Executive Summary: Key Legal and Evidentiary Issues

• Constitutionality of Ontario’s “New Policy” under ss. 6, 7 and 15 of the Canadian Charter of Rights and Freedoms, particularly mobility and equality rights of International Medical Graduates (IMGs).
• Heightened interlocutory threshold: whether the applicants established a strong prima facie Charter breach to justify suspending a province-wide policy mid-match.
• Proof of irreparable harm focused on loss of a meaningful opportunity to secure residency, career trajectory damage, and the non-quantifiable impact on professional identity, rather than purely economic loss.
• Competing public interest and balance of convenience, including deference to governmental policy choices versus the need to prevent ongoing Charter infringements.
• Evidentiary weight of data on residency fill rates, IMG versus Canadian Medical Graduate (CMG) retention in Ontario, and affidavits illustrating systemic and adverse-effects discrimination.
• Procedural and timing issues, including the late adoption of the New Policy during an active CaRMS cycle, compressed litigation timelines, and arguments about delay by the applicants.

Background and facts of the case
The proceedings arise from a challenge by two internationally trained physicians, Dr. Nathália Elino Da Silveira and Dr. Ilana Polegatto Lagosta, to a sudden change in Ontario’s medical residency matching rules that effectively shut them out of the main round of residency competitions. Both are highly qualified Brazilian-trained surgeons who immigrated to Canada, obtained permanent resident status, and invested heavily—financially and personally—in requalifying to practise medicine in Ontario. Each passed the necessary examinations, undertook clinical work to maintain competence, and arranged their lives and finances on the basis of the established rules governing access to residency positions.
Dr. Da Silveira is a vascular surgeon who graduated in the top 1% of her class in Brazil and is a permanent resident of Canada. She and her husband purchased a home in Ontario in July 2025, pay substantial taxes, and have a Canadian-born child. She met all pre-existing requirements for participation in the first iteration of the CaRMS matching process, including paying approximately $15,000 in exam fees and maintaining clinical practice experience.
Dr. Lagosta is a surgical oncologist and general surgeon who immigrated under the Federal Skilled Worker Program, in part because of the value Canada placed on her medical qualifications. She and her husband endured significant financial hardship after immigration: exhausted savings due to exam costs, reliance on food banks, and taking low-wage work such as housecleaning and dishwashing before her husband secured work in the nuclear energy sector. She too has a Canadian-born child and has demonstrated a long-term commitment to living and practising in Ontario.
For both applicants, obtaining a residency is essential. In Ontario, as a general rule, practising as a physician requires completion of a medical residency leading to specialty certification by the Royal College of Physicians and Surgeons of Canada or family medicine certification by the College of Family Physicians of Canada. Residency positions are awarded through the national Canadian Resident Matching Service (CaRMS), which runs a matching algorithm based on ranked preferences from both applicants and medical schools.

The new Ontario residency policy and its terms
Historically, residency positions were divided into separate streams: one for Canadian Medical Graduates (CMGs) trained at Canadian schools, and another for International Medical Graduates (IMGs) trained abroad. CMGs competed among themselves for designated CMG positions, while IMGs did the same within a separate quota for IMG positions. Candidates who did not match in the first round (the First Iteration) could compete again for unfilled positions in the Second Iteration, though more than 92% of all positions—especially in specialties—were typically filled in the First Iteration. Remaining spots tended to be in rural family medicine and generalist northern posts, and even those were oversubscribed.
For the 2026 intake, applications through the CaRMS portal opened on 10 September 2025 with a deadline of 27 November 2025. Almost one month into the application period, on 8 October 2025, the Ontario Minister of Health directed CaRMS to implement a new rule (the “New Policy”) governing IMG participation in the First Iteration. Under the New Policy, effective immediately, only IMG candidates who had completed at least two years of high school in Ontario were eligible to take part in the First Iteration. A narrow exemption existed for applicants whose inability to attend two years of Ontario high school resulted directly from a legal guardian’s deployment or posting outside Ontario in specific federal roles, such as the Canadian Armed Forces, the Canadian Diplomatic Service, or the Department of Foreign Affairs.
The New Policy did not alter CMG eligibility. Its practical impact was to create a new internal division within the IMG pool, privileging those with two years of Ontario secondary education and excluding all other IMGs from the main match round. Those excluded could still compete in the Second Iteration, but only for the limited and often less competitive positions typically left unfilled after the first round. Both applicants, having been educated abroad and immigrating as adults, did not and could not meet the two-years-of-Ontario-high-school requirement and were therefore barred from the primary competition despite having met all substantive professional and licensing prerequisites.

