Court of Appeal Judgment Summary Notes

General Civil Appeal from the Supreme Court, Trial Division — Statutes — Liability — Breach of Statutory Duty — The appellant was injured when, in the course of her employment by the respondent as a nursing assistant at the Nambour General Hospital, she twisted her back lifting a canister out of a plastic tub sitting on the top shelf of a steel trolley — Quantum was agreed between the parties to be $600,000 — It was common ground between the parties, and the primary judge held, that the appellant, by proving that she had been injured at work, established prima facie that the respondent employer had breached its duty to ensure the appellant’s “workplace health and safety” — In order to escape liability, the respondent relied on s 26(3) of the Workplace Health and Safety Act 1995 (Qld) — It was also common ground at the trial and on appeal that the Manual Tasks Code of Practice 2000 was a “code of practice” within the meaning of s 26(3) and that it applied in the circumstances under consideration — The primary judge held that the respondent had discharged its duties under the Act — On Appeal — The appellant had handled the canister on only two or so occasions prior to the accident — She found it awkward to handle — Another nurse in the sterilising department, Ms Currey, gave evidence that she had handled the canister over a lengthy period — She said that she complained about it and “just used to comment that it was awkward” — Ms Ricardi was the nurse unit manager of the sterilising department — Ms Ricardi was aware that staff in the department had voiced concerns to the effect that the canister was awkward to handle because of its uneven weight distributions — Other evidence of Ms Ricardi reveals a robust disposition to “get on with the job” and cope with any difficulties rather than reflecting on how they arose or whether they could be minimised — The evidence established that the Task was “a problem task” and that the respondent failed to employ a risk management process to determine whether the Task was a “problem task” — The respondent failed to adopt and follow the way stated in the Code for identifying the Task as a “problem task” and thus failed to come within s 26(3)(a) — An issue which loomed large on the trial and on the appeal was whether consultation within the meaning of s 2.1 of the Code had taken place and whether training had been given to the appellant “in sufficient depth to do [her] jobs safely” — Workplace discussions about the awkwardness involved in handling the canister do not amount to a relevant consultation — The significance of the lack of consultations for present purposes is that it is a further illustration of the respondent’s failure to comprehend and apply the Code’s requirements — The rudimentary training given to the appellant about the lifting and handling of objects had little, if any, bearing on the handling of the canister — Consideration could also have been given to whether it was desirable that it be handled by shorter than average or weaker than average persons — The respondent failed to escape the liability imposed on it by operation of s 28 of the Act — In particular, it failed to establish that it adopted and followed the “way” stated in the Code for managing exposure to the relevant risk — It also failed to prove that it had satisfied the requirements of s 26(3)(b) of the Act — HELD: Appeal allowed, Order of the primary judge be set aside, Respondent to pay the appellant the sum of $639,435.91 and costs.

General Civil Appeal from the Supreme Court, Trial Division — Torts — Negligence —Employer and Employee — Damages — In January 2005, whilst employed in an optometry practice owned and operated by the appellants the respondent was sexually molested by an elderly male customer (“the offender”) — After a three day trial, the primary judge found that the appellants were in breach of their duty to protect the respondent, “an employee in a vulnerable position” — Damages were assessed at $390,558.82 and it was ordered that judgment be entered for the respondent in that sum — On Appeal — The offender entered the shop unaccompanied — He requested the respondent, who, as usual, was attending the shop by herself, to fit his glasses — The respondent, who had been behind the reception desk, came around into the body of the shop and fitted them on his face — She then took the spectacles and walked to the back of the shop past the reception desk and turned into the workroom — The respondent was then sexually molested by the offender — There was no view into the workroom from the street, footpath or reception area — Mr Richard Jennings, a “consultant safety and security risk analyst” made reports which were tendered — Mr Jennings conceded in cross-examination that the subject business was not one that “incurred any special security or safety risks which would be the case in a retail shop where the product sold was of substantial value” — There was no evidence of any assault on a female employee having taken place in an optometry shop and no evidence which might warrant the conclusion that such an attack might occur except by way of