The CPSO’s discipline jurisdiction extends to a physician’s conduct toward staff, colleagues, and other healthcare workers, not only to conduct toward patients. The category of “professional misconduct” under the Health Professions Procedural Code includes any conduct that would reasonably be regarded by other members of the profession as disgraceful, dishonourable, or unprofessional, and that includes conduct in the workplace where the physician’s seniority and authority can be used to coerce or intimidate.
College of Physicians and Surgeons of Ontario v Iannantuono, 2023 ONPSDT 20, is a serious illustration. The Ontario Physicians and Surgeons Discipline Tribunal imposed an 18-month suspension on a senior general surgeon for what it described as a “boundary violation of the highest order” committed against a hospital ultrasound technician during a personal medical examination he had arranged through irregular means. The case is the second in this case-comment series on CPSO boundary-violation discipline (alongside CPSO v Stein, which addressed boundary violations toward a patient), and it is precedent for the proposition that the regulator’s authority extends to coworker misconduct as fully as to patient misconduct.
The facts
Dr. Biagio Iannantuono is a general surgeon who has been registered with the CPSO since 1993. In 2022, he was practising at a small community hospital. Ms. X (the pseudonym used in the OPSDT decision to protect the complainant’s identity) was an ultrasound technician at the same hospital, where she had worked for six years.
In January 2022, Dr. Iannantuono saw his family physician for a personal medical complaint that required a testicular ultrasound. The requisition was not marked as urgent. Departing from usual practice, Dr. Iannantuono asked his family physician to give the requisition to him personally rather than send it directly to the hospital’s Diagnostic Imaging Department, which was the normal intake mechanism. He then approached Ms. X at the hospital and personally asked her to perform the ultrasound on him, identifying himself as a senior surgeon at the hospital.
Ms. X agreed to accommodate Dr. Iannantuono as a courtesy, given his seniority. The requisition was a routine non-urgent referral; in the ordinary course it would have been booked through normal hospital intake and assigned to whichever technician was available.
The examination did not proceed in accordance with Ms. X’s standard professional protocol. Before she could complete her instructions about disrobing and draping, Dr. Iannantuono undressed below the waist and exposed himself to her. During the ultrasound itself, he repeatedly failed to follow her instructions about covering, leaving himself exposed multiple times. He then asked her to expand the scope of the examination to scan for inguinal hernias, which was not on the requisition.
Although palpation is not part of an ultrasound technician’s role, Dr. Iannantuono asked Ms. X to palpate his groin and instructed her on the technique. When her tentative attempt did not satisfy him, he physically grabbed her hand, repositioned it, and pressed her fingers into his groin in a manner that caused her hand to make contact with his penis. He repeated this on the other side of his groin, and then a third time on the original side. At the conclusion of the examination he stood up unclothed below the waist, exposing himself to Ms. X again before she left.
The OPSDT decision records Ms. X’s account of feeling intimidated by Dr. Iannantuono’s seniority and unable to stop the conduct in real time. She was visibly upset and tearful afterwards.
The decision
The OPSDT found Dr. Iannantuono guilty of professional misconduct. The tribunal characterized the conduct as a “boundary violation of the highest order,” involving:
- Exposure to a staff member and requiring her to make contact with his penis several times
- Abuse of his authority and disrespectful behaviour as a senior surgeon
- Rejection of proper procedures in arranging and carrying out the ultrasound
- Offensive and harmful conduct toward another health care professional
The penalty, accepted by the tribunal as a joint submission of the parties, included:
- An 18-month suspension of his medical licence
- Individualized instruction in professionalism and ethics, at his own expense
- Therapy with a CPSO-approved mental health professional
- Continuous observation by an approved practice monitor, who must enter into a prescribed undertaking to the CPSO and submit monthly logs of the physician’s patient encounters
- Notification to all patients of the practice monitor requirement
- Ongoing monitoring of compliance with the order
- Costs of $6,000 to the CPSO
The repeat-misconduct context
A central piece of context for the penalty calibration: Dr. Iannantuono had engaged in similar misconduct approximately 15 years earlier and had received only a one-month suspension at that time. The earlier discipline did not deter the present misconduct.
The pattern has two implications for the doctrinal analysis.
First, it explains why the 2023 penalty is meaningfully higher than the 2008 penalty. The CPSO’s penalty framework gives weight to a member’s prior discipline history. A repeat offender who has already been the subject of formal discipline for similar conduct is treated more seriously than a first offender, because the prior discipline establishes that the member was on notice of the wrongness of the conduct, and the repetition rebuts any inference of a one-off lapse.
