTED BY THE DENTAL COUNCILOF NEW ZEALAND [2023] NZHC 189 [14 February 2023]IN THE HIGH COURT OF NEW ZEALANDGREYMOUTH REGISTRYI TE KŌTI MATUA O AOTEAROAMĀWHERA ROHECIV-2022-418-17[2023] NZHC 189UNDER the Health Practitioners CompetenceAssurance Act 2003IN THE MATTER OF an appeal against a decision of the HealthPractitioners Disciplinary Tribunal dated 16December 2022BETWEEN BHARATH RAJA SUBRAMANIAppellantAND A PROFESSIONAL CONDUCTCOMMITTEE APPOINTED BY THEDENTAL COUNCIL OF NEW ZEALANDRespondentHearing: 7 February 2023 (by VMR)Appearances: A H Waalkens KC for AppellantA N Lane and R E Mould for RespondentD D Vincent for Health Practitioners Disciplinary Tribunal,abiding the outcome (excused)Judgment: 14 February 2023Reissued: 20 February 2023[REDACTED] JUDGMENT OF OSBORNE JThis judgment contains redaction of personal or sensitive information.This judgment was delivered by me on 14 February 2023 at 4.00 pmpursuant to Rule 11.5of the High Court RulesRegistrar/Deputy RegistrarDate:Introduction[1] The Health Practitioners Disciplinary Tribunal (the Tribunal)1 on 16 December2022 (following a hearing on 1 to 4 February 2022) found a charge of professionalmisconduct on the part of the appellant, Dr Bharath Subramani (a registered dentist)was established. Dr Subramani had admitted that his conduct in treating 11 patientsbetween October 2017 and October 2018 amounted to professional misconduct unders 100(1)(a) and s 100(1)(b) Health Practitioners Competence Assurance Act 2003 (theAct). The Tribunal cancelled Dr Subramani's registration to take effect six weeks fromthe date of the decision. The Tribunal imposed a censure and ordered Dr Subramanito pay a fine of $10,000. Additionally, he was ordered to pay $150,000 to the costs ofthe Professional Conduct Committee (now the respondent to this appeal).[2] Dr Subramani has appealed those parts of the Tribunal's penalty decision bywhich his registration was cancelled and he was fined $10,000.[3] On 23 December 2022, on a without notice application, I made orders (by wayof interim relief under r 20.10(2)(c) High Court Rules 2016) that the date on whichDr Subramani's registration would be cancelled (unless an earlier order was made)would be 17 February 2023 and that the Tribunal's decisions as to censure, fine andcosts were stayed until further order of the Court.2[4] Dr Subramani's appeal has been scheduled a timetabling conference on27 February 2023. The appeal concerns only the cancellation of registration and thefine of $10,000.[5] Pending his appeal Dr Subramani seeks:(a) a stay of the Tribunal's decision; and(b) permission to continue to practise as a dentist (under supervision andwith voluntary limits).1 A professional conduct committee appointed by the Dental Council of New Zealand v SubramaniHPDT number 1282/Den21/511P dated 16 December 2022 [Committee decision].2 Subramani v Professional Conduct Committee [2022] NZHC 3619.BackgroundDr Subramani[6] Dr Subramani is a general dentist first registered with the Dental Council ofNew Zealand in 2012. He began working at Lumino Garry Rae Dentist in Greymouthin mid-2014. Lumino opened a further dental practice in Greymouth and from2 October 2017 Dr Subramani was the sole dentist in charge there until October 2018.The complaints[7] Dr Chris Brooks, a clinical advisor with the Lumino Group, undertook a reviewof Dr Subramani's practice as a result of receiving, in September 2018, advice as toconcerns about the care of patients. That led to the termination of Dr Subramani'scontract.[8] All the allegations in the charge against Dr Subramani related to the careprovided to patients at Lumino Greymouth between October 2017 and October 2018.[9] From early 2019 Dr Subramani established his own practice (Coast SmilesDental Spa), and practised under conditions imposed by the Council, includingsupervision.