an entirely fortuitous random act of violence which might occur regardless of location — The appellants were entitled to regard the magnitude of the risk of assault and the probability of its eventuating as singularly slight — The evidence did not suggest that Mr Jennings had any expertise in the workings of an optometry business and his opinion that employees in a business of the type in question should always be within the public gaze may be thought problematic — In cross-examination, Mr Jennings accepted that providing a lockable door “would simply increase the likelihood or the duration or the ferocity of an assault” if an attacker got into the backroom undetected — Having regard to the magnitude of the risk of a female employee being assaulted and the absence of persuasive evidence that one or more of the precautions identified by the primary judge or advocated by counsel for the respondent was or were practical or likely to afford an employee an appreciable degree of protection from assault, it was not established that it was unreasonable of the appellants not to have taken any such precaution — It is necessary to consider the appeal against quantum in case the above findings on liability do not survive an appeal — It is accepted that the evidence of the respondent needed to be treated with considerable caution — The respondent attended an interview for prospective employment at Franz Felfer Optometry days before the commencement of the trial — The respondent provided Ms Crilly, the interviewer with a resume at the time of her job interview — This rather damaging document was not disclosed, although the evidence was that the respondent’s solicitors explained to the respondent her duty of disclosure — The respondent was less than frank when on oath about a matter which she must have realised had a substantial bearing on the outcome of her damages claim — When this blatant dissembling is coupled with her failure to disclose her resume, and the difficulties with her evidence concerning her mental history it is impossible to regard the respondent as a witness of credit — The evidence does not support the award of $200,000 for future economic loss, the calculation of which was based on the premise that the respondent would be able to work only five hours per week — It is reasonable to assess future economic loss on the basis that the respondent had the capacity to work up to 16 hours per week — HELD: Appeal allowed with costs, Judgment at first instance be set aside.

Application for Leave from the District Court — Professions and Trade — Lawyers — Remuneration — The applicant was a solicitor retained by the respondents — His retainer was terminated in late 1999 — On or about 28 April 2004 the applicant delivered an itemised account for $31,647.02 to the respondents — On 19 January 2005 the respondents applied to the Solicitors Complaints Tribunal for the appointment of a costs assessor to assess the account — The clerk of the Tribunal appointed a costs assessor, who issued a costs assessment in the sum of $26,696.07 on 9 May 2006 — On 6 July 2006 the applicant filed a claim in a Magistrates Court for “Professional costs and outlays as specified in the Statement of Claim” together with interest and costs — So far as presently relevant, he claimed this relief in his pleading — “a) the sum of $26,696.07 being monies owing pursuant to the Written Assessment …. dated 9 May, 2006.” — On Appeal — The relationship between a solicitor and his or her client was contractual, and on the termination of the retainer, the solicitor had a cause of action for moneys owing pursuant to the contract — The solicitor’s cause of action accrued when he or she completed the work, rather than upon the expiration of one month from the delivery of the account — The applicable limitation period was six years from the accrual of the cause of action — Section 6ZE(2) of the Queensland Law Society Act 1952 (Qld) provided that “a binding costs assessment” might be “enforced as a debt for the assessed amount” — The provisions of Part 2A division 6A of the QLS Act were intended to provide a procedure for the resolution of quantum that was alternative to and less formal and expensive than Court proceedings — In short, these provisions were not intended to provide an alternative source of the solicitor’s entitlement to fees or costs; nor were they intended to alter or provide an alternative limitation period applicable to the solicitor’s claim — Section 10(1)(d) of the Limitation of Actions Act applies where the claimant has a right of recovery sourced in a statute and a cause of action (that is, a factual situation which would support his or her right to judgment ) has arisen — Section 6ZE(2) of the QLS Act was not a source of the applicant’s right of recovery — It merely provided an appropriate procedural mechanism for the enforcement of the right to recover the fees or costs (a right that had been conferred by contract and that had arisen on the termination of the retainer) in circumstances where the only issue was quantum and that was now resolved in a way that was binding on the parties — HELD: Application dismissed with costs.

