Executive Summary: Key Legal and Evidentiary Issues

• Judicial review focused on the reasonableness of the Health Professions Appeal and Review Board’s (HPARB) decision upholding the Inquiries, Complaints, and Reports Committee (ICRC) findings.

• Scope of the ICRC’s mandate and its obligation to investigate complaints without determining liability or causation.

• Adequacy of the ICRC’s investigation, including the sufficiency of records reviewed and expert involvement.

• Assessment of whether Dr. Goldhar’s conduct met professional standards in light of a rare surgical complication.

• Consideration of procedural fairness and whether Mr. Leigh received proper notice and opportunity to participate.

• Determination that no costs were awarded as the respondents did not seek them.

Facts of the case

Mr. Leigh was referred to Dr. Goldhar in the summer of 2021 due to blurred vision. Dr. Goldhar performed cataract surgeries on Mr. Leigh’s right and left eyes in October and November 2021, respectively. Shortly after the second surgery, Mr. Leigh developed endophthalmitis, a rare but recognized complication, and was promptly referred to a retinal specialist who operated on him the same day. The specialist later referred Mr. Leigh back to Dr. Goldhar, which was standard practice. Mr. Leigh subsequently developed further complications, including corneal inflammation and a detached retina, and was referred to a corneal specialist in February 2022. Mr. Leigh ultimately decided against further surgery due to a poor prognosis for vision recovery.

Complaints and committee review

Dissatisfied with the outcome, Mr. Leigh filed a complaint with the College of Physicians and Surgeons of Ontario, raising concerns about Dr. Goldhar’s actions, including alleged promises of a full cure, delayed referrals, surgical errors, and dismissive communication. The ICRC reviewed the complaint and found that Dr. Goldhar acted diligently, the complication was rare, and there was no evidence of surgical error or inappropriate delay. The ICRC also noted the importance of documenting surgical risks and found no concerns with Dr. Goldhar’s management or communication.

Appeal to the Health Professions Appeal and Review Board

Mr. Leigh appealed to the HPARB, arguing the ICRC’s investigation was inadequate and the decision unreasonable. The HPARB upheld the ICRC’s findings, confirming the adequacy of the investigation and the reasonableness of the decision. The Board emphasized that the ICRC’s role is not to determine liability or causation but to screen complaints and consider whether further action is warranted. The HPARB also found that the length of the investigation and the handling of Mr. Leigh’s concerns were reasonable.

Judicial review and court’s analysis

Mr. Leigh then sought judicial review of the HPARB’s decision. The Divisional Court considered whether the HPARB’s decision, and by extension the ICRC’s decision, was reasonable. The court reiterated that its jurisdiction was limited to reviewing the reasonableness of the decision, not to rehearing the complaint or determining liability. The court found that the ICRC had made reasonable efforts to review relevant records and that the investigation was adequate, supported by expert involvement and comprehensive documentation. The court also found that Mr. Leigh had received appropriate notice and opportunity to participate in the process.

Ruling and outcome

The Divisional Court dismissed Mr. Leigh’s application for judicial review, finding no basis to intervene in the decisions of the HPARB or the ICRC. The court held that both bodies acted within their mandates and that the decisions were reasonable. No costs were awarded, as the respondents did not seek them. The successful parties in this matter were Dr. Goldhar and the Health Professions Appeal and Review Board, with no monetary award or costs ordered in their favor.