[10] In October 2018 Dr Brooks wrote to the Dental Council outlining his concernsagainst Dr Subramani's practice. A Professional Conduct Committee (the Committee)was convened to investigate the matters raised.The charge[11] A disciplinary charge was brought against Dr Subramani. In a subsequentlyamended form Dr Subramani accepted the conduct amounted to professionalmisconduct. The hearing proceeded in relation to penalty, with Dr Subramani(through counsel) not requiring any of the witnesses to attend the hearing andstatements being taken as read. The charge related to 11 patients, all of whom providedstatements. Six other dentists also provided statements as did Dr Andrea Cayford, anindependent expert witness.The misconduct[12] Established aspects of Dr Subramani's misconduct included:(a) failure to undertake necessary diagnostic evaluation;(b) the taking of x-rays of such an inadequate standard that they servedlittle or no purpose for diagnostic and treatment planning;(c) the provision of inappropriate and unnecessary treatment, including theplacing of fillings and providing bite splints;(d) recommending inappropriate and unnecessary treatment for patients,including extractions;(e) providing dental treatment of an inadequate standard, including smallfillings;(f) charging excessive fees for some aspects of treatment;(g) failing to obtain informed consent from patients prior to providingservices; and(h) inadequate documentation and clinical record keeping.The Committee's assessment of the misconduct[13] The Committee concluded that Dr Subramani's misconduct was serious for thefollowing reasons:3(a) Negligent care was delivered to 11 patients(b) For each patient, there was sub-standard care on a number of bases(c) For each patient the negligent care occurred at more than oneappointment3 Committee decision, above 1, at [650] — the "MRACDS" referred to at (e) is an educationprogramme of the Royal Australasian College.(d) Some of the conduct was unethical. For example over an 11 monthperiod, multiple fillings were placed when not required.(e) the failure to record a patient's medical history is a major departurefrom accepted practice and is potentially fatal. He did this despitehaving just completed his education for MRACDS(f) Some of Dr Subramani's patients were vulnerable. The Tribunal feltthat Dr Subramani's overtreatment and overcharging of his patientsMr and Mrs [Angus] who were superannuitants was a significantbreach of his obligations and of their trust.(g) Dr Subramani's care of Mr [Bell] was woefully inadequate, extensiveand invasive. The inconvenience for remedial work was extensive.(h) The cumulative effect of all of the shortcomings is very seriousindeed.[14] The Committee referred to the seriousness of Dr Subramani's failures, both interms of the physical and mental consequences for patients and the financialconsequences for patients.[15] In relation to the protection of the public, the Committee recorded:[615] The practitioner's case is that because of the passage of time and hissupervision with Dr Shand, a penalty of suspension, cancellation or evensupervision is not now required. The Tribunal does not agree. The conductwhich gave rise to this charge includes treatments such as root canals, whichDr Subramani is not yet able to perform without further education andsupervision. It would be a derogation of the Tribunal's responsibilities to thepublic not to consider supervision. Although the Dental Council has imposedconditions on Dr Subramani's practice, the Tribunal must impose a penaltycommensurate with the conduct which we have found to amount toprofessional misconduct.[616] Dr Subramani's practice has fallen below the standard expected of adentist in multiple ways. The span of his negligence is extensive. He comesto the Tribunal for professional misconduct in 8 categories of practice and inthe care of 11 patients. These are not minor shortcomings. As noted above atparagraph 322, the failure to record a patient's medical history is a majordeparture from accepted practice and is potentially fatal. He did this despitehaving just completed his education for MRACDS.[617] The Tribunal considers Dr Subramani is operating at the level of ajunior dental student. The degree of supervision and scope is that of a third orfourth-year student. The public is entitled to expect that when they consult aregistered dentist, he or she is able to meet the basic standards of the practiceof dentistry. The privileges and responsibilities associated with the title ofdentist require the practitioner to practise at the level of a dentist.[16] The supervision of Dr Subramani by Dr Shand, as referred to by the Council,was a central aspect of the submissions made by Mr Waalkens KC in urging a penaltyshort of cancellation or suspension.