Application for Leave from the District Court — Limitation of Actions — Extension of Period — Cause of Action in Respect of Personal Injuries — The applicant seeks leave to appeal pursuant to s 118(3) of the District Court of Queensland Act 1967 against an order of a judge of the District Court on 6 October 2010 allowing the respondent’s application, by originating application for an order, that the time for commencing proceedings claiming damages for personal injuries by the respondent be extended to 11 March 2010 pursuant to s 31(2) of the Limitation of Actions Act 1974 (Qld) — The applicant plastic surgeon carried out breast augmentation surgery on the respondent on 13 June 2003 — A claim, some three years and nine months outside the limitation period, and statement of claim were filed in the District Court on 11 March 2010 — The most substantial, if not the only, allegation remaining against the applicant after a concession made by the respondent’s counsel at first instance was that the applicant failed to provide the respondent with adequate information as to the risks associated with the surgery — At first instance the applicant identified the most substantial source of prejudice to the applicant arising from delay as being that: (a) the nurse who assisted the applicant with the procedure and who had contact with the respondent “no longer works for [the applicant] and has indicated that she will not assist” in the defence; and (b) the disadvantage suffered by the applicant in having to rely on evidence of her usual practice rather than “on personal recollection of events” — In dismissing the first ground, the primary judge said: “I cannot recall being directed to any material to indicate that that situation might be different had the action been commenced within the time limits prescribed by the Act …” — When discussing the second ground his Honour said that the inference which the applicant sought to have him draw was that, without delay, the applicant may have been able to rely on a personal recollection of events — On Appeal — In respect of both grounds then the primary judge looked, impermissibly, to the comparison of the prejudice which was likely at the time of application to that which would have existed in any event had the application been made within the limitation period — Although the prejudice created by the delay in commencing proceedings is relevant and may be a very significant consideration, Brisbane South Regional Health Authority v Taylor (1996) 186 CLR 541 makes it plain that the existence and extent of any prejudice to the applicant must be assessed as at the date of the application — The primary judge did not make this assessment — He thereby failed to give due weight to the prejudice suffered by the applicant, both presumptive and actual, and to the fact that an extension of time would operate to deprive the applicant of the protection of the Act — In considering prejudice, the primary judge examined the arguments advanced on behalf of the applicant, which centred around evidentiary problems the applicant would face resulting, at least in part, from the passage of time — The approach of the primary judge was to assume that the applicant, having brought herself within s 31(1), was entitled to an extension of time unless the respondent to the application for an extension of time established “some matter justifying the exercise of a discretion against the granting of an extension” — That reversed the onus of proof — The applicant had adduced sufficient evidence to satisfy the evidentiary onus on it to show “that prejudice would be occasioned” — It remained for the respondent to persuade the court that the prejudice to the applicant was not such as to warrant the exercise of the discretion against the granting of the application to extend time — The lengthy delay in commencing proceedings has given rise to presumptive prejudice of the type discussed in Brisbane South at 555 — There was also significant actual prejudice to the applicant existing at the date of the application to extend time and the respondent has failed to show that delay has not made the chances of a fair trial unlikely — HELD: Application for leave granted, Appeal allowed, Orders at first instance be set aside, The Application filed on 10 June 2010 be dismissed with costs.

Application for Leave Sustainable Planning Act — Administrative Law — Judicial Review — Procedural Fairness — Bias — Apprehension of Bias — Environmental Planning — Planning Scheme and Instruments — On 15 December 2010 Robin DCJ sitting in the Planning and Environment Court ordered that the applicants until further order, desist from undertaking any activity involving use by the public for the consumption of food and beverages, including such uses as comprise a material change of use as a Café, Tavern, Restaurant, Reception Room or any other undefined use which is assessable under the Gold Coast City Plan 2003, on the roof top of the building known as the ‘Burleigh Beach House’ — The applicants, whom it is convenient to refer to by name rather than status in the proceedings, are Elsafty Enterprises Pty Ltd, the lessee of the land, represented by its director Mr El Safty, and Sustainable International Property Pty Ltd, represented by its director Mr Youssef, the proposed operator of the roof top facility — The applicants had contended below, in response to an application by the GCCC for an enforcement order to restrain the proposed use of the roof top for the consumption of food and drink in premises which Elsafty Enterprises operates a restaurant, that a permit to do so was not required because such a use was encompassed in the existing permit to operate a restaurant — On 7 March 1986 Row DCJ made formal orders subject to certain conditions — Relevant, for this application, are the following as issued by the GCCC: “the Council of the City of Gold Coast hereby approves an application to erect a Restaurant on land described as … subject to the following conditions: (28) Restaurant to accommodate no more than 200 people. … (36) The approval is only for a restaurant and any discotheque type activity would be subject to consent for indoor recreation and would require a Town Planning Application” — At the hearing below and on this application the position of the GCCC was that there was no absolute opposition to the use proposed, merely that the applicants were required to go through the usual planning processes as had occurred in the past, for example, for extended restaurant facilities around the swimming pool — After the hearing had concluded on 14 December 2010 the primary judge gave ex tempore reasons the following morning mindful that both sides were