A Wagga psychiatrist who had been sleeping with a loaded gun beside his bed has lost his registration after engaging in a sexual relationship with a patient more than half his age.
Dr Luke Johnson, who has practiced in the city privately since he was registered as a psychiatrist in 2009, this week lost that privilege in a ruling by the NSW Civil and Administrative Tribunal (NCAT) when it found him guilty of professional misconduct.
On Wednesday, the NCAT found Johnson failed to maintain professional boundaries with a patient, prescribed inappropriately and failed to keep adequate records.
Johnson began treating a female patient - referred to by the court as Patient A - in April 2016. The then-20-year-old was referred to him after a GP consultation where she complained of worsening symptoms in the context of a long-standing mood disorder. He diagnosed her with major depressive, cannabis use and borderline personality disorders.
He treated Patient A on more than 100 occasions in the ensuing 15 months, with the NCAT finding the relationship crossed the line on October 18, 2016.
Patient A did not give oral evidence during four days of hearings before NCAT last month, with the court hearing from Johnson, his treating psychiatrist, his supervisor, and two further psychiatrists delivering expert evidence.
Johnson had previously been supervised while practicing, but banned from dealing with female patients, under sanctions imposed by the HCCC in March 2021.
The tribunal last month heard Johnson and his wife had been sleeping with loaded guns beside their beds for years after a failed home invasion, and the night before the psychiatrist crossed the line with his patient a firearm had been pointed at him by his wife during what the couple thought was another attempted raid on their home.
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It was during an appointment the following day Patient A asked Dr Johnson not to mention his wife and suggested they run away together.
He said he was taken aback by the proposal but "that he identified very, very strongly with her, found her attractive and saw the proposal as an escape" from his stresses, which as well as the fallout from the attempted home invasions included working long hours while saving for a house deposit and feeling his marriage was falling apart.
He told the tribunal they were both "in a daze" during three ensuing meetings over the next 10 days that his own psychiatrist Dr O'Dea noted him describing as having "sexual charge".
"We are satisfied ... Dr Johnson did either agree to or encourage Patient A into thinking that a personal relationship was possible," the tribunal found.
They were in daily contact from November and by December Patient A had moved to Sydney. While Dr Johnson informed Patient A he was in Sydney on December 23 "to avoid an escalation", he was surprised when she arrived at his hotel.
After a drink in the bar, she came up to his room and kissed before becoming distressed. "he placated her by suggesting lunch the next day", which they did, and the therapeutic relationship continued by telehealth.
The relationship became sexual in February 2017 and it continued after Dr Johnson stopped treating Patient A in June.
"Dr Johnson said that after February 2017 he paid for everything," the NCAT said.
A complaint reporting the personal relationship had begun during and continued after Dr Johnson treated Patient A was lodged in July 2020 when the intimate relationship came to an end. Conditions were imposed on Dr Johnson's registration after a hearing the following March.
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The HCCC in December 2022 referred the Johnson matter for disciplinary orders and sought to have Johnson's registration cancelled, rather than suspended, for one to two years.
While accepting his conduct "dictates the imposition of a protective order", Johnson submitted a reprimand and continuation of his restrictions, or a time-limited suspension, would be an appropriate outcome if a professional misconduct finding was made.
However, the NCAT noted The Royal Australian and New Zealand College of Psychiatrists has a zero tolerance on sexual boundary violations and ruled such a penalty was not sufficient.
The tribunal was satisfied Dr Johnson engaged in unsatisfactory professional conduct over the relationship, in arranging an MRI for Patient A in June 2017, and in prescribing an antidepressant in Patient A's name with the intention of providing it to his then-family members instead.
While Dr Johnson denies he failed to make and keep adequate records, they were "obviously incomplete as there is no reference to the relationship" from October 18, 2016, the tribunal said.
Johnson described the relationship at various times to the tribunal as not being a "love fantasy" but rather that he initially used Patient A as "a means to an end" because he "wanted to escape", and eventually it was too late to go back and he was "resigned to ending up with her". The tribunal agreed with the HCCC's submission the effect of such language was to blame the patient, rather than himself, for the boundary violation.
His treating psychiatrist, Dr O'Dea, told the tribunal he felt narcissism was playing a role in Johnson's not moving on to accept responsibility for his behaviour and feeling empathy over the potential consequences.
Dr Johnson's registration was cancelled until November 15, 2025, and he must pay the HCCC's costs of the entire proceedings.
"At the expiration of the period of cancellation, Dr Johnson must re-apply for registration and show that he has addressed the issues giving rise to the cancellation and should be permitted to resume practice," the NCAT said.
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