[17] Dr Subramani's practice had been supervised by Council-approved dentalpractitioners from March 2019, Dr Michael Shand filling that role fromSeptember 2020. Dr Subramani has been restricted to a limited scope of dentistry(described as "basic" dentistry) and has been subject to prior approval of Dr Shand forall his intended treatment plans and to regular visits by Dr Shand. Dr Shand's evidenceto the Committee was that in his opinion Dr Subramani was practising satisfactorilyand without risk to the public.[18] In relation to Dr Subramani's ongoing supervision, the Council found:[638] Between March and September 2019 Dr Subramani worked under thedirect supervision of Dr Timmins. Then from 1 June 2020 to August 2020 hewas supervised by Dr Alex Munro. Since September 2020 Dr Shand has beenhis supervisor. A practitioner who has had more than 3 years to learn andrehabilitate should not now require ongoing intensive supervision at the levelthat Dr Subramani has, and further education in order to widen his scope toundertake general dentistry. Despite the fact that he has experienced positivedirect and indirect supervision of about 700 hours over the past 18 months forDr Shand, he still requires further education. The Tribunal concluded thatDr Subramani has done a lot but achieved little.[639] Dr Subramani's "rehabilitation" seems to be a lifelong journey. Basedon his progress to date, it is difficult to understand that within the foreseeablefuture he will be operating at the standard expected of a reasonable dentist.The public safety cannot take second place to Dr Subramani's ongoinglearning on the job, to achieve the level of competence expected of a graduate.[19] Finally, the Council concluded in its assessment of what was the leastrestrictive penalty appropriate in the circumstances that:[652] Because of the seriousness of the conduct and our lack of confidencein Dr Subramani's ability to reach and maintain the standard required of adentist, the Tribunal does not believe anything short of cancellation isappropriate. The Tribunal is not satisfied that Dr Subramani can work withoutsupervision, or that Dr Subramani would be able to work without supervisionafter a further three years, which is the longest period the Tribunal could orderfor. Therefore, a term of suspension followed by conditions that he workunder supervision would provide no long-term protection for the public.Conclusion[653] Temporary periods of supervision and support are appropriatewhere there is a prospect of rehabilitation. The Tribunal is not persuaded thatis the case here. In all of the circumstances as outlined above, the penalty ofcancellation under section 145101(1)(a) is fair, reasonable and proportionate.Dr Subramani is to be allowed some time to organise his practice. The stay application[20] The stay application is brought pursuant to r 20.10 High Court Rules. Thatrule provides:(1) An appeal does not operate as a stay—(a) of the proceedings appealed against; or(b) of enforcement of any judgment or order appealed against.(2) Despite subclause (1), the decision-maker or the court may, onapplication, do any 1 or more of the following pending determinationof an appeal:(a) order a stay of proceedings in relation to the decision appealedagainst:(b) order a stay of enforcement of any judgment or order appealedagainst:(c) grant any interim relief.(3) An order made or relief granted under subclause (2) may—(a) relate to enforcement of the whole of a judgment or order orto a particular form of enforcement:(b) be subject to any conditions for the giving of security thedecision-maker or the court thinks just.[21] The fact that an appeal does not operate to stay the effect of the appealed orderreflects the general rule in litigation that a party is entitled to enjoy the fruits of ajudgment in their favour and that a party seeking a stay must persuade the Court that,if a stay is not granted, the appeal right would be rendered nugatory.44 Philip Morris (New Zealand) Ltd v Liggett & Myers Tobacco Co (New Zealand) Ltd [1977]2 NZLR 41 (CA).[22] The considerations relating to a stay under r 12 Court of Appeal (Civil) Rules2005 have application to the considerations under r 20.10 — a balancing exercise isinvolved, taking into account the consequences for all parties to the appeal.5 Thecriteria to be applied are:(a) whether the appeal will be rendered nugatory if a stay is not granted;(b) the bona fides of the applicant in the prosecution of the appeal;(c) whether the successful party will be injuriously affected by the stay;(d) any effect on third parties;(e) the novelty and importance of the questions involved in the appeal;(f) the public interest in the proceeding;(g) the apparent strength of the appeal; and(h) the overall balance of convenience.