concerned for an early decision — There is no complaint that his Honour overlooked any relevant fact in his careful recital of the history and of the issues — The primary judge considered the relevant provisions in the legislation and concluded that the proposed use was not a minor change in the scale or intensity of an existing use and the restraint order should be made — On Appeal — It was abundantly clear that the judge had not reached any conclusion on the construction point when he adjourned proceedings on the evening of 14 December 2010 — He said so several times and recognised the analysis to be difficult — With one or two exceptions, towards the end of the hearing where some mild exasperation at lengthy and unfocussed cross-examination is discernible from the primary judge, the interventions were directed to exposing the issues which had to be decided — There can be no doubt, after reading the whole transcript of the proceedings, that Mr El Safty had detailed knowledge of the relevant planning scheme and supporting legislation as well as of the long history of this site — Mr Youssef’s self-proclaimed expertise in property matters at the commencement would have conveyed to a fair minded observer that he did not think that he required legal assistance — These men were tertiary educated, commercially astute and experienced developers who, no doubt, from a past course of dealings with local authorities, thought that a satisfactory outcome could be negotiated rather than retaining lawyers when the application was served on them — The earnest attention to the issues by the primary judge set out very fully in a lengthy ex tempore judgment given the following morning after a late sitting demonstrates appropriate even handedness — The definition of a “Restaurant” in the 1982 Town Planning Scheme for City of Gold Coast is not materially different in the 2003 Planning Scheme except the meals served are no longer to be “substantial” and the patrons need not be seated — There is nothing about the proposal for upwards of 250 people on the roof engaging in the consumption of food and liquor purposes with music which is incidental to the operation of the restaurant — Nor is it necessarily associated with the restaurant — What is proposed is a separate facility, not the stroll up to the roof with a glass of wine (with or without the plates of tapas) to look at the view between courses from the restaurant below mentioned by Mr Cooke — The applicants contend that on a proper construction of the Planning Scheme and its definitions the flat roof of the building would not be included in the calculation of the Total Use Area — I would conclude that the applicants are correct in arguing that the roof area does not exceed the allowable margin of total use area — But that is not the true issue — What is proposed is the start of a new use of the premises — The plan to have the restaurant provide the food and, in the interim, liquor for reward would involve a change in the scale of the existing restaurant use that exceeded “the limits expressed in the approved Plan of Development” — HELD: Application for leave to appeal refused with costs.

Appeal against Conviction from the District Court — Miscarriage of Justice — Particular Circumstances Amounting to Miscarriage — On 13 January 2010 after a three day trial before a jury in the District Court Maroochydore, the appellant was convicted of two counts of rape, two counts of unlawful carnal knowledge and one count of attempting to procure an intellectually impaired person to commit an indecent act — Mr RAI is 49 years of age and has borderline intellectual functioning and behavioural difficulties probably as a result of brain damage which he sustained in an accident when he was 13 years old — The complainant was the appellant’s biological daughter, R who was aged between 16 and 17 during that time period — She also has an intellectual impairment — The complainant’s evidence was pre-recorded before Dodds DCJ on 22 November 2006 on the basis that she was declared a ‘special witness’ for the purposes of s 21A of the Evidence Act 1977 (Qld) — On Appeal — This matter has an extensive history of delay including a significant period of delay on the part of the appellant — It is important to remember at the outset that there is a presumption of sanity and of capacity for a matter — It must be determined whether when Mr RAI was re-arraigned and the trial commenced on 11 January 2010 the trial judge was satisfied that he was both fit to plead and to stand trial — In this case the learned trial judge had seen Mr RAI on a number of occasions and particularly had seen him in interactions with his mother — Of particular significance was the lengthy cross-examination of a number of witnesses on 1 December 2009 — A perusal of the transcript of that date clearly indicates that Mr RAI was closely involved in instructing his mother on that occasion — There are numerous instances in the transcript where it is clear that Mr RAI is querying particular issues — It is readily apparent from a reading of the transcript that Mr RAI was clearly following the exchanges which were going on in the Court — It is also clear that he is giving very firm instructions to his mother on a number of occasions — Furthermore as Mr RAI had essentially refused to undertake any examinations there was no evidence before the learned judge that he would not be able to understand the proceedings or the nature of the trial — A reading of the transcript of the trial as a whole similarly does not reveal anything to indicate that Mr RAI was not able to understand the nature of the evidence against him, give instructions about his response to the charges and have his version of events put to the witnesses — At the close of the prosecution case, Mr RAI made it very clear that he did not wish to give evidence — The transcript indicates that they were his very clear instructions — Whilst Mr RAI had none of the safeguards which come with having a competent counsel engaged on one’s behalf there is no doubt that his mother capably conducted a defence on his behalf — There is no doubt that Mr RAI knew what he wanted to rely on and he communicated his version of the facts to his mother — Mr RAI and his mother were not, of course, conversant with court procedure, but the learned trial judge patiently and consistently gave appropriate guidance at crucial times — It cannot be the case that s 613 must be engaged whenever there is any level of intellectual impairment — Furthermore, the section cannot be automatically engaged and remain engaged when the accused wilfully refuses to submit to an examination to clarify the issue — HELD: Appeal dismissed.

