Executive Summary: Key Legal and Evidentiary Issues

• Adequacy of the ICRC investigation under the “reasonable efforts” standard; exhaustive interviews and credibility findings are not required .

• Deferential review: HPARB’s affirmation of a remedial agreement assessed for reasonableness, not correctness, consistent with Vavilov .

• Procedural fairness challenges (21 items) largely unpersuasive and, in part, not raised before HPARB; no breach found .

• Record-supported concerns: possible premature discharge, inadequate discharge planning, sparse risk assessment notes, and therapeutic relationship shortcomings .

• Transparency warning: court flags risk of crafting dispositions to avoid public posting under the Protecting Patients Act, though no remittal ordered here .

• Bottom line: application dismissed; no order as to costs .

Factual background
On March 20, 2022, the applicant presented to an emergency department expressing a wish to die and requesting medical assistance in dying. She was voluntarily admitted to a psychiatric unit. The treating psychiatrist’s diagnostic impression was persistent depressive disorder with dependent and borderline features. An SSRI (Prozac) was prescribed but declined due to prior experience. Despite the applicant’s wish to remain, she was discharged on March 28, 2022 with security present. A professional complaint was filed on August 25, 2022, alleging improper assessment and treatment, profiling, inaccurate statements, failure to provide supports, and an unsafe discharge while suicidal .

Regulatory proceedings and remedial outcome
The ICRC’s Mental Health Panel did not uphold every allegation but identified several concerns: lack of support in the record for the diagnostic labels; insufficient exploration and documentation of suicidal risk; indicators that discharge may have been premature; inadequate discharge planning; and shortcomings in the therapeutic relationship for which the physician bore significant responsibility. It also questioned why an alternative antidepressant was not attempted if persistent depressive disorder was suspected and noted a prior written caution relating to discharge planning. The panel accepted a remedial agreement requiring self-study on risk factors and management of personality disorders and persistent depressive disorders, and on discharge planning, culminating in a ~2,000-word report to the College within four months, subject to review and potential return to the ICRC if concerns remained .

HPARB review
On August 8, 2024, the HPARB upheld the ICRC decision. It found the investigation adequate because the ICRC need only obtain essential information; it is not obligated to interview witnesses, assess credibility, or review every record. The HPARB concluded that the remedial agreement addressed the identified risks and fell within the range of reasonable outcomes open to the ICRC, emphasizing that its role was to assess reasonableness rather than choose the best disposition .

Judicial review
The applicant sought judicial review, arguing inadequate investigation, procedural unfairness, and unreasonableness in upholding the remedial agreement. Applying the reasonableness standard under Vavilov and recognizing the contextual nature of procedural fairness (with reference to Baker), the court held that the HPARB’s determinations on investigation adequacy and fairness were reasonable. The court clarified, among other points, that the physician received the ICRC decision on the same day as the applicant (July 28, 2023) and that many fairness issues were not raised before HPARB. It deferred to the ICRC/HPARB on the chosen remedial disposition as a reasonable response to the panel’s concerns .

Outcome and significance
The application was dismissed with no order as to costs. While accepting remediation as reasonable here, the court cautioned that crafting dispositions to avoid the transparency requirements of the Protecting Patients Act could undermine openness and may render a decision unreasonable in a future case. Given that the remedial program was completed in 2023, the court did not remit the matter but flagged the transparency concern as potentially systemic .