Applicants’ challenge and legal issues raised
The applicants brought an application in the Ontario Superior Court of Justice, seeking an interlocutory injunction to restrain Ontario from implementing the New Policy pending a full constitutional hearing. They argued that the New Policy violated multiple rights under the Canadian Charter of Rights and Freedoms.
First, under section 6, they alleged that the New Policy infringed mobility rights by denying Canadian citizens and permanent residents who had not attended high school in Ontario a fair opportunity “to pursue the gaining of a livelihood” as physicians in Ontario. They argued that differentiating IMGs based on where they lived as teenagers effectively discriminated among persons based on province of previous residence and was not saved by section 6(3), which permits general laws and reasonable residency requirements only if they do not discriminate primarily on residence and are genuinely reasonable in light of the service being provided.
Second, under section 15, they alleged that the two-years-of-Ontario-high-school rule amounted to discrimination based on national or ethnic origin and related protected grounds, including adverse-effects discrimination. While neutral on its face, the requirement disproportionately excluded immigrants, racialized candidates, refugees, and internationally educated professionals who, by definition, could not have completed Ontario high school. The applicants argued that the rule functioned as a proxy for national origin and entrenched systemic barriers faced by these groups in accessing medical training and licensure.
Third, under section 7, the applicants contended that excluding them from the main residency match interfered with their liberty and security interests in making fundamental life choices about career and livelihood. They also argued that any deprivation of those interests was not “in accordance with the principles of fundamental justice” because the New Policy was arbitrary, overbroad, and grossly disproportionate in relation to its stated goal of improving physician retention in Ontario.
In response, the respondents—the Minister of Health and the Attorney General of Ontario—focused their submissions on the interlocutory injunction test rather than on the underlying Charter merits. They argued that the applicants had failed to show irreparable harm and that the balance of convenience and public interest favoured allowing the New Policy to stand during the match. They maintained that the policy was aimed at maximizing the likelihood that residency positions would go to individuals with deep roots in Ontario who were more likely to continue practising in the province, particularly in light of physician shortages.

The interlocutory injunction framework
Both sides accepted that the governing test for an interlocutory injunction against government action was the three-part framework from RJR-MacDonald Inc. v. Canada (Attorney General): (1) a serious issue to be tried; (2) irreparable harm if the relief is not granted; and (3) a balance of convenience, including the public interest, that favours granting the injunction. Where an injunction effectively grants much of the final relief, particularly in the public law context, courts require a higher threshold: a strong prima facie case, rather than a mere serious issue.
The court, per Koehnen J., recognized that the relief sought—suspending operation of a provincial policy that structured the entire residency match—was both systemic and time-sensitive. He therefore applied the more stringent “strong prima facie case” standard but acknowledged the interdependence of the three branches of the test: strength in one area could compensate for relative weakness in another. Despite the respondents’ strategic choice not to engage deeply on the Charter merits at this stage, the court undertook a substantive evaluation of the section 6, 15, and 7 arguments because the strength of the rights claim was integral to the balance of convenience analysis.

