A finding of sexual abuse against a member of the College of Physicians and Surgeons of Ontario can produce a range of disciplinary outcomes. Under the current framework, established by the Protecting Patients Act, 2017 (Bill 87), certain types of sexual abuse trigger mandatory revocation of the member’s certificate of registration. Where the conduct predates the 2017 amendments, or falls outside the mandatory revocation categories, the OPSDT has discretion to impose a range of penalties, including suspension and practice restrictions. Where restrictions are imposed and the member subsequently contravenes them, the contravention is itself an act of professional misconduct.
College of Physicians and Surgeons of Ontario v Peirovy, 2023 ONPSDT 26, is the leading recent example of contravention proceedings following a sexual abuse finding. The OPSDT found that Dr. Javad Peirovy had failed to comply with the practice restrictions imposed on him in 2016 following an earlier finding that he had sexually abused four patients. The 2023 finding produced a seven-month suspension and enhanced signage requirements on his return to practice.
The case is doctrinally significant for three reasons. It illustrates the contravention-of-terms category of professional misconduct, which is distinct from the underlying conduct that led to the original restrictions. It highlights the role of CPSO compliance monitoring in enforcing post-discipline restrictions. And it raises the broader question of whether remedial penalties in sexual abuse cases are adequate to protect the public, a question with a long history in Ontario professional regulation.
The 2015 finding and the 2016 restrictions
The proceedings that led to the 2016 restrictions began with complaints about Dr. Peirovy’s conduct toward female patients in a walk-in clinic. The matter proceeded to the Discipline Committee (the predecessor of the OPSDT). In a 2015 decision, the committee found that Dr. Peirovy had committed sexual abuse against four patients. The conduct predated the 2017 Protecting Patients Act amendments to the Health Professions Procedural Code, and so was assessed under the discretionary framework that applied before mandatory revocation was introduced for specified categories of sexual abuse.
The penalty imposed in 2015 was a six-month suspension, a reprimand, costs, and practice restrictions. The restrictions, formalized in 2016, required Dr. Peirovy:
- To have a CPSO-approved chaperone (called a “practice monitor”) present for any professional encounter with a female patient
- To keep a log of his encounters with female patients and submit it to the CPSO monthly
- To post specified signage in his waiting room and examination or consultation rooms in all practice locations, stating that he could not see female patients without a practice monitor and directing patients to the CPSO website for further information
The CPSO appealed the 2015 penalty to the Divisional Court on the basis that it was inadequate. The matter was remitted to the Discipline Committee in 2017 for reconsideration. On reconsideration in 2018, the same penalty was substantially reimposed. The proceedings were a focal point in the public debate that contributed to the Protecting Patients Act, 2017, which introduced mandatory revocation for specified categories of sexual abuse and tightened other aspects of the framework. Dr. Peirovy’s conduct, however, was not subject to the new mandatory revocation provisions because it predated them.
The 2023 compliance audit
In March 2021, approximately five years after the 2016 restrictions took effect, the CPSO conducted a routine compliance audit. The audit randomly selected ten female patients seen by Dr. Peirovy and obtained their patient charts. The CPSO then telephoned the selected patients to inquire about whether Dr. Peirovy had been complying with the chaperone requirement.
The audit revealed that Dr. Peirovy had been seeing female patients without his approved practice monitor present. As a result, the CPSO terminated its approval of that practice monitor.
Dr. Peirovy then proposed a new practice monitor. While the proposal was still under review, he told the proposed monitor that she had been approved by the CPSO. On October 12, 2021, before the CPSO had in fact approved her, he saw female patients in her presence as if she were the approved monitor. He did not produce a patient log for that day to the CPSO with the rest of his October 2021 logs.
The audit also identified failures in the required signage. In one practice location, the sign in the waiting room was folded so that the practice restrictions were not visible. In another, there was no sign at all in one of the examination rooms.
The misconduct findings
The OPSDT made findings on two grounds.
Conduct disgraceful, dishonourable, or unprofessional. Dr. Peirovy’s failure to comply with the practice restrictions imposed under the 2016 order would reasonably be regarded by other members of the profession as disgraceful, dishonourable, or unprofessional. The category captures conduct the profession would not accept; failure to comply with discipline-imposed restrictions falls squarely within it.
Contravention of a term, condition, or limitation on a certificate of registration. The misconduct regulation (O. Reg. 856/93) includes, as a discrete category of misconduct, contravening a term, condition, or limitation on a member’s certificate of registration. The practice restrictions imposed in 2016 took effect as conditions on Dr. Peirovy’s certificate. His failures to comply with them (the absence of an approved monitor, the false representation that a monitor had been approved, the missing logs, and the deficient signage) were each contraventions.
The two grounds operate together. The same conduct can be both disgraceful, dishonourable, or unprofessional and a contravention of a term, condition, or limitation. The discrete categorization matters because it produces a separate basis for the finding and supports a broader range of remedial responses.
