The College of Physicians and Surgeons of Ontario regulates physicians’ clinical practice, but its mandate is broader than that. The Health Professions Procedural Code defines “professional misconduct” to include not only conduct in the clinical setting but conduct that would reasonably be regarded by other members of the profession as disgraceful, dishonourable, or unprofessional. The category captures conduct that bears on a physician’s integrity, regardless of whether it occurred in a clinical context.
College of Physicians and Surgeons of Ontario v Karim, 2023 ONPSDT 18, is a useful illustration. The Ontario Physicians and Surgeons Discipline Tribunal suspended a family physician’s licence for five months for conduct that had nothing to do with her clinical practice: she fraudulently used Ontario’s public health insurance system while non-resident in the province for a period of three years. The case is precedent for the general proposition that the CPSO’s regulatory authority extends to a physician’s personal honesty in dealings with the public health system, not only to clinical competence and conduct in the doctor-patient relationship.
The OHIP residency framework
Ontario’s Health Insurance Plan (OHIP) is publicly funded health coverage available only to residents of Ontario. Eligibility is governed by the Health Insurance Act and its regulations. The basic test for residency, set out in Regulation 552 under the Act, requires a person to:
- Make Ontario their primary place of residence
- Be physically present in Ontario for at least 153 days (approximately five months) in any 12-month period
- Not be absent from Ontario for more than 30 days within the first 183 days after establishing residency
A person who does not meet these requirements is not entitled to OHIP coverage. Use of OHIP-funded services by a non-resident is a fraud against the Ontario health care system. The provincial Crown can pursue restitution, and in serious cases, criminal prosecution. The regulator (in the case of a physician, the CPSO) has separate jurisdiction over the conduct as professional misconduct.
The facts
In 2015, Dr. Sadiqa Karim, a family physician, applied for OHIP coverage. The application required her to verify three things: that she would be physically present in Ontario for at least 153 days in any 12-month period; that she would not be absent from Ontario for more than 30 days in the first 183 days of residency; and that she made and intended to continue to make Ontario her primary place of residence. She used her Ontario family practice address on the application. The application was approved, and OHIP coverage was issued.
In fact, Dr. Karim was not living in Ontario. She was living in New York. Between 2015 and 2017, while resident in New York, she used OHIP coverage to pay for healthcare services for herself in Ontario: approximately $1,800 in services across the period, plus a further approximately $3,900 for a hospital visit.
When the matter was investigated, Dr. Karim acknowledged that she knew or ought to have known that she was not entitled to OHIP coverage during the period in question. She made restitution to the Crown in the amount of $16,636 in exchange for an arrangement that closed off the criminal route. The CPSO matter then proceeded as a regulatory discipline matter only.
The decision
The OPSDT found Dr. Karim guilty of professional misconduct. The conduct met the standard of “disgraceful, dishonourable or unprofessional” conduct under the Health Professions Procedural Code. The penalty:
- A five-month suspension of her medical licence
- Ethical retraining at her own expense
- Filing of proof of payment of restitution to the Crown
- Costs of $6,000 to the CPSO
The penalty reflects several mitigating factors apparent on the face of the decision: Dr. Karim made full restitution, she cooperated with the investigation, she acknowledged the wrongdoing, the duration of the misconduct was limited (three years rather than longer), and the financial scope was modest in absolute terms. The five-month suspension is significant but not at the severe end of the range available to the tribunal for misconduct of this nature.
The doctrinal lesson
The case is precedent for the general proposition that the CPSO’s regulatory authority extends to a physician’s personal honesty in dealings with the public health system. The misconduct here had no nexus with Dr. Karim’s clinical practice: she did not provide bad care, she did not act inappropriately with patients, and her clinical competence was not in issue. The misconduct was personal: a physician applying for and using public health coverage to which she was not entitled, while resident in a different jurisdiction, over a sustained period.
The CPSO’s authority to discipline for this conduct rests on the broad definition of professional misconduct in the Health Professions Procedural Code. Conduct that would be regarded by other members of the profession as disgraceful, dishonourable, or unprofessional can attract discipline whether or not it took place in the clinical setting. Other examples that have produced discipline in Ontario include tax fraud, misrepresentation in immigration applications, and dishonesty in non-clinical commercial transactions.
The doctrinal point matters for at least two reasons. First, it confirms that physicians are accountable to the regulator for their integrity in personal financial dealings, not only for their clinical work. Second, it confirms that the threshold for “disgraceful, dishonourable or unprofessional” conduct is not unreasonably high: the financial scope of Dr. Karim’s misconduct was modest, the harm was non-clinical, and the regulatory response was nonetheless meaningful.
The CPSO discipline cluster
Karim is one in a series of recent Ontario discipline decisions that, taken together, illustrate the range of the CPSO’s regulatory authority:
- 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 (this case): misuse of OHIP while non-resident
Together, the cases illustrate that the CPSO’s mandate extends 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, and (as Karim shows) personal conduct in dealings with the public health system. The category of “professional misconduct” is correspondingly broad.
Why this case matters
For physicians. Conduct outside the clinical setting, including in personal financial dealings, can attract regulatory discipline if it would reasonably be regarded as disgraceful, dishonourable, or unprofessional. The threshold is not unreasonably high. Physicians who are uncertain about their OHIP residency status or other public-benefit eligibility should obtain clear guidance before assuming they are entitled.
For patients and members of the public considering whether to file a CPSO complaint. The case is a useful reminder that the CPSO’s authority is broad. Concerns about a physician’s integrity in non-clinical contexts (financial dishonesty, misrepresentation, fraud) can be the subject of a complaint just as concerns about clinical conduct can. For more on the CPSO complaint process, see Should I File a CPSO Complaint Against My Doctor? and A Patient’s Guide to Making Complaints About Health Care in Ontario.
For lawyers screening regulatory matters. CPSO v Karim is useful precedent on the lower end of the disciplinary spectrum for non-clinical integrity matters. The five-month suspension reflects the mitigating effect of cooperation and full restitution; matters with more aggravating factors (sustained denial, larger financial scope, no restitution) will be calibrated upward against this benchmark.
For a fuller introduction to medical malpractice claims in Ontario more generally, see Suing for Medical Malpractice in Ontario: What You Need to Know.
Decision Date: August 24, 2023
Tribunal: Ontario Physicians and Surgeons Discipline Tribunal (OPSDT)
Citation: College of Physicians and Surgeons of Ontario v Karim, 2023 ONPSDT 18 (CanLII)
