Gynaecologist and obstetrician Dr Naylin Appanna has been suspended from practising for three months. Photo: Supplied / NZME / Facebook
WARNING: This story deals with sexual harm and may be distressing.
A gynaecologist who met a woman on a "sugar daddies" website, performed an STI test on her during a date while she was intoxicated, asked her to sign a contract consenting to bondage, and recorded himself performing sex acts on her at his clinic, has been suspended.
Hamilton doctor Naylin Appanna, who once moonlighted as a fetish ball organiser, also gave the woman a date rape drug for "pain".
Appanna had his registration suspended for three months by the Medical Council after a Health Practitioners Disciplinary Tribunal [HPDT] found him guilty of professional misconduct.
The tribunal upheld the charges against Appanna that he inappropriately blurred the boundaries between his personal and professional lives and his practice, by using his position and expertise as a specialist in connection with his personal sexual practices.
The tribunal said he did this by providing health services to the young woman at the same time as having sexual encounters with her.
But the victim told the Herald she thought Appanna would be struck off and was shocked at the short length of the suspension.
The complainant, another woman who reported Appanna's conduct on behalf of the victim, said a three-month suspension was a disappointing result after a three-year process and disproportionate to what she believed was "predatory behaviour".
By contrast, Appanna - who had credentials to work in parts of Australia - was immediately suspended there over the same case, and despite attempts by him to appeal to the Supreme Court of Victoria, he remains suspended in Australia.
In a decision dated November 21, the New Zealand tribunal said Appanna's conduct amounted to malpractice or negligence and he was suspended by the Medical Council of New Zealand on December 5.
It ordered him to pay $74,296 in costs and said if he returns to practice he must undergo supervision for one year including undertaking a review of his prescribing practices and his understanding of boundaries and his position of power as a doctor.
The Herald asked Appanna whether he planned to return to practice but he declined to comment.
The first date and the STI test
In May 2019 Appanna met the victim, referred to as Ms J, on an app called "Seeking Arrangement".
Ms J told the tribunal the app was an online platform where wealthy older men known as "sugar daddies" paid young women "sugar babies", to meet and spend time with them. It did not always involve sex.
Appanna's username on the app was "W_olf" and according to his profile he was looking for a "sub" to enter into a "dom-sub" relationship with him, where one partner is more dominant and powerful while the other partner submits.
On May 15, 2019, Appanna collected the 26-year-old from the bus stop near her home and they drove to a bar and restaurant.
During drinks at the restaurant Appanna, who is married, told Ms J he required everyone he had sexual contact with to have a sexually transmitted infection [STI] test.
He offered to pay for the test but said he was a gynaecologist and could do it now at his office if she wanted.
The purpose of the test, he told the Supreme Court of Victoria when trying to appeal his suspension in Australia, was to facilitate future unprotected sex.
"That said, it is not evident that he personally underwent such a test," the Court said in its decision released in October last year.
Ms J, who had been drinking wine, agreed to the test and they drove to the Women's Health Centre where Appanna's name appeared in large letters on the building.
The former Women's Health Centre where Naylin Appanna took his date. Appanna no longer runs a clinic from the building and his name has disappeared from the outside. Photo: Natalie Akoorie / NZME
According to Appanna's evidence to the Supreme Court, he says they went to his office in order to print a contract.
He told the Supreme Court he printed the contract and videoed Ms J "giving full consent to everything that she had agreed prior to us meeting".
However, the New Zealand decision said Ms J never signed the contract, which contained all the rules that Appanna expected of a "sub".
Alone at the office with Ms J, Appanna performed the STI test during which he "fingered" her in a sexual manner.
He then said he did not want to wait for the results and that they could always "take a pill" if she had any infections.
Following that Dr Appanna tied Ms J to a chair next to the bed and then used vibrators on her for the purpose of achieving orgasm. He also performed oral sex on her.