[23] Both counsel referred to these as the applicable considerations and I willconsider the application by reference to them.Supplementary evidence[24] Affidavit evidence has been filed in support of and in opposition to the stayapplication.Dr Subramani[25] Dr Subramani in December filed an affidavit in which the main points were:(a) his continued satisfactory supervision by Dr Shand;5 Yan v Mainzeal Property and Construction Ltd (in rec and in liq) [2014] NZCA 86, (2014)22 PRNZ 296 at [25].(b) the lack of negative or other feedback from the Council since Dr Shandbegan reporting to the Council in September 2020;(c) his employment of four staff;(d) the recent recruitment of Dr Beata Migda as a qualified dentist in thepractice, aware of his disciplinary case and supportive of him;(e) the 3,800 patients on his books;(f) a shortage of dentists on the West Coast;(g) his being the only dentist on the West Coast available to offer out-of-hours and emergency treatment; and(h) the business and reputational harm that will be caused to his practiceand staff if he has to close.Dr Shand[26] Dr Shand provided a supporting affidavit in December 2022. He had retiredfrom fulltime practice in 2019 but had been prepared to continue in a supervisory roleto support Dr Subramani. Dr Shand repeats that Dr Subramani has continued topractise satisfactorily within the limited scope of his dental practice and without riskto the public. He states that he has commended to the Council that Dr Subramani'srestriction to basic dentistry should be lifted.Dr Rae[27] For the Committee, two affidavits have been filed.[28] Dr Rae (of Lumino) deposed that since the Tribunal hearing he has seen severalpatients with dental treatment carried out by Dr Subramani to below an acceptablestandard. He says he also receives from patients complaints about the cost of theirtreatment by Dr Subramani. He refers to the number of patients his practice sees andposes that he does not think that it would affect the practice if Dr Subramani wasunable to practise.Dr Gray[29] Dr Andrew Gray provided the Committee's second affidavit. As well as beinga registered dentist he is the Deputy Registrar (Protection) of the Council. He explainsthat Dr Shand (through his retirement arrangements) is no longer available as asupervisor and refers to the Council's identification of a replacement supervisor,Dr Sue Gorrie, should a stay be granted. Dr Gray refers to reviews of Dr Subramanion Google, which Dr Gray views as concerning because they raise concerns aboutDr Subramani's dental treatment and also that he might be pressuring patients to givepositive reviews.[30] Dr Gray refers to the availability of dentists on the West Coast, noting there arenow nine. He refers to an article produced by Dr Subramani about the shortage ofdentists on the West Coast as being an "old article" (originally published in 2002).[31] In relation to Dr Subramani's current practice, Dr Gray opines that the numberof patients Dr Subramani is seeing (50 to 60 patients per months across five months,per Dr Shand's latest report) is very low and indicative of someone working one totwo days per week. On that basis he takes issue with the suggestion that cancellationof registration would have a "devastating" effect on the local community.[32] Finally, Dr Gray deposes that there is significant public interest in this case onthe West Coast, and refers to articles published at the time of the Council hearing.[33] For Dr Subramani, reply affidavits were filed both by Dr Subramani and byDr Shand.Dr Subramani[34] Dr Subramani rejected suggestions contained in Dr Gray's affidavit as tocontinuing unsatisfactory practises or pressure in relation to Google reviews. Heresponds in some detail.[35] Dr Subramani also takes issue with any suggestion that the availability ofdentists on the West Coast is at an acceptable level — he attaches the Council's ownworkforce analysis for the period 2017 to 2019 to indicate that the West Coast has theworst ratio in the country for dentists per population. He refers to the part-timepractice or near-retirement situation of several of the dentists on the Coast. Heemphasises he remains the only dentist who provides after-hours and emergency work,and mentions referrals he currently receives from one of the DHB doctors atGreymouth. In response to Dr Gray's evidence as to the number of patients he sees,he notes that those are the patients but their consultations and follow-ups may numberup to seven for ongoing treatment.