Second, the trajectory raises a more general question about whether the prior penalty was adequate. A one-month suspension for boundary-violation misconduct is, by current Ontario standards, substantially lighter than would now be imposed for comparable facts. The CPSO’s calibration of penalties for boundary violations has shifted significantly over the intervening years, with the regulator and the legislature both increasing the seriousness with which such conduct is treated. The trajectory of Iannantuono (a one-month suspension followed by repeat misconduct followed by an 18-month suspension) illustrates the cost of inadequate initial penalties.
The doctrinal lessons
The case stands for several propositions.
Boundary violations against staff are within the CPSO’s discipline jurisdiction. The case makes explicit what was previously implicit: a physician’s misconduct toward a healthcare coworker can attract regulatory discipline as fully as misconduct toward a patient. The doctrinal anchor is the broad definition of “professional misconduct” in the Health Professions Procedural Code, which is not limited to patient-facing conduct.
The use of seniority and institutional authority to coerce compliance is part of the misconduct. The OPSDT decision specifically identified abuse of authority as a component of the wrongdoing. A physician who creates a coercive dynamic with a junior coworker, particularly one who feels institutional pressure to be cooperative and deferential, cannot rely on the formal absence of an objection in the moment.
Manipulating clinical processes to circumvent normal safeguards is itself a problem. Dr. Iannantuono did not simply commit boundary violations during a randomly assigned examination. He arranged the examination in a way that gave him control over the choice of technician, by taking the requisition personally rather than routing it through the hospital’s intake. The tribunal treated this manipulation of process as part of the misconduct, separate from the conduct in the examination room itself.
Joint penalties remain a meaningful framework. The 18-month suspension, the supervision requirements, and the cost award were all the product of a joint submission accepted by the tribunal. Joint submissions in CPSO discipline matters are common and are typically accepted by tribunals where the proposed penalty falls within a reasonable range. The framework allows the parties to negotiate a penalty that is more cohesive and more rapidly imposed than would result from contested proceedings, while still reflecting the severity of the conduct.
The CPSO discipline cluster
Iannantuono is one in a series of recent Ontario discipline decisions that, taken together, illustrate the range of the CPSO’s regulatory authority. The case-comment cluster on this site now includes:
- CPSO v Stein: boundary violations with a patient, plus an attempted cover-up
- CPSO v Luchkiw: failure to cooperate with a College investigation
- CPSO v Kadri: disruptive conduct and incompetence in a hospital setting, with ineffective remediation
- CPSO v Phillips: online misinformation and witness intimidation
- CPSO v Karim: misuse of OHIP while non-resident
- CPSO v Iannantuono (this case): boundary violations against a hospital coworker, with prior discipline history
Together, the six cases illustrate the CPSO’s reach across the full range of physician conduct: clinical care, conduct in patient relationships, conduct in workplace settings, public conduct, conduct in the regulatory process itself, conduct in personal financial dealings, and conduct toward healthcare colleagues.
Why this case matters
For physicians. The CPSO’s discipline jurisdiction is not limited to conduct toward patients. Conduct toward healthcare colleagues and coworkers, particularly conduct that exploits seniority or institutional authority, falls squarely within the regulator’s authority. The “professional misconduct” definition is broad enough to capture these dynamics, and the penalties reflect the seriousness of the conduct.
For healthcare workers who may be subject to inappropriate conduct from physicians. A complaint to the CPSO is one route. The hospital’s own internal mechanisms (including patient relations, human resources, and in many cases occupational health and safety processes under provincial legislation) are another. The pathways are not mutually exclusive, and the CPSO route does not depend on the complainant being a patient.
For lawyers screening regulatory matters. Iannantuono is useful precedent on the calibration of penalty for boundary-violation misconduct in workplace settings, particularly where the physician has a prior discipline history. The 18-month suspension reflects the joint submission of the parties; comparable misconduct without a prior history would likely produce a lower penalty, while comparable misconduct with more aggravating factors (more incidents, more serious physical contact, ongoing denial) would produce a higher one.
For more on the CPSO complaint process generally, see Should I File a CPSO Complaint Against My Doctor? For the broader framework of complaints and reviews in Ontario healthcare, see A Patient’s Guide to Making Complaints About Health Care in Ontario.
Decision Date: September 1, 2023
Tribunal: Ontario Physicians and Surgeons Discipline Tribunal (OPSDT)
Citation: College of Physicians and Surgeons of Ontario v Iannantuono, 2023 ONPSDT 20 (CanLII)