He gave her $100 for food and took her home. On May 21 Appanna messaged Ms J to tell her the test result had come back clear. He never sent the results to her GP.
After the first encounter Appanna met Ms J on Wednesday nights at his office.
"While there they would have drinks and Dr Appanna would make videos of him using sex toys on her."
Ms J once performed oral sex on him but they never had sexual intercourse.
Appanna would film their sexual activity on a camera mounted to a tripod in his office and at the beginning of each recording he would get Ms J to state that she consented to the sexual acts he was doing.
This included spanking her with different objects and using sex toys on her.
After filming, Appanna would put the video on his work computer and re-watch it.
The date rape drug and the 'relationship'
The second date on May 22, 2019 involved sex toys and bondage, and was videoed. There was no more payment.
When Ms J complained of being sore, Appanna went to his medicine cupboard which contained Panadol, Ponstan, Tramadol and Midazolam.
He gave her 3.75mg of Midazolam, without a prescription, to make her pain "more tolerable", he said, despite acknowledging Midazolam was not a pain reliever and that when giving it to Ms J he described it as a "date rape drug", the Supreme Court decision said.
The Class C drug is a type of benzodiazepine and induces sleepiness. It was commonly used for sedation before medical procedures.
Ms J described Appanna's comment as having been "a scary thing to say to someone" and said she was "weirded out" by it and only took half of the Midazolam tablet at the clinic and the other half when she got home.
Appanna later sought to justify the supply of Midazolam as akin to the treatment of a "person close to you" in an acute or emergency situation, the Supreme Court decision said.
"That said, 'J' subsequently left the premises together with the applicant in an Uber, not an ambulance," the Court said.
On May 24 Appanna offered to refer Ms J to a pain specialist and obtained her permission to request her medical notes from Waikato Hospital.
In text messages with Ms J on the subject he wrote: "Anything for my new baby."
They met again on May 26 at the Women's Health Centre and after Appanna spoke with Ms J concerning her pain.
"He also says that he offered to refer her to a pain clinic on this occasion, which, he claims, was 'exactly what is suggested in the guidelines'," the Supreme Court said.
They met on two further occasions, on May 30 and June 5.
One of those times was at the health centre and the other appeared to have been at a restaurant and then a motel with another woman described by Appanna as his "partner".
Allegations and investigations
In June 2019 Appanna went to Australia to do locum work in a rural town.
He sent Ms J a photograph of a patient taken after a forceps delivery while she was still on the operating table with her legs in stirrups.
He told the Supreme Court he took the photograph "with full permission of the patient" and that he told the patient it was being taken to "send to a partner to show her what I had been doing".
On July 12 Ms J requested Appanna delete the videos of her. He declined, and offered to edit out the video so there was only audio left which Ms J was unhappy with.
In August 2019 Ms J went to the police about the videos. There was a suggestion - denied by Appanna - that he had threatened to release them.
Ms J told the Herald Appanna's behaviour set off alarm bells and when he refused to delete the videos she "panicked" and turned to a trusted person for help.
She said she believed he would use the videos against her. Ms J sought help from the Midland Sexual Health Support Services and the Medical Council was notified.
No charges were laid by police however the Medical Council launched a professional conduct committee [PCC] investigation in October that year, culminating in the charges of professional misconduct against Appanna.
The charges were brought to a hearing in Hamilton in August.
Appanna did not give evidence at the hearing but in a statement to the tribunal said he regretted the consensual relationship with Ms J, despite having admitted to being "smitten".
"This was most certainly not a case of my entering into a sexual relationship with a patient. That said, I accept that having provided some medical services to Ms J, I did taint our personal relationship with services of a professional nature."
He said he accepted he had not acted in keeping with Medical Council guidelines about a doctor providing medical services to a person close to them, and that it was inappropriate to send Ms J the photo of the Australian patient.
He denied that he undertook a smear test on Ms J but did not dispute the STI test, and said he only provided the Midazolam as a pain relief.