[36] He rejects the suggestion that the remaining dentists on the West Coast would,without difficulty, pick up dental work that he will be unable to undertake if notpractising.[37] Dr Subramani then provides financial details as to the effect of cancellation.He believes it likely he would lose the services of Dr Migda and all his staff. He givesdetails of his income position (supporting from the practice himself, his wife and theirchild) and of their asset position, with mortgage liabilities to the bank. He deposesthat it would be extremely difficult for him to borrow further funds to support himselfand his family.[38] He responds in particular detail to Dr Rae's evidence in relation to twoanonymous patients and then summarises that he does not accept the criticisms madeof him in relation to those two patients.DiscussionThe affidavitsDr Shand[39] Dr Shand introduces his supplementary documents by stating he can onlyrepeat what he stated before, namely, he has no doubt Dr Subramani is a safe dentalpractitioner who presents no real risk to the public, especially when Dr Shand refersin detail to his observations of Dr Subramani's work and his own supervision of thatwork. He refers to the valuable and essential service Dr Subramani is providing to theWest Coast community. He suggests Dr Rae's affidavit contains speculation about thetwo patients' treatment and that one cannot conclude fault lies with Dr Subramani.Dr Migda[40] Dr Migda qualified in dentistry in 1989. She states (at 2 February 2023) shehas been working in Dr Subramani's practice for just over two weeks, has observedthe quality of his dentistry and considers it "entirely appropriate and to a satisfactorystandard". She says people on the West Coast would suffer were Dr Subramani to bestopped from practising.[41] I refer to four main areas of discussion coming out of these various affidavits:(a) the standard of Dr Subramani's recent practise — while it wasappropriate for the Committee to draw to the Court's attentioninformation of which the deponents had become aware, it would beinappropriate to rely on the information being reported as sufficientlyaccurate to constitute evidence against the granting of a stay —questioning of the original sources of the reported information mightwell alter the impression provided by the reports;(b) the supervision arrangements — the replacement of Dr Shand byDr Gorrie means there would be continuing supervision in place shoulda stay be granted;(c) the impact on Dr Subramani and associated persons — thesupplementary evidence points clearly to the significant financialconsequences for Dr Subramani and his staff should the cancellationtake effect; and(d) availability of dentists on the West Coast — whereas Dr Gray pointedout that an article relied on by Dr Subramani as to dentist shortages onthe West Coast was first published in 2002, the Council's ownup-to-date figures indicate clearly the extent to which adults on theWest Coast are behind all other regions in their access to dentists.6The approach to the Tribunal's findings[42] The Tribunal reached its findings in the light of Dr Subramani's acceptance ofa lengthy set of agreed facts, his acceptance that statements should be taken as readand in the light of the questioning of witnesses and the receipt of lengthy submissionsat a four-day hearing. In relation to the Tribunal's findings, in this context, Irespectfully adopt the observations of Simon France J in A v A Professional ConductCommittee that deference to a specialist Tribunal, such as the Committee, isappropriate because:7[i]t is well established that a specialist tribunal may, and indeed is expected to,assess the evidence using its professional knowledge and experience.The supervision arrangements[43] I now turn to consider the factors here present, the subject of counsels'submissions and to balance those factors. I preface this discussion by noting that itwas Mr Waalkens' submission that what makes this case and the present applicationunique is the supervision arrangements in place for Dr Subramani's practice, given heis restricted to basic dentistry with those services closely and reliably supervised.Those arrangements, Mr Waalkens submits, well and truly protect the public andessentially remove any