Kate* has been redecorating.
There are three bright Frida Kahlo prints on a wall and, on a shelf in the lounge room, she's placed a statue of a Japanese beckoning cat which is meant to encourage good luck into her home.
But no matter how hard she tries, it still feels dirty.
"I wake up screaming," she says.
Her home was the site of betrayal and trauma. And try as she has to make the space into something safe, it hasn't worked.
"I wake up with nightmares, night terrors."
It was in her home that Kate remembers being manipulated by someone she should have trusted — her treating medical professional, psychiatrist Scot Nicolson Duffton.
"I was his star patient," she says.
"I didn't want to do anything that would jeopardise my quality of health care … and if that meant having sex with my doctor to be cured, that's what I had to do."
A six-month ABC investigation has examined more than a decade of disciplinary decisions against health professionals, finding almost 500 workers who have been sanctioned for inappropriate sexual conduct involving their patients.
The investigation found that people working in mental health settings make up almost a third of all proven sexual misconduct cases among health workers.
Dozens of these workers, including psychiatrists, psychologists and nurses who have crossed sexual boundaries with their patients, are still allowed to treat patients today.
Although the vast majority of Australia's 850,000 healthcare workers uphold their ethical obligations, the number who are subject to complaints is growing.
'I better just not say anything'
Kate first met Duffton in late 2019 when he was assigned to her care through a program called Hospital in the Home.
Unlike other psychiatrists she had seen, Duffton insisted she address him by his first name and complimented her looks and intellect.
He also gave Kate — who was going through a bad break-up, dealing with childhood trauma and recovering from a suicide attempt — unprecedented hope for her future.
"He basically told me that he could cure me of my mental illness and that he was going to do that by going to Harvard Medical School and learning a [new] technique," Kate says.
Duffton shared books with her, checked in via text a few times a day and started coming to her house for cups of tea and takeaway dinners. Kate felt she had met a health professional who really cared.
"I thought it was that he cared about me because he saw something special in me," she says.
Duffton took advantage of Kate's vulnerability.
Kate remembers one night they spent together when she had smoked at least five joints on top of a large dose of a powerful prescription medication.
That was the first time they had sex.
"I remember thinking 'Oh, shit.' Like, if I say no, I won't have a doctor that cares about me anymore. I better just not say anything."
Duffton would later say the pair had spoken about what was happening and that it was consensual.
Kate doesn't see it that way.
In her vulnerable state, she says she accepted what was happening, and feared the consequences if the relationship — or whatever it was — ended.
Massive power imbalance
Mental health professionals and their patients have a unique relationship founded on trust.
Patients let down their guard, divulging their fears, traumas and innermost thoughts.
UTS professor Jenni Millbank says in these intimate settings, boundaries can become blurred.
"There is a very high likelihood of those [inappropriate] relationship cases occurring in a mental health setting where the patient is psychologically vulnerable and where there's an intimacy that builds up between the practitioner and the patient," Professor Millbank says.
Of the 153 cases the ABC investigation found in a mental health setting, almost 40 workers were either allowed to continue working or returned to practise after a period of deregistration.
Many of the cases involved serious transgressions. In one case, a Melbourne psychiatrist impregnated a patient. In another, a psychiatrist in Sydney injected a patient he was dating with heroin.
In both cases, the psychiatrists themselves were found to have had a mental illness at the time of their misconduct, and their reinstatement was reliant on compliance with a long list of conditions.
A Victorian psychologist who initiated a sexual relationship with a former client once they turned 18 was suspended for 18 months — after which she was automatically allowed to see patients again.
Some mental health workers with proven complaints against their name aren't removed from practice at all.
Nurse offered to buy drugs
A nurse in Queensland entered into a "consensual relationship" with a woman he met after she was admitted to a mental health ward following a psychotic episode. According to tribunal findings, he also offered to buy the woman drugs including meth and GHB.
Accepting he had already been suspended for two years pending the hearing, that he was remorseful and had shown insight into his behaviours, the Queensland Civil and Administrative Tribunal declared he presented as "no risk" to the public and placed only a reprimand on his registration.
Experienced Brisbane psychiatrist and researcher Warwick Middleton estimates about one in three of his complex trauma patients have had a sexual relationship with someone involved in their treatment.
He says it's never appropriate and never the patient's fault.
"There's a massive differential in terms of power," Professor Middleton says.
"It just is even more important that the therapist actually really understands what's going on and respects the need for safety and clear boundaries."
The peak professional body for psychiatrists is the Royal Australian and New Zealand College of Psychiatrists. It revokes the fellowship of members with proven sexual misconduct complaints against them.
This doesn't stop a psychiatrist from practising, but it prevents them from associating with the college or taking advantage of training and leadership opportunities.
"We believe that having a policy which provides clarity to the profession and clarity for the community is actually very, very important to weed this issue out," president Vinay Lakra says.
"A boundary violation is a very serious breach of the doctor-patient relationship."
'The system is broken'
Duffton continued Kate's formal treatment for several intense hours every week. But the boundaries between doctor and patient had become completely blurred.
It had the effect of alienating Kate from her life outside of their sessions. Kate remembers Duffton told her that if anyone found out about their "relationship" his career was over but also, that her life would be ruined too.
Kate's mental health wasn't recovering — she was deteriorating.
She tried to take her own life again.
In early 2020, seven weeks after they first had sex, Duffton told Kate he was moving to Western Australia. There he continued the relationship during hours-long phone calls.