However, a gynaecologist told the tribunal an STI test was an "invasive clinical examination" that should only ever occur in the context of a doctor-patient relationship.
"The incidence of 'fingering' during the examination is a very clear example of the blurring of professional and personal boundaries."
The expert thought Appanna's use of his building for out-of-hours bondage exhibited "extreme poor judgement" and said Midazolam was not an appropriate medication for pain relief.
The tribunal found Ms J a credible witness and largely took her word over Appanna's, accepting there was a power imbalance and saying the transition between clinical services and sexual contact was "swift and seamless".
It also found the doctor told Ms J he could help her with medical matters, that sending the photo was unprofessional, and that Appanna disclosed Ms J's personal health information and phone number without her consent to a reporter from another media outlet, during the PCC investigation.
A sign in the reception of Dr Naylin Appanna's Women's Health Centre in 2019 showed a chaperone was required for all patient consultations. Photo: Natalie Akoorie / NZME
Penalty dismays Ms J and expert
Ms J has spent the past three years trying to move past what Appanna did believing that at the end of the process the doctor's registration would be cancelled.
She said she was "dumbfounded" by the penalty and felt like the doctor had been "let off easily".
She told the Herald she still feels "grossed out" by what happened and was pulled back into feelings of anxiety at each stage of the process.
Ms J said reading her statement to the tribunal and being cross-examined was "awful" but her advice to anyone who found themselves in a similar situation with a doctor was to tell someone.
Appanna's conduct is described as predatory by Waikato Sexual Assault Assessment and Treatment Service lead clinician Dr Kate Taylor, who made the complaint about Appanna on behalf of Ms J.
"In my view, the fact he made it really clear to her that he is a medical professional and has the wherewithal to help her and that he was prepared to exchange medical services for sex shows that he has very unclear boundaries regarding his professional and personal life."
This, combined with Ms J having "unmet medical needs", made the situation Appanna created unsafe for her, Taylor said.
She believed Ms J may have had poor understanding of what a doctor-patient relationship should be, making her susceptible to Appanna's influence when those boundaries were crossed.
Taylor said Appanna was in a position of authority and holding himself out to be a man of standing within the community who has power and money.
That the video recording was her consent, was a false premise Taylor said, because "consent is not fixed in time and you can change your mind at any stage".
"Consent is given freely, actively, voluntarily and consciously, to every act, every time."
Taylor said it needed to be clear that Appanna's conduct was completely outside the expected practice of a medical practitioner in New Zealand.
She praised the courage of Ms J in speaking up and continuing to endure the "drawn-out" process.
"We owe her a debt of gratitude for doing what she could to ensure the safety of others and I urge other people who have been in similar situations, with any doctor, to come forward."
Taylor said she was dismayed Appanna's penalty was limited to a three-month suspension and supervision for one year and found it challenging to accept that after three years of him vigorously defending his conduct, he would be rehabilitated after three months.
Suspensions, court action and chaperones
In Australia, Appanna was immediately suspended under a national law that cannot be overturned by a District Court as is the case in New Zealand.
An Australian Health Practitioner Regulation Agency (Ahpra) spokesperson said the Medical Board of Australia's decision in June 2020 to suspend Appanna under immediate action powers was appealed by the doctor to the Victorian Civil and Administrative Tribunal.
He was unsuccessful and in April 2021 Appanna sought leave to appeal to the Supreme Court of Victoria on a question of law but leave was refused by the Court in October last year.
Unlike in New Zealand, Australia has not used chaperones since 2017.
"An independent review of the use of chaperones to protect patients in Australia recommended no longer using chaperones as an interim restriction while allegations of sexual misconduct are investigated," the Australian spokesperson said.
The Medical Board of Australia instead uses other ways to protect patients such as gender-based restrictions, restricting patient contact, or suspending the doctor's practice.
Taylor noted that when New Zealand's Medical Council requires a doctor to be chaperoned the doctor must notify patients but does not have to explain why.
