Court finds regulator failed to address medical certificate that contradicted its findings
The Supreme Court of British Columbia has quashed a Health Professions Review Board decision and ordered the College of Physicians and Surgeons of British Columbia to reconsider a patient complaint after finding that the college failed to address a medical certificate documenting a diagnosis that differed from the diagnosis identified in its findings.
In Katterhagen v. The College of Physicians and Surgeons of British Columbia, 2026 BCSC 2122, the court ruled that the college's disposition was unreasonable because neither the college nor the review board explained a medical certificate diagnosing pronator strain, despite the college's conclusion that the physician had diagnosed lateral epicondylitis.
The complaint arose from a workplace injury in December 2011 that caused persistent pain in the patient's left elbow and forearm. The physician treated the patient from January 2012 through June 2013.
The patient alleged that the physician remained committed to an epicondylitis diagnosis despite continuing symptoms and failed to consider alternative diagnoses meaningfully. A neurosurgeon subsequently diagnosed pronator syndrome and performed surgery in April 2014, relieving much, but not all, of the patient's arm pain.
The patient complained to the college in November 2022. In May 2023, the college concluded that the physician had met the expected standard of practice and provided no criticism of his care.
After the review board identified missing medical records, the college reopened its investigation and issued a reconsidered disposition in April 2024, maintaining its original conclusion. The review board subsequently upheld the adequacy of the investigation and the reasonableness of the disposition.
On judicial review, the Supreme Court examined a medical certificate stating that the patient suffered from pronator strain. That same day, the physician referred the patient to a colleague and asked for clarification on whether it was lateral epicondylitis or pronator strain.
The court found that the certificate contradicted the physician's account that he remained confident in his epicondylitis diagnosis and the college's conclusion that he had diagnosed only lateral epicondylitis. Neither decision-maker explained the certificate's significance.
Applying the reasonableness principles in Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65, the court found that the omission undermined the justification, transparency and intelligibility of the college's decision.
The court rejected the college's request to infer that it had considered the certificate. It concluded that the diagnosis of pronator strain did not meaningfully change the physician's diagnosis of epicondylitis.
However, the court expressly found that the physician had not breached the expected standard of practice. It also declined to determine whether the review board's finding that the college's investigation was adequate was patently unreasonable.
The court quashed the review board's decision. It remitted the matter to the college, leaving it to determine whether further investigation concerning the medical certificate was required or whether additional reasons based on the existing record would suffice.
