Medical regulation in Canada operates province by province. Each province has its own regulatory college (the College of Physicians and Surgeons of Ontario for Ontario; the Collège des médecins du Québec for Quebec; and so on), each with its own framework for assessing professional conduct and imposing discipline. The provincial structure can produce complexity where a physician is licensed in multiple provinces or where conduct in one province has consequences in another. The framework for handling these cross-jurisdictional situations is an important and sometimes under-examined area of professional regulation.
College of Physicians and Surgeons of Ontario v Faruqi, 2026 ONPSDT 4, released by the Ontario Physicians and Surgeons Discipline Tribunal on January 21, 2026, is a recent application of the cross-jurisdictional framework. The physician was an Ontario-licensed obstetrician-gynecologist specializing in fertility and reproductive medicine who had been practising in Quebec. Following a Quebec investigation, he had admitted to 16 counts of professional misconduct before Quebec’s medical discipline tribunal, resulting in a three-month suspension and $15,000 in fines. The CPSO subsequently brought discipline proceedings in Ontario based on the Quebec findings, and the Ontario Tribunal imposed a two-month suspension, a reprimand, mandatory completion of the PROBE Ethics and Boundaries Program, and costs.
The case is doctrinally important for several reasons. It is a recent and clear articulation of the framework under which Ontario can rely on misconduct findings made by another Canadian regulatory body to ground discipline proceedings in Ontario. It illustrates the substantive test that requires the underlying facts to constitute professional misconduct under Ontario’s framework, even where the original finding was made elsewhere. It demonstrates the limits of cross-jurisdictional discipline by carefully declining to make Ontario findings for some Quebec-specific issues. It addresses the framework for findings of professional misconduct based on contraventions of federal legislation, including the Assisted Human Reproduction Act. And it provides a useful reference on the framework for handling the practical reality that physicians often hold multiple provincial licences and that professional conduct standards apply across provincial lines.
The legal framework — cross-jurisdictional professional discipline
A brief overview of the legal framework is useful for the analysis.
The provincial nature of Canadian medical regulation. Medical practice is regulated provincially under the constitutional framework. Each province establishes its own regulatory college with authority over physician registration, professional standards, and discipline. The framework operates with significant similarity across the provinces but with material differences in specific rules, procedural frameworks, and substantive standards.
The dual-licensing framework. Physicians can hold registrations in multiple provinces. The framework permits a physician to practise in each province where they are licensed, subject to that province’s specific rules. The framework also imposes ongoing reporting obligations: physicians are typically required to report adverse regulatory actions in other jurisdictions to all colleges where they are registered.
The cross-jurisdictional discipline framework. Where a physician licensed in Ontario has been the subject of disciplinary action in another Canadian jurisdiction, the framework permits the CPSO to bring its own discipline proceedings based on the other jurisdiction’s findings. The framework is established in two principal sources:
- The Professional Misconduct Regulation (O Reg 856/93). Under the Medicine Act, 1991, SO 1991, c 30, the Professional Misconduct Regulation defines acts that constitute professional misconduct. The regulation includes provisions that treat findings of misconduct by another regulatory body or jurisdiction as a basis for Ontario discipline where the underlying conduct would constitute misconduct under Ontario’s framework.
- The Health Professions Procedural Code. Schedule 2 to the Regulated Health Professions Act, 1991 establishes the procedural framework for discipline. The framework supports the cross-jurisdictional analysis and the imposition of sanctions following Ontario findings.
The substantive test. The cross-jurisdictional framework operates with a substantive test: the underlying facts must constitute professional misconduct under Ontario’s framework, not just under the other jurisdiction’s framework. The framework therefore requires the Ontario Tribunal to:
- Accept the factual findings made by the other jurisdiction (typically without re-litigating the underlying facts)
- Analyze whether those facts, on the Ontario regulatory framework, would constitute professional misconduct
- Make findings on the Ontario record where the substantive test is met
- Decline to make findings where the underlying facts do not map onto Ontario’s framework
The framework is meaningful protection for physicians: it prevents automatic wholesale importation of out-of-province findings where the conduct is jurisdiction-specific. It is also meaningful protection for patients: it ensures that conduct that would be professional misconduct in Ontario is addressed regardless of where it occurred.
The federal legislation framework. Some professional misconduct involves contravention of federal legislation rather than provincial regulation. Where the federal statute is one designed to protect public health or to govern professional conduct in a regulated area, the framework supports the conclusion that contravention can constitute professional misconduct under provincial regulatory frameworks. The Assisted Human Reproduction Act, SC 2004, c 2 is the principal federal legislation governing reproductive medicine in Canada, and its contravention can support professional misconduct findings.
The joint submission framework. Where the parties agree on a proposed penalty, the Tribunal can accept the joint submission unless it would bring the administration of the regulatory regime into disrepute or is otherwise contrary to the public interest. The framework supports efficient resolution of cases where the issues have been substantively addressed and the parties have agreed on appropriate sanctions.