real risk of harm to the public. Mr Waalkens emphasises thatthe disciplinary charge focused on work undertaken by Dr Subramani in 2017 and2018 (all at least five years ago). Mr Waalkens submits that the wider interests of thecommunity — in having a dental practitioner such as Dr Subramani available, andparticularly when he is the only local after-hours/emergency practitioner — weighs infavour of a stay.6 It is unclear why Dr Gray drew attention to the age of the article about West Coast dentist shortagesbut did not in his affidavit go on to identify from the Council's own records either the statisticalor the general up-to-date picture identifying the situation on the West Coast.7 A v A Professional Conduct Committee [2018] NZHC 1623 at [17]. See also Williams v AProfessional Conduct Committee [2018] NZHC 2472 at [103].Will the right of appeal be rendered nugatory?[44] The appeal seeks to overturn the cancellation of registration and the fine. Werethe fine to be quashed, having previously been paid by Dr Subramani, it could berefunded. The focus must therefore be on the consequences to Dr Subramani'spractising dentistry. The quashing of his cancellation would lead to his ability topractise again in New Zealand as a dentist.[45] The refusal of a stay would not render the appeal nugatory in the usual senseof that test. There is no evidence that Dr Subramani would not find employment as adentist if his appeal is successful.Bona fides of the appellant[46] There is nothing to suggest that the appellant is other than bona fide in bringingand pursuing this appeal.Will the successful party be injuriously affected by the stay?[47] The immediate implementation of the cancellation would have an impact onthe practice Dr Subramani owns, with which Dr Migda is now associated. Therewould clearly be a dramatic impact on that practice and its staff members. Thefinancial impact on Dr Subramani and his family, both in terms of income andpotentially their equity position, will clearly be significant.[48] As noted by Ms Lane, for the Committee, this consideration does not fitcomfortably with the professional jurisdiction discipline. The Committee, inprosecuting a charge of professional misconduct, acts not in a personal interest but,pursuant to its appointment by the Council under the Act, with the principal purposeof protecting the health and safety of members of the public, including by ensuringaccountability of health professionals.88 Health Practitioners Competence Assurance Act 2003, s 3.[49] It is therefore appropriate to approach the question of injury by considering theimpact of a stay on both public safety and public confidence in the dental professionand its disciplinary processes.[50] I recognise some force in Mr Waalkens' contention that the supervisionarrangements in place have the function of protecting the public in order to remove arisk of harm to the public. I have Dr Subramani's affidavit evidence that his "dentalwork these days is very different in its competency and other respects to the particularcases which the Tribunal has reviewed", and that Dr Shands' regular reporting to theCouncil has been "satisfactory in terms of confirming that [he is] practising safely andappropriately". I also have Dr Subramani's detailed response to what Dr Rae hasreported in relation to two patients.[51] While, upon the basis of the evidence filed on this interlocutory application, Iam not prepared to draw any conclusion as to a recent instance of incompetent orotherwise unsatisfactory conduct, it is necessary having regard to the public healthcontext of this litigation to focus back on what the Tribunal has found. The Tribunal,with the benefit of not only factual evidence from both patients and dentists but alsothe unchallenged expert opinion evidence of Dr Cayford, concluded:9 In imposing a penalty on Dr Subramani, the Tribunal has had the protectionof the public and rehabilitative prospects of Dr Subramani at the forefront.