Rigid Adherence to Clinic’s Rules and Procedures Results in College Complaint and Remedial Action Against Physician

The Health Professions Appeal and Review Board (“HPARB”) recently confirmed a decision of the Inquiries, Complaints and Reports Committee (“ICRC”) of the College of Physicians and Surgeons of Ontario (“CPSO”) to take remedial action against a physician who was found to have placed undue focus on clinic procedures and rules, to the detriment of patient care. Following its investigation and review of a patient-initiated complaint, the ICRC issued advice and ordered the physician to complete a specified continuing education program (“SCERP”).

Background Facts

The physician worked at a walk-in clinic. The complaint to the CPSO arose as a result of an interaction between the physician, his staff, and the mother of a young patient, whom he saw for medical care related to symptoms of respiratory infection. After examining the patient, the physician prescribed antibiotics for suspected pneumonia and ordered chest x-rays. A follow-up appointment was booked for the next day in order to provide the chest x-ray results and to re-evaluate the patient’s condition. When the complainant attended the clinic the following day without her daughter, the clinic staff informed her that she would be charged a fee for a missed appointment. The mother explained that her daughter was with family and asked if the child’s father could bring her daughter into the clinic the next morning. Clinic staff called the Children’s Aid Society (“CAS”) when the patient did not arrive with her father by the agreed upon appointment time the following day. Later that afternoon, the patient and her father attended the clinic. She was evaluated and sent to the hospital, where she remained for 24 hours after being admitted with a diagnosis of pneumonia.

The Complaint and Response

The mother complained to the College that the physician had behaved unprofessionally, in that he had failed to explain the clinic procedures related to cancellations, refused to withdraw the missed appointment fee, and threatened to inform “Child Services” on hearing of her grievance. In his response, the physician explained that the complainant had been given specific follow-up appointment times for herself and her daughter, and stated that if the mother knew her daughter would not be available at the scheduled time, she should have said so. He further explained that when the complainant first attended the clinic, she signed intake sheets which clearly defined the clinic’s policies.

The ICRC’s Decision

After investigating the complaint, the ICRC decided to advise the physician that his focus should be on clinical care and a sick child rather than on procedural issues and the failure of patients or their family members to follow his rules and procedures. The ICRC also found the physician’s record to be brief and illegible in this case, and required him to complete a specified continuing education program in medical record-keeping, and to undergo a reassessment consisting of a review of 25 patient charts.

While the ICRC was of the opinion that it was reasonable for the physician and his staff to contact the CAS with concerns about the child, it found that an altercation of sorts had taken place when the mother attended the follow-up appointment and that this was largely attributable to the physician and his staff’s undue focus on procedures and rules, to the detriment of patient care. The ICRC noted that this type of rigid and confrontational approach creates circumstances where conflict occurs, and that the ICRC expects a more courteous and sensitive approach to patients and patient care than was demonstrated by the physician and his staff in this particular case.

HPARB Review

At the request of the physician, this decision was reviewed by HPARB. The panel of HPARB upheld the ICRC’s decision, finding the investigation to be adequate and the decision to be reasonable. With respect to the ICRC’s concerns about the rigid and confrontational attitude taken by the physician and his staff, HPARB found that this was reflected in the documentation in the patient file and in the statements that were made by the physician and his staff in response to the complaint, noting “Approaches which fuel rather than defuse altercations in patient care settings, create additional stresses and are not conducive to positive patient care.” Furthermore, HPARB found that the physician’s complaint history with the CPSO, which demonstrated that other patients had expressed concerns with the physician’s communications and procedures, supported the ICRC’s decision to require remedial action related to patient relations.


While policies and procedures are important for the proper functioning of a medical clinic, the ultimate focus must always be on the patient. Care should be taken to avoid a rigid and confrontational approach when dealing with administrative issues. In addition, it is important to take detailed notes regarding all interactions with patients and their legal representatives or guardians.

If you have any questions about this decision, please do not hesitate to contact us.

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