The clinical and regulatory context — fertility and reproductive medicine
A brief context overview is useful for the analysis.
Fertility and reproductive medicine. Reproductive medicine includes the diagnosis and treatment of infertility, the assisted reproductive technologies (in vitro fertilization, intracytoplasmic sperm injection, others), the use of donor reproductive material (sperm, eggs, embryos), and related areas. The field has developed substantially over the past several decades and operates at the intersection of medical, legal, and ethical frameworks.
The Canadian regulatory framework for reproductive medicine. Reproductive medicine in Canada is regulated through a combination of federal and provincial frameworks. The principal federal statute is the Assisted Human Reproduction Act, SC 2004, c 2 (AHRA), which establishes the broad framework for reproductive technologies and the prohibitions on certain practices. Provincial frameworks address registration, professional conduct, and clinical practice standards through the regulatory colleges.
The Assisted Human Reproduction Act prohibitions. Section 7 of the AHRA establishes prohibitions on the commercial purchase of reproductive material. The framework prohibits paying or offering to pay for sperm, eggs, or embryos. The framework also prohibits acting as an intermediary in such transactions and prohibits the advertisement of such transactions. The prohibitions reflect the public policy choice that reproductive material should not be subject to commercial exchange in Canada.
The constitutional framework. The Supreme Court of Canada addressed the constitutional validity of the AHRA in Reference re Assisted Human Reproduction Act, 2010 SCC 61. The framework upheld the federal jurisdiction over the prohibitions on commercial reproductive transactions while striking down other provisions that the Court found to be intra-provincial regulation of medical practice. The prohibitions on payment for and advertising of reproductive material remain in force and operate as the principal federal regulatory framework in reproductive medicine.
The clinical practice framework. Within the federal prohibitions, clinical practice in reproductive medicine operates under provincial regulatory frameworks. Provincial colleges set practice standards including informed consent, clinical decision-making frameworks, record-keeping requirements, and other elements of professional practice. The framework also includes age restrictions in some provinces and other clinical eligibility considerations.
The Quebec age restrictions framework. Quebec, like some other provinces, has specific frameworks for certain fertility services including age restrictions on access to certain assisted reproductive technologies. The framework reflects clinical, ethical, and resource allocation considerations. Where a Quebec patient is not eligible for a specific service in Quebec, the framework does not directly address what can be done in other provinces, but the referral of a Quebec patient for a service that is prohibited in Quebec can be regulated under Quebec’s professional conduct framework.
The Quebec findings
The misconduct proceedings in Quebec resulted in admissions by the physician to 16 counts of professional misconduct before Quebec’s medical discipline tribunal. The categories of misconduct included:
Federal Assisted Human Reproduction Act contraventions:
- Advertising and facilitating paid egg donation, contrary to the federal statute
- Paying egg donors, also prohibited under federal law
Quebec professional conduct issues:
- Improper referral of a patient for fertility services prohibited in Quebec due to age restrictions
- Unprofessional and disparaging comments about another healthcare professional
- Record-keeping concerns under Quebec’s regulatory framework
- Financial practice concerns under Quebec’s regulatory framework
The Quebec disposition:
- Three-month suspension of the physician’s licence in Quebec
- $15,000 in fines
The physician later resigned from the Quebec college but retained his Ontario registration. The Quebec resignation did not foreclose the Ontario discipline proceedings; the Ontario framework permits proceedings based on the established facts regardless of whether the physician remains registered in the other jurisdiction.
The CPSO discipline proceedings
The CPSO brought discipline proceedings in Ontario based on the Quebec findings. The Tribunal conducted the cross-jurisdictional analysis under the Professional Misconduct Regulation framework, considering each category of Quebec misconduct against the Ontario regulatory framework.
Categories where Ontario findings were made:
The Tribunal made Ontario findings on three categories of misconduct:
- Contravention of federal reproductive legislation. The advertising and payment for egg donation under the Assisted Human Reproduction Act. The framework treated contravention of federal legislation designed to protect public health as falling within Ontario’s professional misconduct definitions. The framework is uniform across the country because the federal legislation applies nationally.
- Conduct considered disgraceful, dishonourable, or unprofessional. The Ontario framework includes the general category of conduct that is disgraceful, dishonourable, or unprofessional. The framework is intentionally broad to capture conduct that is inconsistent with professional standards even where it does not fit a more specific category. The Tribunal found that the underlying conduct fell within this category.
- Public disparagement of another healthcare professional. The framework for professional conduct includes obligations of professional collegiality and the avoidance of unprofessional commentary about other clinicians. The framework recognizes that public disparagement can undermine patient trust in the healthcare system and the integrity of inter-professional relationships. The framework applies to both written and oral commentary.
