Alberta Court of Appeal refuses family physician’s application to practice in the province

An assessor found he was functioning at the level of a medical student and needed further training

Alberta Court of Appeal refuses family physician’s application to practice in the province

The Alberta Court of Appeal has upheld the College of Physicians and Surgeons' decision to refuse an application for registration to practise as a family physician in the province.

Manjeet Sandhu applied to practise as a family physician in rural Alberta. He obtained his medical education from India and has practised as a family and emergency physician in India for about 20 years. He has also completed a practical nursing program in Ontario and a fellowship in Texas.

As part of the application process in Alberta, Sandhu must complete a three-month preliminary clinical assessment, which was eventually terminated after two weeks. An assessor advised the College of Physicians and Surgeons of Alberta that Sandhu had "the medical knowledge" but was "unable to appropriately apply this knowledge" and "know how to prioritize medical concerns." Accordingly, the College refused Sandhu's application for registration and required him to complete further education before applying again.

Sandhu applied for judicial review of the College's review panel's decision, arguing that he was denied procedural fairness and that the panel's decision was unreasonable.

The chamber's judge upheld the review panel's decision. The judge emphasized that the College must protect and serve the public interest. It was for the College to determine its procedures. The judge further said there was no merit to Sandhu's complaints regarding lack of orientation, failure to use particular tools, lack of feedback, early termination, or bias.

The College's mandate

The College is responsible for establishing, maintaining, and enforcing registration standards for those practicing medicine in Alberta. An applicant must complete a Practice Readiness Assessment (PRA) satisfactory to the College to be registered on the provisional register for independent practice. The assessment ensures that the applicant's "training and clinical skills are substantively equivalent to those of a Canadian-trained physician entering independent practice in Alberta."

 Procedural fairness

Sandhu appealed the chamber judge's decision to the Alberta Court of Appeal. Sandhu argued that he was denied procedural fairness. He said he received insufficient information regarding preparing and conducting his practice readiness assessment. He also asserted that the lack of procedural fairness was exacerbated by the preliminary clinical assessment's early termination when the assessor refused to continue after only two weeks.

The appeal court ruled that Sandhu was not denied procedural fairness. The court found that the College had sent a letter of understanding to Sandhu, stating how he would be evaluated and the tools and standards that would be used. The court was satisfied that the letter contained sufficient information regarding evaluation standards and guidelines.

The court also rejected Sandhu's argument that he did not receive an orientation to the practice setting where he would be doing his preliminary clinical assessment. The court found that the letter sent to Sandhu referred to the required orientation and clearly stated that the onus was on Sandhu to ask for more orientation from his sponsor if he wished.

 Further education requirement

In his appeal, Sandhu challenged the imposition of a further training requirement, asserting that it was unreasonable because the College failed to consider the evidence that Sandhu had the necessary medical knowledge.

 The court found that the College's assistant registrar based the decision on overwhelming evidence that Sandhu posed a substantive risk to the public. Further, the assessor concluded that Sandhu was functioning at the level of a medical student and needed further training.

The appeal court declined to interfere with the assistant registrar's exercise of discretion in imposing the two-year educational requirement considering the patient safety concerns outlined in the case records. The court also noted that the jurisdiction and authority of the assistant registrar to impose the two-year educational requirement was not raised as a ground for appeal before the panel or the chamber's judge. The court was not satisfied that it had an adequate record to address this issue and declined to do so in the appeal.

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