Executive Summary: Key Legal and Evidentiary Issues

• The sufficiency and accuracy of Dr. Annika Card’s disclosures regarding her disciplinary history in her application for medical registration were in question.

• The College’s process for withdrawing acceptance of an application based on alleged untruthful, inaccurate, or incomplete information was scrutinized for procedural fairness.

• The admissibility of additional evidence on appeal was challenged, focusing on whether due diligence was exercised in presenting such evidence.

• The applicable standards of review for factual and legal findings by the College were central to the court’s analysis.

• Inconsistencies between Dr. Card’s application responses and information from the College of Physicians and Surgeons of Saskatchewan were examined.

• The College’s statutory and by-law authority to regulate registration and require full disclosure was interpreted and applied.

Facts of the case

Dr. Annika Card, a physician licensed to practice in Saskatchewan, submitted an application for medical registration to the College of Physicians and Surgeons of Newfoundland and Labrador (the College) on April 22, 2024. The application required her to attest that all information provided was complete, true, accurate, and up to date, and included questions about her licensing and disciplinary history. Dr. Card disclosed an undertaking to withdraw from call due to medical issues and ongoing complaints, but indicated there were no restrictions, suspensions, or revocations of her license, and no formal investigations or disciplinary proceedings.

The College requested further documentation, including a Certificate of Professional Conduct from the College of Physicians and Surgeons of Saskatchewan (CPSS). The certificate, received on May 22, 2024, revealed that Dr. Card had been the subject of an investigation by CPSS, with more than 60 patient-related concerns, five undertakings, and, as of April 24, 2024, three charges of unprofessional conduct and fifteen complaints under investigation. The certificate also noted that Dr. Card’s request for reappointment to the Saskatchewan Health Authority had been denied as of December 28, 2022.

On July 3, 2024, the College wrote to Dr. Card, outlining inconsistencies between her application and the information from CPSS, and provided her an opportunity to explain. Dr. Card responded on July 8, 2024, stating she had disclosed all activities at CPSS to the best of her knowledge at the time and explained her understanding of the terms and form limitations.

On July 10, 2024, the College withdrew acceptance of Dr. Card’s application, citing reasonable grounds to believe she had provided untruthful, inaccurate, or incomplete information, pursuant to By-law 4, section 5(1). Dr. Card filed an appeal with the Supreme Court of Newfoundland and Labrador on August 12, 2024, seeking to overturn the College’s finding and discontinue the application without prejudice to her professional record.

Policy terms and relevant clauses

The College’s authority to regulate medical registration and withdraw acceptance of applications is based on the Medical Act, 2011, S.N.L. 2011, c. M-4.02, and its by-laws. By-law 4, section 5(1), allows the College to deny or withdraw an application if there is reason to believe the applicant has provided untruthful, inaccurate, or incomplete information. The by-laws require applicants to provide truthful, accurate, and complete information about their disciplinary history, and failure to do so is grounds for denial.

Procedural history and legal analysis

Dr. Card applied under Rule 58.16 of the Rules of the Supreme Court, 1986, to introduce additional evidence on appeal, asserting she was unaware of the Executive Committee’s decision in Saskatchewan until after submitting her application. The court found that the evidence could have been provided earlier and dismissed the application for fresh evidence for lack of due diligence.

The court identified four issues: whether additional evidence should be included on appeal, the standard of review, whether the College erred in finding reasonable grounds to believe Dr. Card provided untruthful, inaccurate, or incomplete information, and whether the College failed to follow a fair process. The court applied the Baker factors to assess procedural fairness and found the process was administrative in nature, did not require an oral hearing, and provided Dr. Card with adequate opportunity to respond to the College’s concerns.

On the substantive grounds, the court found no palpable and overriding error in the College’s assessment. The record showed Dr. Card was subject to multiple complaints, undertakings, and investigations in Saskatchewan at the time of her application, and the College’s conclusion that her disclosures were incomplete or inconsistent was supported by the evidence.

Ruling and overall outcome

The appeal was dismissed. The court upheld the College’s decision to withdraw acceptance of Dr. Card’s application for medical registration, finding the process fair and the decision supported by the record. The College of Physicians and Surgeons of Newfoundland and Labrador was the successful party and was awarded its taxed costs and disbursements on Column 3, except for the interlocutory application under Rule 58.16, for which no costs were ordered. The specific amount of costs was not determined in the decision and is to be taxed pursuant to the court’s scale.