Categories where Ontario findings were not made:
The Tribunal declined to make Ontario findings on some Quebec-specific issues:
- Failure to provide detailed invoices. The Quebec regulatory framework requires physicians to provide itemized invoices in specific circumstances. The Ontario framework includes a more limited requirement: itemized accounts must be provided only if requested by the patient. The framework therefore declined to find Ontario misconduct on this basis because the conduct that fell short under the Quebec framework would not have fallen short under the Ontario framework.
- Certain financial and regulatory breaches without an Ontario equivalent. Some Quebec-specific regulatory requirements do not have an Ontario equivalent. The framework declined to make Ontario findings where the underlying conduct did not map onto an Ontario regulatory provision.
The framework for declining to make findings is doctrinally important. It establishes that out-of-province findings are not automatically imported wholesale. The cross-jurisdictional discipline framework operates on a substantive test, not a reciprocity test. The Ontario Tribunal must analyze each category of conduct against the Ontario regulatory framework and make findings only where the substantive test is met.
The penalty
Accepting a joint submission by the parties, the Tribunal imposed:
- Two-month suspension of the physician’s Ontario licence
- Formal reprimand published on the public register
- Mandatory completion of the PROBE Ethics and Boundaries Program — a specialized professional development program addressing ethics and professional boundaries issues
- $6,000 in costs payable to the CPSO
The mitigating factors:
The Tribunal accepted the joint submission in light of several mitigating factors:
- The admissions made by the physician in Quebec, which were also accepted in the Ontario proceedings
- The expressions of regret for the underlying misconduct
- The prior discipline already imposed in Quebec (three-month suspension and $15,000 in fines), which reduced the additional sanction needed in Ontario
The joint submission framework. Joint submissions in professional discipline operate similarly to joint submissions in criminal sentencing. The Tribunal can accept the joint submission unless it would bring the administration of the regulatory regime into disrepute or is otherwise contrary to the public interest. The framework supports efficient resolution and rewards cooperation where the underlying conduct has been substantively addressed.
The doctrinal anchors
Several doctrinal anchors emerge from the case.
The out-of-province misconduct framework. Ontario can bring discipline proceedings based on findings of misconduct made by another Canadian regulatory body. The framework is established under the Professional Misconduct Regulation (O Reg 856/93) and the Health Professions Procedural Code. CPSO v Faruqi is the principal recent cluster authority on the framework.
The “facts would constitute misconduct if in Ontario” substantive test. The cross-jurisdictional framework operates on a substantive test: the underlying facts must constitute professional misconduct under Ontario’s framework, not just under the other jurisdiction’s framework. The framework is meaningful protection against automatic wholesale importation of out-of-province findings.
The “out-of-province findings not automatically imported” principle. The Ontario Tribunal must analyze each category of conduct against the Ontario regulatory framework and decline to make findings where the substantive test is not met. The framework is a deliberate limit on cross-jurisdictional discipline and reflects the principle that Ontario discipline must be grounded in Ontario regulatory standards.
The federal legislation contravention framework. Contravention of federal legislation designed to protect public health can constitute professional misconduct under provincial regulatory frameworks. The framework supports uniform application across the country for conduct that contravenes nationally applicable rules. CPSO v Faruqi is the principal recent cluster authority on the federal contravention framework.
The Assisted Human Reproduction Act framework. Section 7 of the AHRA establishes prohibitions on the commercial purchase of and advertising for reproductive material in Canada. The framework was upheld constitutionally by the Supreme Court of Canada in Reference re Assisted Human Reproduction Act, 2010 SCC 61. Contraventions can support professional misconduct findings in provincial discipline proceedings.
The Professional Misconduct Regulation framework. The Professional Misconduct Regulation (O Reg 856/93) under the Medicine Act, 1991 defines acts that constitute professional misconduct in Ontario. The framework includes the cross-jurisdictional discipline provisions and a range of substantive categories of misconduct.
The dual-licensing physician framework. Physicians can hold registrations in multiple provinces. The framework imposes obligations to maintain compliance with each province’s rules and to report adverse regulatory actions across jurisdictions. The framework permits discipline proceedings in each province where the physician is registered.
The “professional conduct beyond patient care” framework. Professional conduct standards extend beyond direct patient care to include advertising practices, financial arrangements, and public commentary about colleagues. The framework recognizes that the broader professional context affects patient trust and the integrity of the regulatory regime.
The professional disparagement framework. Public disparagement of another healthcare professional can constitute professional misconduct. The framework recognizes that professional collegiality and the avoidance of unprofessional commentary contribute to patient trust and the integrity of inter-professional relationships. The framework applies to both written and oral commentary.
The joint submission framework in discipline. Where the parties agree on a proposed penalty, the Tribunal can accept the joint submission unless it would bring the administration of the regulatory regime into disrepute or is otherwise contrary to the public interest. The framework supports efficient resolution of cases where the issues have been substantively addressed.