Assessment of Charter issues: sections 6, 15 and 7
On section 6, the court found that the New Policy drew an explicit distinction among IMGs based on their Ontario high school attendance, which in turn restricted permanent residents’ and citizens’ ability to pursue a livelihood in medicine in Ontario if they had not met the two-year schooling requirement. While section 6(3) allows laws of general application and reasonable residency requirements for public social services, it specifically excludes practices that discriminate primarily on the basis of province of present or previous residence. The court found a strong prima facie case that the New Policy did just that, since the decisive factor was where the candidate had lived as a teenager, rather than any genuine indicator of future practice location. The court also stressed that IMGs already sign return-of-service contracts tethering them to specific regions in Ontario with financial penalties for non-compliance, and that there was no evidentiary basis to support the notion that two years in an Ontario high school predicted long-term physician retention better than existing mechanisms.
On section 15, the court rejected the respondents’ argument that the policy was non-discriminatory simply because it applied equally to those born in Ontario and those born elsewhere. It emphasized the doctrine of adverse-effects discrimination: even facially neutral rules can violate equality rights where they impose a disproportionate burden on protected groups. The two-years-of-Ontario-high-school condition was characterized as a “built-in headwind” for internationally educated and racialized candidates, refugees, and immigrants who arrived as adults and could never have satisfied that requirement. By effectively conditioning access to the First Iteration on teenage residence in Ontario, the policy operated as a proxy for national origin and residence history, excluding individuals on the basis of an immutable characteristic over which they had no control.
The court illustrated the equality impact with a hypothetical comparison between two candidates, Susan and Rahima. Both attend the same Ontario high school, same Canadian university, and same foreign medical school; Rahima, a Syrian refugee who arrived only for grade 12, academically outperforms Susan. Under the New Policy, Susan is eligible for the First Iteration while Rahima is not, solely because Rahima did not spend two full years at an Ontario high school—an outcome that in practice tracks Rahima’s national origin and refugee history, not her merit or qualifications. This, in the court’s view, supported a strong prima facie case of discrimination contrary to section 15.
With respect to section 7, the court acknowledged that the jurisprudence on applying section 7 to employment or professional opportunities is less settled. Nonetheless, the applicants argued that choices about one’s profession and lifelong career path can implicate the sphere of liberty and personal autonomy protected by section 7. They further submitted that excluding them from the primary residency match was arbitrary, overbroad, and grossly disproportionate given the absence of evidence that the New Policy enhanced retention beyond existing contractual and policy tools. The respondents conceded that, at minimum, there was a serious issue to be tried under section 7, even if the case on this ground was not as strong as under sections 6 and 15.

Irreparable harm analysis
The court then turned to whether the applicants would suffer irreparable harm absent an injunction. It accepted the unchallenged evidence that about 92% of Ontario residency positions, including nearly all specialty positions, are filled in the First Iteration. The Second Iteration typically offers mostly rural family medicine or generalist positions, and even those are oversubscribed. For IMGs excluded from the First Iteration, the realistic consequence is a significant reduction in the chance of matching, at least a one-year delay in starting postgraduate training, and a serious risk of never matching at all.
Ontario argued that this harm was speculative because the actual match results were unknown and could not be predicted without a full assessment of all candidates. It also claimed that any harm was economic and compensable in damages. The court disagreed. It emphasized that the applicants were not being outcompeted on merit but rather excluded from the main competition altogether based on an irrelevant and likely unconstitutional criterion. Citing case law that recognizes lost professional opportunities—such as the withdrawal of admission to medical school—as irreparable harm, the court concluded that the loss here went far beyond lost income. It went to the core of the applicants’ life plans, sense of self, and ability to practise in the specialties in which they had already proven themselves, all on the basis of an “indelible characteristic” (where they lived during high school) that appears unrelated to physician competence or retention.
The court also adopted a broad, contextual view of irreparable harm consistent with RJR-MacDonald, noting that courts have treated permanent market loss, being put out of business, and permanent loss of natural resources as paradigmatic examples. It held that depriving a person of the realistic ability to pursue their chosen medical career is, if anything, even more complex and difficult to quantify, thereby strengthening the case that damages could not adequately remedy the loss.

