The Ontario Physicians and Surgeons Discipline Tribunal has now decided several COVID-19 misinformation cases involving physicians whose public commentary on the pandemic was found to constitute professional misconduct. The penalties have varied substantially. At the high end, the tribunal has revoked licences and imposed long suspensions. At the lower end, the tribunal has accepted joint submissions for shorter suspensions and reprimands. CPSO v Turek, 2024 ONPSDT 1, is at the lower end of this spectrum.
The case is doctrinally useful for two reasons. It illustrates the professional misconduct framework as applied to physicians who use their professional credentials when making public statements that contradict public health recommendations. And it situates a specific COVID-19 misinformation case within a discipline spectrum that the tribunal itself has now begun to calibrate explicitly.
The substantive facts
Dr. Caroline Anne Turek identified herself as a physician on her Twitter and Facebook accounts. Between 2020 and 2022, she made public statements on those and other online platforms that the CPSO alleged constituted professional misconduct. The conduct fell into four categories:
- Inappropriate criticism of public health and government policies. Statements opposing prolonged lockdowns, masking, and vaccine mandates, in terms the tribunal found went beyond legitimate professional disagreement.
- Promotion of unaccepted treatments. Statements supporting the use of Ivermectin and Hydroxychloroquine for the treatment of COVID-19, contrary to the public health recommendations in effect at the relevant time.
- Inappropriate criticism of the CPSO. Statements attacking the regulatory college for its support of public health recommendations during the pandemic.
- Statements opposing COVID-19 vaccination. Assertions that COVID-19 vaccines were unsafe, and opposition to vaccine mandates.
The matter proceeded on a joint submission of the parties. Dr. Turek admitted that her conduct constituted professional misconduct. The tribunal accepted that the penalty should be a two-month suspension and a reprimand.
The professional misconduct framework
The OPSDT’s jurisdiction over professional misconduct flows from the Medicine Act, 1991 and the Health Professions Procedural Code (Schedule 2 to the Regulated Health Professions Act, 1991). The Code defines professional misconduct to include both specifically enumerated grounds (sexual abuse, fraud, certain specified conflicts of interest) and a catch-all category captured by the phrase “disgraceful, dishonourable or unprofessional” conduct. The catch-all has been interpreted to cover conduct that, while not falling within an enumerated ground, is sufficiently incompatible with the responsibilities of a physician to warrant discipline.
In COVID-19 misinformation cases, the tribunal has consistently held that public statements by physicians that contradict public health recommendations during a pandemic fall within the catch-all. The reasoning is that physicians’ professional status gives their public statements additional weight in the eyes of patients and the public. A statement by a physician that COVID-19 vaccines are unsafe carries more credibility than the same statement by an unqualified speaker. When the underlying assertion is not supported by the available evidence and runs counter to public health recommendations during a public health emergency, the additional credibility creates harm that justifies professional discipline.
The OPSDT’s finding in Turek reflects this reasoning: “trained physicians publicly discouraging people from following public health guidelines and promoting unrecognized treatments undermined the actions of the public health authorities at a critical time.” On that footing, the conduct constituted disgraceful, dishonourable, and unprofessional conduct.
The Charter framework
A physician’s public commentary engages section 2(b) of the Canadian Charter of Rights and Freedoms — the freedom of expression. Professional discipline that restricts a physician’s expression must therefore be balanced against the Charter value at stake.
The leading framework is Doré v Barreau du Québec, 2012 SCC 12, which addresses Charter analysis in administrative discipline decisions. Under Doré, the decision-maker must balance the impact of the disciplinary measure on the Charter value (here, freedom of expression) against the statutory objectives (here, the protection of the public and the integrity of the profession). The decision is reviewed for reasonableness on judicial review.
In COVID-19 misinformation cases, the OPSDT has consistently held that the balance favours professional discipline. The reasoning, in essence: physicians retain their Charter right to participate in public debate, but they do not have a right to use their professional credentials to promote misinformation that undermines public health during a pandemic. Disciplinary measures calibrated to the seriousness of the conduct strike a proportionate balance.
The penalty calibration
What makes Turek distinctive is the explicit calibration. The OPSDT noted that the case was distinguishable from “more serious discipline matters relating to improper communications about public health guidelines during the COVID-19 pandemic where physicians received more serious penalties.” The two-month suspension and reprimand reflected the lower end of the discipline spectrum.