[52] The temporary period of supervision which Dr Subramani had enjoyed,appropriate in the view of the Tribunal where there is a prospect of rehabilitation, wasfound not to be appropriate any longer for Dr Subramani because on its assessment ofthe evidence the Tribunal concluded there was not a prospect of Dr Subramani'srehabilitation (that is to a standard of a safe and responsible practitioner).10Significantly, as Ms Lane identified, the treatment that was subject to the charge wasnot overly complex and in many cases was largely the same as the "basic dentistry"which Dr Subramani has been in recent years permitted to practise. On the evidence9 At [620].10 At [653].before the Tribunal (in 2022) the Tribunal's conclusion was that Dr Subramani waspractising at the level of a junior dental student.11[53] In assessing risk of injury, it would be inappropriate to depart from theconclusion of the specialist body reached on a substantial body of evidence followinga lengthy penalty hearing. While the absence of definitive evidence as to recentshortcomings in Dr Subramani's practise is to be noted, the risk of injury to the publicremains significant — that is inherent in the Tribunal's conclusion that (as at 2022)Dr Subramani was still operating at the level of a junior dental student. This factorweighs significantly against a stay.The effect on third parties[54] On the evidence provided, and notwithstanding the comparatively lowernumber of patients that Dr Subramani may be seeing, he is providing a resource in aregion that is significantly underserved in access to dentists. It also appears that his isthe only practice offering after-hours/emergency services.[55] Refusal of a stay would mean that existing patients of Dr Subramani wouldneed to see another dentist and that in some circumstances, particularly of urgency,members of the public may be delayed in getting access to a dentist.[56] These are factors to be weighed in the balancing exercise but have to beassessed carefully having regard to the risk of harm to patients. I also take into accountDr Migda's engagement in the practice on a fulltime basis, with the apparent capacityto assume an increased workload.[57] This particular factor — effect on third parties — is most fairly regarded asneutral.Novelty and importance of the question involved[58] There is no novelty in the issues raised by this appeal. That said, there issignificant importance both for Dr Subramani and for the regime of professional11 At [617].discipline. I accept Ms Lane's submission that the disciplinary importance leans infavour of a stay not being granted — if the clear conclusions of the Tribunal leadingto registration being cancelled are to be overridden — the appropriate point is after thesubstantive appeal hearing and not upon the basis of the more limited material andargument available on an interlocutory hearing.Public interest in the proceedings[59] As observed by this Court in Edwards v A Professional Conduct Committee,there is an inherent public interest in disciplinary proceedings.12[60] As with the previous factor, the public interest in this proceeding leans slightlyin favour of matters being determined following a substantive appeal hearing.Apparent strength of the appeal[61] I have regard to the technical nature of the subject matter and the Tribunal'sspecialist expertise in relation to the matters of penalty it had to determine. I have alsohad the benefit of considering the reasoning in the Tribunal's 669-paragraph decision.I do not consider the prospects of a successful appeal could be classified as "strong".I view this factor as neutral.Conclusion[62] Against the background of my consideration of the above factors, I am clearlysatisfied that the fair and just outcome is that the cancellation of Dr Subramani'sregistration should not be stayed. I am further satisfied that there is no basis at all forstaying the order of the payment of a fine.[63] The interim relief previously granted was ordered to be in place until17 February 2023 (unless earlier order was made).12 Edwards v A Professional Conduct Committee [2022] NZHC 971 [at 36].[64] In the circumstances it is appropriate the cancellation of Dr Subramani'sregistration not be stayed. The previous stay of the censure, fine and costs order willbe rescinded.[65] Costs must follow the event.Orders[66] I order:(a) the interim relief granted in relation to Dr Subramani's cancellation ofregistration shall expire at midnight on 7 March 2023;(b) the stay granted in relation to Dr Subramani's censure, fine and costsorder is rescinded forthwith;(c) the appellant is to pay to the respondent the costs of the stay application(both without notice and on notice) on a 2B basis together withdisbursements to be fixed by the Registrar.Osborne JSolicitors:Wotton & Kearney, WellingtonCounsel: A H Waalkens KC, AucklandClaro Law, WellingtonCopy to: D D Vincent, HPDT