Evidence insufficient to find medical professional acted inappropriately or unethically: inquiries committee
The Ontario Health Professions Appeal and Review Board (HPARB) and the College of Physicians and Surgeons of Ontario (CPSO) chose to take no further action against a doctor accused of unethical conduct relating to an alleged referral fee program.
The parties in this case were physicians who shared a cardiac and medical imaging clinic. The applicant was a majority shareholder, while the respondent was a co-owner. They had a falling out that led to the termination of their business relationship.
In October 2017, the applicant filed a complaint with the CPSO. He alleged that the respondent paid referral fees to other physicians for sending patients to the clinic for diagnostic tests. He claimed that this practice was unethical and violative of professional regulations governing medical practice in Ontario.
In October 2019, the CPSO’s Inquiries, Complaints, and Reports Committee cautioned the respondent to avoid remuneration systems that could be interpreted as referral fees or present a conflict of interest. The respondent requested a review.
In January 2021, the HPARB directed the CPSO to conduct a more thorough investigation and to reconsider its decision. The initial investigation was inadequate since numerous questions remained unanswered, such as what the specific terms of the alleged referral fee program were, who devised it, how the fees were paid, and whether the respondent benefited from the program, the HPARB said.
In its follow-up investigation, the CPSO gathered additional information, including submissions from both parties and an affidavit from the clinic’s operations manager.
The respondent denied the existence of a referral fee program. The payment system in place compensated physicians for the time that they spent supervising tests, not for the referral of patients, he said. The terminology used in transcripts, where the payments were called referral fees, was misleading and not indicative of unethical behaviour, he argued.
Ultimately, the CPSO maintained its decision to take no action against the respondent but reiterated its expectation that physicians should avoid systems of remuneration that could raise concerns about referral fees or conflicts of interest.
In Ahluwalia v Bhesania, 2024 CanLII 75691 (ON HPARB), the HPARB issued a decision finding the CPSO’s investigation sufficient and its decision reasonable. The CPSO's decision showed a coherent and rational connection between the facts of the case and the outcome, the HPARB said.
While both parties provided conflicting information, the CPSO had gathered enough evidence to support its conclusion that there was no definitive proof of the respondent’s unethical conduct, the HPARB added.
The HPARB noted that the dispute between the parties appeared to be more of a business disagreement than a professional misconduct matter. The HPARB stressed that the CPSO’s mandate was to protect the public by ensuring the adherence of physicians to professional standards, not to resolve business conflicts between medical practitioners.