The factors that placed Turek at the lower end (rather than the higher end) appear to have included:
- The matter proceeded by joint submission rather than contested hearing, indicating acceptance of responsibility
- The conduct was statement-based (public posts) rather than practice-based (treatment of specific patients in problematic ways)
- The misconduct did not involve the misuse of medical exemption letters or other practice-based misuse of professional authority
- The conduct was time-limited and addressed in the joint submission
The OPSDT’s acceptance of joint submissions on penalty follows the general principle that where the parties have reached agreement and the proposed penalty falls within an acceptable range, the tribunal accepts it absent compelling reason to depart. The principle is analogous to the R v Anthony-Cook, 2016 SCC 43, framework in criminal sentencing but operates in the administrative context with appropriate adjustments.
The COVID-19 misinformation sub-grouping
Turek now completes a sub-grouping of four COVID-19 misinformation cases on this site that together cover the OPSDT discipline spectrum:
- CPSO v Luchkiw: physician refused to cooperate with a CPSO investigation into improperly issued COVID exemption letters
- CPSO v Phillips: physician disciplined for COVID-19 communications including issuing exemption letters
- CPSO v Trozzi: the most severe of the four cases, involving misinformation plus professional incompetence
- CPSO v Turek (this case): the lower-end calibration
The cluster now functions as a coherent reference set on COVID-19 discipline in Ontario. The four cases together illustrate the range of conduct and the corresponding range of penalties, and provide a useful framework for understanding where any particular case sits within the spectrum.
For prospective clients with complaints about physician conduct during the pandemic, or for the bar generally needing reference points on the OPSDT’s calibration approach, the four-case sub-grouping is now substantively complete.
The broader CPSO discipline cluster
The CPSO discipline cluster on this site now includes nine cases across several substantive categories:
COVID-19 misinformation (4): Luchkiw, Phillips, Trozzi, Turek
Sexual abuse and boundary violations (3): CPSO v Stein (attempting to date a patient), CPSO v Iannantuono (inappropriate touching), CPSO v Peirovy (failure to comply with practice restrictions imposed for sexual abuse)
Financial misconduct (2): CPSO v Kadri (nephrologist licence revoked), CPSO v Karim (non-resident OHIP fraud)
The cluster now provides substantial coverage of the main categories of physician discipline in Ontario.
The doctrinal lessons
The case stands for several propositions.
Physicians’ public statements carry professional weight. A physician’s use of professional credentials in public commentary attracts professional responsibility for the content of the commentary. Where the content is misinformation contradicting public health recommendations during a pandemic, the professional weight creates harm that the OPSDT will discipline.
The professional misconduct catch-all is broad. The “disgraceful, dishonourable or unprofessional” standard is not limited to misconduct in the clinical setting. It extends to extra-clinical conduct (public statements, social media posts, online commentary) that affects the integrity of the profession.
Charter balance favours discipline in this context. Physicians retain their Charter rights, but the OPSDT and the reviewing courts have consistently held that disciplinary measures calibrated to the seriousness of COVID-19 misinformation strike a proportionate balance under the Doré framework.
Joint submissions are accepted where the penalty is within range. Where the parties propose a penalty that the tribunal regards as within the acceptable range for the conduct, the joint submission is accepted. This produces predictable outcomes and reduces the need for contested hearings on penalty.
Calibration is explicit. The OPSDT is now distinguishing COVID-19 cases on the basis of severity and producing calibrated penalties accordingly. The lower end of the spectrum (Turek) involves statement-based misconduct addressed through joint submission. The higher end (Trozzi) involves statement-based misconduct combined with other professional misconduct and practice incompetence.
Why this case matters
For prospective clients. The OPSDT discipline process operates independently of any private malpractice claim. A finding of professional misconduct does not by itself establish negligence in a civil claim, but it can be a useful starting point for prospective clients who are evaluating their options. For COVID-19 specifically, the discipline process has produced public findings about physician conduct that may be relevant to civil claims by patients who relied on the conduct.
For the bar. The four-case COVID-19 sub-grouping is a useful reference set on the OPSDT’s approach to physician speech during the pandemic. The doctrinal frameworks (professional misconduct, Doré Charter balance, joint submissions on penalty) are reasonably stable now. Future COVID-19 cases will be assessed against the calibration the tribunal has now established.
For the public health community. The discipline cases collectively reinforce the principle that public health recommendations and professional standards are mutually reinforcing during a health emergency. Physicians whose public commentary undermined public health were disciplined; the cumulative effect is a clearer set of expectations for the profession going forward.
For more on filing complaints about physician conduct, see Should I File a CPSO Complaint? and A Patient’s Guide to Making Complaints About Health Care in Ontario.
Decision Date: January 19, 2024
Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal
Citation: College of Physicians and Surgeons of Ontario v Turek, 2024 ONPSDT 1 (CanLII)
Penalty: Two-month suspension and reprimand (accepted on joint submission)
