By Jeremy Wilkinson, Open Justice reporter of 
Salil Elias Photo: Otago Daily Times
A doctor who had sex with a vulnerable and drug-dependent patient in his examination room is back working in medicine less than two years after he was banned from practising.
Salil Elias lied to the Medical Council about having sex with the woman, only later admitting the affair had occurred when police testing confirmed DNA in her underwear was his.
While a judge dismissed criminal charges of sexual violation against him because his victim was not a reliable witness, the Health Practitioner's Disciplinary Tribunal cancelled his registration in 2023 until he could prove to the Medical Council he could practise safely.
Now, less than two years later, Elias has donned the stethoscope again but can see female patients only with a council-approved chaperone.
According to the agreed summary of facts, Elias was working as a general practitioner at a health centre in Dunedin, and the victim, known as S, was his patient between 2012 and 2016.
In November 2016, her psychotherapist contacted the Health and Disability Commissioner (HDC) with a complaint that Elias had been having sex with his patient and depositing $400 into her account each time.
Elias denied the allegations to the HDC, which in turn passed on its investigation to the Medical Council, including evidence of transactions from his bank account into his victim's.
It was later found he had made two payments totalling $500 to her in 2015 and said this was because she asked him for financial assistance. The payments also predate the two times he was found to have had sex with the woman at his clinic.
Sex at the Clinic
Ms S has a history of dysthymia, which is a persistent depressive disorder, as well as a long history of opiate dependence, intravenous drug use and alcohol abuse.
She was already receiving prescription opiates when Elias became her doctor in 2012, but he escalated her treatment with stronger drugs and never recorded any notes about her medication management.
Elias was aware she had a history of drug abuse and often presented at the clinic in an inebriated state. He was also aware she was significantly dependent on opiates.
Elias admitted that between June and July in 2016 he had sex with S in the consultation room at his clinic in the middle of the day.
In 2017, the Medical Council emailed Elias with allegations that he'd been having sex with his patient, which he denied.
Then, in 2018, the council notified police, who laid charges of sexual violation against Elias. At this point, he continued to deny sexual intercourse had occurred.
It wasn't until 2019 when police tested the DNA evidence that Elias admitted to his employer he'd had a sexual relationship with S.
His lawyer applied for the charges to be dropped on the basis that he was allegedly being blackmailed by S, and in 2022 a District Court judge dismissed the charges on the basis that she was an unreliable witness.
'An accident waiting to happen'
Medical professionals are subject to a strict code of ethics which specifically prohibits them from entering into intimate relationships with their patients.
While his criminal charges were dismissed in court and Elias was cleared of any criminal sexual misconduct, the tribunal convened a hearing to determine whether he was fit to continue practising as a doctor.
"Dr Elias created significant dependence on himself and then exploited his position by engaging in sexual misconduct with S in his consultation room, on two occasions," the tribunal said in its ruling, released this week.
"At the time this sexual conduct occurred, S had been a patient of Dr Elias for about four years. She was particularly vulnerable, not only because of the inherent power imbalance in the doctor/patient relationship, but also because of her history of psychiatric illness, including dysthymia (depression) and significant opioid dependence."
The tribunal also found he over-prescribed opioids to the woman for nearly four years without taking steps to find out if she was abusing substances or to refer her to a specialist agency.
A specialist called in to give evidence at the tribunal said Elias' prescribing in this area was "an accident waiting to happen", given the patient's background.
By the time Elias was taken to the tribunal, he'd been under supervision for more than four-and-a-half-years and had required a chaperone while seeing female patients.
Taking that into consideration, the tribunal ordered that his registration be cancelled but with no time restrictions placed on his reregistering with the Medical Council, as long as he completed a sexual misconduct test before doing so.
According to the Medical Council register, Elias has had his practising certificate approved as of March this year. There is no link to the tribunal's decision on the register, but it does note that he must continue to have a chaperone while seeing female patients.
He was also censured by the tribunal and ordered to pay $45,000 in legal costs.
Elias, who now works at a health centre in the South Island, declined to comment for this article.
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* This story originally appeared in the New Zealand Herald.