Sentence Application from the Childrens Court — Sentencing Orders — Discretion to Record Conviction — Relevant Considerations — On 29 October 2010, the applicant was sentenced on his plea of guilty on one count of dangerously operating a motor vehicle — The offences occurred after the applicant took his mother’s car, without her permission, and picked up three young girls (one at least of whom was previously known to him) — He drove at times at speed, and on a number of occasions in a way described as doing “burnouts”, ultimately losing control of the vehicle and crashing into a power pole — The circumstance of aggravation referred to in the indictment relates to one of the girls, who suffered an injury to her leg — After the accident, the applicant helped another of the passengers, who was unable to release her seatbelt, to get out of the car — The applicant went and sat in another car, and asked the driver of that car to take him to his home — When she did not do so, he got out of the car, and ran off — The applicant participated in a Youth Justice Conference (YJC), which resulted in a YJC Agreement — This recorded the applicant’s apology to the complainant, and that his three passengers wished the applicant well — Having imposed the sentence, the learned sentencing Judge turned to the question of recording a conviction — She observed that ordinarily a conviction would not be recorded for a juvenile first offender, even for a serious offence, if based on criminal negligence — She then said, “Added to that is the fact that you ran away before the police arrived defeating any hope of testing you for alcohol” — She observed that a conviction was less likely to have an impact on the applicant’s employment, which has been in the area of labouring and as a factory hand — Her Honour decided to record a conviction — On Appeal — It is clear that the learned sentencing Judge relied upon one matter which could have been included in the indictment, namely, that the applicant left the scene of the incident, before a police officer arrived, in circumstances where there was evidence to establish that he knew, or ought reasonably to have known, that another person had been injured — Her Honour relied on the applicant’s intoxicated condition — She did this as the explanation for his departure, and undoubtedly regarded it as a circumstance which made more serious his conduct in leaving the scene of the incident — While her Honour expressly recognised in her sentencing remarks that the applicant could not be sentenced on the basis of his intoxicated state, it is clear that she acted on this basis when deciding the conviction should be recorded — The principle established in The Queen v De Simoni (1981) 147 CLR 383 applies also to a decision whether or not to record a conviction — It would follow that a decision to record a conviction was in this case wrongly made — It is now well established that the prima facie position under provisions such as ss 183 and 184 of the YJ Act is that a conviction is not to be recorded against a child — Even without reference to such provisions, reluctance has been expressed to record a conviction against a child in the case of a serious offence which is substantially the product of criminal negligence, rather than of malice or conscious wrongdoing — The fact remains that the offence was a serious offence — Nevertheless, the complainant’s injury is clearly at the lower end of the range of injuries which would qualify as grievous bodily harm — Bearing in mind the prima facie position previously referred to, and notwithstanding the seriousness of the offence, the circumstances of this case on balance would justify an order that no conviction be recorded — HELD: Application for leave to appeal be granted, Appeal allowed, The order at first instance recording a conviction be set aside.