"He was just placating me so that I wouldn't divulge the relationship, the nature of the transgression of the relationship," she says.
But Kate eventually reached breaking point. She told Duffton she couldn't keep the secret anymore.
"I said to him, 'I can't do it anymore, I can't do it anymore, I'm going to have to tell someone,'" she says.
"I think I sent him a few messages saying, 'Are you OK? I'm so sorry.'"
She later confided in a home nurse.
"I said, 'Do you think I'm vulnerable?' And she said, 'Yes.' And I said, 'Oh,'" Kate remembers.
"And that was like a moment of realisation for me because I sort of thought that I had agency in the relationship, but I absolutely didn't because I was so unwell."
The nurse guessed what had been happening, then notified a senior colleague, who was obliged to make a mandatory report to the national regulator, Australian Health Practitioners Agency (AHPRA).
The next day, police arrived to take Kate to hospital out of apparent concern for her mental health. Kate says she was not offered testing for pregnancy or sexually transmitted infections, not referred to specialist counselling and not advised she could make her own report to AHPRA.
She decided to notify the agency in addition to the complaint lodged by the Tasmanian Health Service to ensure the regulator had her full perspective.
"The AHPRA process seemed to go on for months. It was very difficult," Kate says.
"I would actually go so far as to say that I was promised or strongly suggested that there would be outcomes in [the Tasmanian Civil and Administrative Tribunal] that never occurred, such as a fine and a complete deregistration … that felt like a huge let-down."
Tribunals can fine, suspend, deregister or place conditions on health practitioners subject to findings of unsatisfactory professional conduct or professional misconduct.
Tribunal finds Duffton edged towards victim blaming
During the hearings, Duffton submitted a statement acknowledging that the relationship was inappropriate.
"There were numerous occasions when I repeated to [Kate] that the relationship was entirely inappropriate, and explained to her that despite her repeating that she was an adult and able to make her own decisions, there were other factors at play, such as the power imbalance, that negated that," he wrote in his submission.
"To my ongoing shame, having once transgressed my professional boundaries, I compounded this by not acting on what I knew to be right."
The tribunal agreed with the Medical Board — which brought the case — that Duffton's evidence was self-pitying, self-justifying, and edging towards victim blaming.
The tribunal also agreed that his behaviour was predatory and that he knew what he was doing was wrong, and that it would and did hurt Kate.
It also noted that Duffton had failed to show any evidence of how he had sought to rehabilitate himself.
It described Duffton's actions as "disgraceful" and that it was "difficult to conceive of a more serious breach of professional ethics by a medical practitioner engaged to provide acute psychiatric care".
'Insulting to my intelligence'
Explaining his conduct, Duffton cited the pressure he was under at the time, including the terminal illness of his best friend, the limited face-to-face contact with his partner, and the death of his pet.
Kate was furious when hearing this.
"The death of the family pet was insulting to my intelligence. I don't think if my dog died that would be an excuse to cause serious, lifelong harm on another person," she says.
The Tasmanian Civil and Administrative Tribunal cancelled Duffton's registration.
It ultimately took into account that Duffton was remorseful, admitted to the conduct and had no prior disciplinary history. It also found he constituted a low risk of reoffending.
For this reason, his disqualification period was 2.5 years. He will be eligible to apply to practise again next year.
Kate believes the penalty does not go far enough.
"I thought it was a joke," she says.
"It's 2.5 years. What about the effect on my life? I don't think in 2.5 years I'm going to be OK and ready to work … I'm not eligible for compensation or anything like that.
"The system is very broken, these people are effectively untouchable and that needs to change."
Duffton says he has no interest in returning to psychiatry. He declined an interview and says he accepts full responsibility for his actions.
AHPRA trying to improve process
Health regulation is complex. The Australian system was created to predict and prevent future risk to patients, rather than to punish practitioners for wrongdoing.
The body responsible for investigating complaints, in most states, is the Australian Health Practitioners Agency.
Its chief executive Martin Fletcher says the investigation process can be lengthy and stressful but that's often because of the complexity of the investigations.
"One of the things that's become very clear as we've looked at this area of sexual misconduct is the fact that the regulatory process can be incredibly re-traumatising for the person raising the concern," he says.
He says the agency has tried to address the issue by establishing a service led by social workers designed to provide support and guidance to patients who complain.
He says the agency is also trying to make the tribunal process smoother.
"We're certainly working closely with tribunals to try and iron out any pain points in the process … what the tribunal then does is a matter for them."
Doctor and University of Melbourne law and public health professor Marie Bismark says the true extent of the problem remains unknown because of the many barriers in reporting the behaviours.
"We can get some information from police reports, we can get some information from reports that have gone to AHPRA or the Medical Board, but the suspicion is that they are just the tip of the iceberg," she says.
"There are probably many women who are experiencing sexual misconduct who choose not to come forward."
'Heaviness and grief'
Kate says her life is now "a misery".
"I feel like I've gone into the ocean with all my clothes on, and come out, and I walk around with that all day," she says.
"You know, there's just this heaviness and this grief and this sadness, and I can't see it getting any better."
But she wants to talk about what happened to her so people understand its devastating impact — and to help improve the processes.
"Being a doctor is a privilege and not a right and one that should be respected heavily because patients come to you at their most vulnerable and they tell you the most intimate of things," she says.
"So to do the ultimate and have a sexual relationship or whatever you want to call it is just disgusting. It's absolutely disgusting."
*Kate's name has been changed to protect her identity.
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