The penalty
The OPSDT imposed a seven-month suspension of Dr. Peirovy’s certificate of registration. On his return to practice, the previous restrictions remain in force, with additional requirements:
- The required signage must be translated into all languages in which he provides medical services
- All female patients must initial a copy of the signage in their chart at each and every visit
The translation requirement responds to the practical reality that signs posted in English may not be effective for patients whose primary language is something else. The initialling requirement responds to the practical reality that signage in a waiting room is only meaningful if patients have actually seen and engaged with it. Both requirements increase the documentary record available to the CPSO in any future compliance audit.
The doctrinal lessons
The case stands for several propositions.
Contravention of practice restrictions is a distinct category of professional misconduct. Members subject to practice restrictions following a discipline finding are required to comply strictly. Contraventions are themselves actionable, separate from the original conduct that led to the restrictions, and can support meaningful sanctions including suspension.
Compliance monitoring is part of the regulatory framework. The CPSO conducts routine compliance audits, including by directly contacting patients to verify whether members are complying with restrictions. The audits are how restrictions are made effective in practice. A member who is restricted but assumes the restrictions will go un-monitored is at risk.
Misrepresentation to the CPSO compounds the misconduct. Dr. Peirovy told a proposed practice monitor that she had been approved when she had not. The misrepresentation introduced a layer of dishonesty into the contravention. It is the same theme as the cover-up element in CPSO v Stein, where the member’s response to the College’s investigation became part of the misconduct finding.
Remedial penalties depend on actual compliance. The 2015 penalty allowed Dr. Peirovy to continue practising on the assumption that the restrictions would protect future patients. The 2023 audit revealed that he had not complied. The contravention case is a difficult illustration that remedial penalties depend, ultimately, on the member’s willingness to comply with the restrictions imposed. Where that willingness is absent, the public protection that the remedial framework was supposed to provide is not delivered.
Practical signage requirements have practical limits. The translation and initialling requirements imposed in 2023 are responses to the practical realities that contributed to the contravention. The fact that these refinements were thought necessary suggests that the 2015 and 2016 framework was vulnerable on these particular features.
The boundary-violation sub-grouping
Peirovy is the third boundary-violation case in the rewritten CPSO discipline cluster, alongside CPSO v Stein and CPSO v Iannantuono. Together, the three cases illustrate the range of boundary-violation discipline:
- Stein: sexual interest in a patient with attempted concealment from the College
- Iannantuono: workplace sexual misconduct against a coworker, with prior discipline history
- Peirovy (this case): sexual abuse of multiple patients, with subsequent failure to comply with imposed restrictions
The most serious of the three on the underlying conduct is Peirovy. The case is also the most serious illustration of the limits of remedial penalties: where restrictions are imposed but not complied with, the public protection function of the discipline framework fails.
The CPSO discipline cluster
The rewritten CPSO discipline 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 in the COVID exemption context
- CPSO v Kadri: disruptive conduct, incompetence, and ineffective remediation
- CPSO v Phillips: online COVID-19 misinformation and witness intimidation
- CPSO v Karim: misuse of OHIP while non-resident
- CPSO v Iannantuono: boundary violations against a hospital coworker, with prior discipline history
- CPSO v Trozzi: COVID-19 misinformation with dual misconduct and incompetence findings
- CPSO v Peirovy (this case): contravention of practice restrictions imposed after sexual abuse
The eight cases together illustrate the CPSO’s reach across the full range of physician conduct and the framework of remedial and punitive penalties applied to that conduct.
Why this case matters
For physicians subject to discipline-imposed restrictions. Compliance is not optional, and is monitored. Misrepresentation to the College about compliance compounds the misconduct. The penalty for contravention can be substantial — a seven-month suspension on a record where the original conduct (sexual abuse of four patients) had attracted a six-month suspension is itself notable, and the cumulative impact on the member’s practice is significant.
For patients of physicians with discipline records. The CPSO’s public register records past discipline findings and current practice restrictions. Patients who have concerns about a particular physician’s history can search the register before scheduling an appointment. Where a physician is subject to practice restrictions (including chaperone requirements), the patient is entitled to expect compliance and can report apparent non-compliance to the College.
For lawyers screening regulatory matters. Peirovy is useful precedent on the contravention-of-terms category, on the role of CPSO compliance auditing, and on the calibration of penalty for contravention proceedings following an earlier discipline finding. The seven-month suspension benchmark is at the upper end of the range for contravention cases and reflects both the seriousness of the underlying conduct and the multiple contraventions across multiple categories.
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: November 20, 2023
Tribunal: Ontario Physicians and Surgeons Discipline Tribunal (OPSDT)
Citation: College of Physicians and Surgeons of Ontario v Peirovy, 2023 ONPSDT 26 (CanLII)
Related decision: College of Physicians and Surgeons of Ontario v Peirovy, 2015 ONCPSD 30 (CanLII) — the original 2015 finding of sexual abuse and the practice restrictions