The mitigating factors framework. Where the physician has acknowledged the misconduct, expressed regret, and been subject to prior discipline in another jurisdiction, the framework supports a calibrated Ontario sanction that reflects the totality of regulatory consequences. The framework prevents disproportionate cumulative discipline while maintaining the protective and educational functions of the Ontario regime.
The PROBE Ethics and Boundaries Program as a sanction component. Ontario discipline can include mandatory completion of specialized professional development programs as a component of the sanction. The PROBE Ethics and Boundaries Program is one such program, addressing ethics and professional boundaries issues. The framework treats mandatory remedial education as a protective sanction designed to reduce the risk of recurrence rather than purely punitive.
Why this case matters
For patients. The case provides useful illustration of how the regulatory framework protects patients across provincial lines.
Some practical observations:
Misconduct outside Ontario can result in Ontario discipline. The framework permits the CPSO to bring discipline proceedings based on misconduct findings made in other Canadian provinces. Physicians cannot avoid Ontario regulatory consequences by relocating or by limiting their Ontario practice to specific activities.
Federal legislation matters in professional discipline. Contraventions of federal legislation governing health and clinical practice (such as the Assisted Human Reproduction Act) can support professional misconduct findings. The framework treats federal regulatory compliance as part of the broader professional conduct framework.
Professional conduct extends beyond direct patient care. Advertising practices, financial arrangements, and public commentary about colleagues all fall within regulatory oversight. The framework recognizes that the broader professional context affects patient trust.
Patients can check the CPSO public register. Ontario’s CPSO public register includes information about current and prior discipline actions, conditions on practice, and other regulatory information. Patients considering care from a particular physician can consult the register for relevant regulatory history.
For more on the framework for regulatory complaints and discipline in Ontario, see A Patient’s Guide to Making Complaints About Health Care in Ontario.
For physicians. A few practical observations:
Ethical obligations travel with the licence. Physicians licensed in multiple provinces remain accountable in each province for their professional conduct. The framework imposes reporting obligations and supports discipline proceedings across provincial lines.
Federal legislation compliance is part of professional conduct. Physicians practising in regulated areas (reproductive medicine, controlled substances, others) must maintain compliance with federal legislation as part of their professional conduct framework.
Out-of-province discipline is not automatically duplicated. The Ontario framework requires substantive analysis of whether the underlying facts would constitute misconduct under Ontario’s framework. The framework is not pure reciprocity, and it can produce different outcomes in different provinces for the same underlying conduct.
Joint submissions can produce calibrated outcomes. Where the physician has acknowledged the misconduct and been subject to prior discipline elsewhere, the joint submission framework supports a proportionate Ontario sanction that reflects the totality of regulatory consequences.
The PROBE program is part of the remedial framework. Mandatory completion of specialized professional development programs is a recognized component of Ontario sanctions and operates as a protective rather than purely punitive measure.
Decision Date: January 21, 2026
Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal
Citation: College of Physicians and Surgeons of Ontario v Faruqi, 2026 ONPSDT 4 (CanLII)
Outcome: Ontario discipline proceedings based on Quebec findings. The Ontario Tribunal made findings of professional misconduct on three categories of conduct: contravention of federal reproductive legislation (the Assisted Human Reproduction Act prohibitions on advertising and payment for egg donation); conduct considered disgraceful, dishonourable, or unprofessional; and public disparagement of another healthcare professional. The Tribunal declined to make Ontario findings on some Quebec-specific issues including failure to provide detailed invoices (because Ontario requires itemized accounts only on request) and certain financial and regulatory breaches that have no Ontario equivalent. The framework demonstrates that out-of-province findings are not automatically imported wholesale; the underlying facts must constitute professional misconduct under Ontario’s framework. Accepting a joint submission, the Tribunal imposed a two-month suspension of the physician’s Ontario licence, a formal reprimand published on the public register, mandatory completion of the PROBE Ethics and Boundaries Program, and $6,000 in costs. The Tribunal accepted mitigating factors including admissions, expressions of regret, and the prior Quebec discipline (three-month suspension and $15,000 in fines).
Key authorities: Regulated Health Professions Act, 1991, SO 1991, c 18 (foundational regulatory framework); Health Professions Procedural Code (Schedule 2 to the RHPA); Medicine Act, 1991, SO 1991, c 30 (physician-specific provisions); Professional Misconduct Regulation (O Reg 856/93) under the Medicine Act (defining acts of professional misconduct including cross-jurisdictional findings); Assisted Human Reproduction Act, SC 2004, c 2, particularly section 7 (federal prohibitions on commercial reproductive transactions); Reference re Assisted Human Reproduction Act, 2010 SCC 61 (constitutional framework upholding the federal prohibitions).