"It's not informed consent if you're not given the context of why you are being offered the chaperone.
"We emphasise the vital role of informed consent in every area of practice, and yet here you can go for an intimate internal body exam with no real informed consent around the context of that exam; why the chaperone is being offered or required."
When the Herald put to Appanna that an expert believed his behaviour was "predatory", and asked if he would be rehabilitated after three months, Appanna declined to comment.
Medical Council chairman Dr Curtis Walker said it was important to note the tribunal said Appanna's conduct would have warranted a 12-month suspension, but this was reduced because of delays to the hearing due to Covid-19 restrictions.
"Dr Appanna's conduct was clearly inappropriate and breached numerous standards of professional behaviour," Walker said.
"This was reflected in the tribunal's finding of professional misconduct. The Medical Council respects the tribunal's role in determining the appropriate penalty, and notes that no appeal has been filed in this case."
Medical Council chair Dr Curtis Walker said when the council receives notifications about a breach of professional or sexual boundaries, it prioritises these to ensure the public is protected. Photo: RNZ / Karen Brown
When the Medical Council received the complaint against Appanna it immediately resolved to suspend him.
But before it could he successfully sought a stay in the District Court, which allowed him to continue practising subject to a voluntary undertaking that included a chaperone for all female consultations.
Walker said New Zealand operated under different laws to the Medical Board of Australia, and that Appanna's suspension in Australia was an interim suspension and not the result of a completed disciplinary process.
A controversial doctor
Dr Nalendra Appanna, Naylin for short, was the owner of the Women's Health Centre when he first met Ms J.
In his 60s, Appanna had been a gynaecologist and obstetrician for 36 years and worked at private hospitals in Hamilton and Tauranga as well as running clinics in Hamilton and outlying towns.
He and his wife Sandie, who was his clinic's practice manager, previously organised and attended the R18 NZ Fetish Ball for nine years.
According to the Companies Office Appanna was also involved with adult entertainment companies Starr Strippers, Risque Events, Seductionz, Sensual Events, Hardcandy Productions, and the Cirlesque Ball.
In 2016 he sued a private hospital over the "wrongful suspension" of his operating privileges relating to his competence as a surgeon.
The case dragged through the courts for three years with Appanna winning more than $600,000 in damages because Angelsea Hospital did not first give him an opportunity to respond to the allegations that nurses refused to work with him.
Appanna has also faced at least two complaints to the Health and Disability Commissioner [HDC] over surgeries he performed.
In one case the HDC ordered Appanna to apologise to his patient for going overseas eight days after he performed a hysterectomy on her, without arranging specialist cover for the woman in case of complications.
Four days after he left the country mother-of-five Tracy Aitchison was admitted to Waikato Hospital for emergency repair surgery for a pelvic haematoma that had caused sepsis, a blocked bowel, and an infected appendix.
Aitchison, who has suffered ongoing health complications since the 2016 surgery, said she thought she would die and felt the apology Appanna wrote at the direction of the HDC was "patronising" and insincere.
In the second case, another woman suffered a rectal perforation after a laparoscopic hysterectomy and was admitted to Waikato Hospital with sepsis.
Despite the woman's injury being accepted for cover by ACC, the Health and Disability Commissioner said it could not determine whether there was an issue with how the surgery was performed.
Instead, the HDC said it was concerned about Appanna's clinical record-keeping and would ask him to review his note-taking.
Before his suspension Appanna had been practising part-time at another clinic in Hamilton and is the current director of Well Womens [sic] Clinics.
He is also a shareholder in Bay Topsoil at Tauriko in Tauranga.
* This story originally appeared in the New Zealand Herald.
Where to get help:
Sexual Violence
Victim Support 0800 842 846
Rape Crisis 0800 88 33 00
HELP Call 24/7 (Auckland): 09 623 1700, (Wellington): 04 801 6655 - push 0 at the menu
Survivors Network of those Abused by Priests (SNAP) 022 344 0496