Balance of convenience and public interest
The final branch required weighing the harm to the government and public interest if the injunction were granted against the harm to the applicants and similarly situated IMGs if it were refused. Ontario invoked the presumption, articulated in RJR-MacDonald, that restraining a democratically chosen government policy generally harms the public interest. It argued that the New Policy was a good-faith effort to ensure that scarce residency positions went to candidates most likely to remain in Ontario and that the court should defer to that policy judgment.
The court accepted that governments usually enjoy a presumption that their measures advance the public interest, but stressed that the Charter exists precisely to allow individuals to challenge the “status quo” and to ensure that government action remains within constitutional bounds. The presumption is rebuttable and must be weighed against the harm of ongoing rights violations. Here, the evidence suggested that IMG and CMG retention rates in Ontario were comparable and already high, and that contractual return-of-service obligations provided a more direct and tailored retention tool than the blunt proxy of Ontario high school attendance. This eroded the force of Ontario’s public interest justification.
Ontario also argued that the status quo to be preserved was the post-policy landscape, in which the New Policy already applied. The court rejected that characterization, noting that residency applications had opened weeks before the policy change, and that the New Policy itself was the disruptive factor. Preserving the true status quo meant maintaining the rules in place when the 2026 match opened, not entrenching the contested change. Accepting Ontario’s approach would allow governments to insulate unilateral and possibly unlawful policy shifts from interim judicial review simply by acting quickly enough to create a “new” status quo.
Further, Ontario contended that the court lacked institutional competence to interfere in technical allocation decisions concerning limited residency slots and that the judiciary should not second-guess complex resource allocations with “winners and losers.” The court agreed that it was not its role to decide who should receive residency positions or to design the matching system, but reaffirmed that courts are institutionally competent—and constitutionally required—to assess whether the rules governing access to public programs comply with the Charter. To accept Ontario’s argument would effectively shield entire spheres of public policy from Charter scrutiny, contrary to the constitutional scheme.
Finally, the respondents criticized the applicants for alleged delay, noting that the policy was announced on 8 October 2025 and the motion was heard on 1 December 2025. The court carefully reviewed the timeline and found that the applicants and their allies moved with reasonable speed under challenging circumstances: initial attempts to seek clarification and potential institutional opposition from universities, difficulties in coordinating among practising physicians, loss of potential co-applicants due to fear of reprisal or serious illness, and the need to secure pro bono counsel. The case also involved a preliminary detour to the Divisional Court before being redirected to the Superior Court, during which an interim extension to the application deadline was granted. On these facts, the court found no culpable delay.

Treatment of candidates outside Ontario and timing adjustments
During the hearing, an additional fairness concern emerged: some candidates, like affiant Anantha Soogoor, had shaped their national application strategy around the New Policy. Believing that there would now be fewer competitors for Ontario IMG positions, they concentrated their applications in Ontario and did not apply to other provinces. The court explored whether it could alleviate any prejudice to such candidates by extending CaRMS deadlines for applications to programs outside Ontario as well, potentially coupled with invitations—but not orders—to those faculties to review late applications.
After hearing from CaRMS and representatives of Ontario and national medical faculties, the court concluded that such an extension would create unacceptable complexity and confusion. It would require new directions to CaRMS and multiple universities across the country, differential responses by individual faculties, and a series of communications to candidates in a context already marked by shifting deadlines and legal uncertainties. The court decided that the more prudent course was to limit its remedial intervention to Ontario, the jurisdiction whose policy was under direct challenge.
Ultimately, the court extended only the deadline for IMG applications to Ontario residency positions, taking into account the time needed for the decision to be communicated through government and institutional channels and for candidates to respond.

Outcome and next steps
In its dispositive ruling delivered on 5 December 2025, with reasons issued on 8 December 2025, the Ontario Superior Court of Justice granted the interlocutory injunction. It restrained the Minister of Health and the Attorney General of Ontario from implementing or enforcing the New Policy that restricted First Iteration IMG eligibility to those with two years of Ontario high school, pending final determination of the underlying application or further order of the court. It also extended the deadline for IMGs to apply for Ontario residency positions to 5:00 p.m. on Monday, 8 December 2025, to ensure that affected candidates had a realistic opportunity to submit or adjust applications under the restored rules. The judge invited counsel to arrange a case conference to set a timetable and hearing dates so that the constitutional challenge could proceed expeditiously on the merits.
Accordingly, the successful parties on the motion are the applicants, Dr. Nathália Elino Da Silveira and Dr. Ilana Polegatto Lagosta. The relief granted is entirely injunctive and procedural in nature—suspension of the New Policy and extension of application deadlines—and the decision does not contain any quantified award of damages, compensation, or costs in their favour. On the face of this endorsement, the total monetary award or costs ordered in favour of the successful party cannot be determined and appears to be nil at this interlocutory stage.