Appeal against Conviction & Sentence, Sentence Appeal by A-G (Qld) from the Supreme Court, Trial Division — Interference with Discretion or Finding of Judge — Control of Proceedings — Improper Admission or Rejection of Evidence — Sentence Manifestly Excessive or Inadequate — On 29 June 2010, after a 58 day trial in the Supreme Court at Brisbane, a jury found the appellant Jayant Patel guilty of the manslaughter of three persons and of unlawfully doing grievous bodily harm to another person — The charges arose out of surgical operations which the appellant conducted upon those men whilst the appellant was employed as a surgeon at the Bundaberg Hospital between May 2003 and December 2004 — On 1 July 2010, the trial judge sentenced the appellant to concurrent terms of seven years imprisonment for each of the manslaughter offences and three years imprisonment for the grievous bodily harm offence — The trial judge directed the jury that the trial was “not about botched surgery” but was instead “about surgery performed competently enough”; that it was “not how the Accused performed surgery that matters in these four cases” and that what mattered was “his judgment in deciding to commend the surgery to a patient and, having obtained [the] patient’s consent, in taking the patient to theatre to perform it” — In that respect, the case put to the jury in relation to each patient was that the appellant should not have embarked upon the surgery notwithstanding that each patient had consented to it — The trial judge held that: under s 288 the relevant “act” was not the performance of surgery, but rather the administration of surgical treatment; whilst “surgical treatment” will typically be surgery, that expression may extend to diagnosis of a condition and advice about it; and the duty imposed by s 288 might oblige the surgeon not to commend surgery to a patient or not to perform it even with the consent of the patient — Section 288 creates consequences for any omission to observe or perform a duty in administering surgical or medical treatment — The relevant “omission” is an omission to observe or perform a duty, not an omission to perform an act. The duty might require the person bound by it either to perform an act or to refrain from performing an act — It follows that s 288 may be invoked in a prosecution for unlawful killing, or doing grievous bodily harm, where the death or harm is alleged to result either from a positive act of the accused or an omission by the accused in administering surgical or medical treatment — The appellant contended that the contrast between the language of s 288 (“do any other lawful act” and “in doing such act”) and the language of s 282 (“the performance of the operation is reasonable”) indicated that s 288 applied only in relation to carelessly performed surgery rather than surgery that should not have been performed at all — Section 282 fulfils the very different function of excusing criminal responsibility which otherwise would be imposed by a different provision — In this respect, we respectfully disagree with the trial judge’s conclusion, expressed in his reasons for Ruling No 3, that s 282 applies only where there is no effective consent to the surgical operation — In our respectful opinion s 282 is capable of application both where consent is present and where it is absent — We would respectfully endorse the trial judge’s conclusion that the text of s 288 conveys that it applies both in relation to surgery performed in a criminally negligent manner and in relation to surgery that should not have been performed at all so that undertaking to perform it was, in itself, criminally negligent — The thrust of the appellant’s case was that the change in “direction to an entirely new case after [the prosecution’s] case had closed” necessarily resulted in unfairness — On day 38 the trial judge informed counsel in the course of discussion about the management of the case that he remained concerned about the state of the particulars — On day 39, the trial judge again raised the state of the particulars — Revised particulars of all four charges (“final particulars”) were provided on day 43 — The trial judge observed that they were a “vast improvement” — The trial judge held that the case intended to be propounded by the prosecution on the final particulars was embraced by the old particulars — Grounds 3, 5, 8 and 9 are based on the false premise that the prosecution case changed from one concerned entirely with proving that the appellant had performed the actual surgery negligently, to one concerned only with proving that the appellant should not have operated — There was, in fact, little difference in the evidence admissible in each of the prosecution cases under the different sets of particulars — Defence counsel were content between day 10 and day 43 to proceed with the case as particularised by the prosecution — They were aware that the trial judge was not comfortable with the way the prosecution case had been particularised — The failure to press for further particulars, viewed objectively, is readily explicable as a tactical decision — It is often not in the interests of the defence to have the prosecution case stripped of unnecessary distractions and fully focused — There was no material irregularity or unfairness in the conduct of the trial — The maximum penalty for each of the three manslaughter offences is life imprisonment — The maximum penalty for the offence of doing grievous bodily harm is 14 years imprisonment — None of the offences involved an element of intention to harm — The appellant is elderly and is unlikely to achieve re-registration as a doctor in Queensland, even were he to seek it, so that personal deterrence is not a significant sentencing principle in this case — The effect of the appellant’s offending is broader than its impact on the immediate victims — It had the potential to undermine the Queensland public’s confidence in its hospital system — For these reasons, the primary judge was right to recognise that an important purpose in sentencing the appellant was to make it clear that the community, acting through the courts, denounced his conduct in committing the present offences — In our view, the sentence imposed properly balances the exacerbating and mitigating features of this unique case — It was not manifestly excessive — After careful consideration of the competing exacerbating and mitigating features, we are unpersuaded that the sentences were manifestly inadequate; failed to reflect adequately the gravity of the offending; failed to take sufficiently into account general deterrence; gave too much weight to mitigating factors; or that the judge erred in failing to declare the appellant to be convicted of serious violent offences — HELD: Appeal against conviction dismissed, Attorney-General’s appeal against sentence dismissed, Application for leave to appeal against sentence refused.