In a recent decision, the Health Professions Appeal and Review
Board ("HPARB") upheld the decision of The Scarborough
Hospital not to reappoint a physician to the medical staff as a
result of the physician's lengthy pattern of disruptive
conduct. HPARB held that the physician's conduct and history of
communications with Hospital administrators justified the
Hospital's decision not to renew his privileges.
The case involved Dr. Khan, who had courtesy staff privileges in
the Hospital's Department of Family Practice from 1992 to 2008.
Dr. Khan primarily provided surgical assistant services at the
Hospital, and there was no issue with respect to his skills and
competence in that regard. Rather, the issue that gave rise to the
proceedings was the tenor of his communications with members of the
administration, and in particular with his Chief of Staff. From
2003 onwards, Dr. Khan had repeatedly and often publicly disparaged
administrators, and was intransigent in refusing to participate in
a process to address concerns in a constructive and respectful
Ultimately, in 2008, a panel of Dr. Khan's peers on the
Medical Advisory Committee recommended to the Hospital Board that
his privileges not be renewed. Dr. Khan requested a hearing before
the Hospital Board, following which the Hospital Board decided to
adopt the Medical Advisory Committee's recommendation. Dr. Khan
was entitled to a fresh hearing before HPARB pursuant to the
Public Hospitals Act. This quasi judicial process took
place over several days before a panel of three members of
After hearing all of the evidence, HPARB held that "Dr.
Khan violated any sense of decorum in his communications to and
about [the Chief of Staff], as well as to and about [the Chief
Executive Officer]." HPARB rejected Dr. Khan's argument
that there had been bad faith on the part of the Hospital and that
the Hospital had not followed due process in terminating his
Disruptive conduct on the part of physicians can create a toxic
work environment and is often viewed by Hospitals as exceedingly
difficult to remediate. Administrators often perceive that there is
little the Hospital can do to govern the conduct of physicians
unless the behaviour directly impacts upon patient care. The
College of Physicians and Surgeons' Guidebook for Managing
Disruptive Physician Behaviour is instructive, but in some
instances, dispute resolution mechanisms and progressive discipline
are insufficient to curtail disruptive conduct. In the case of a
credentialed physician, the Hospital must in such cases engage an
exceedingly resource-intensive process, in accordance with its
bylaws, to restrict or terminate a physician's privileges. This
process typically involves several meetings of the Medical Advisory
Committee, a full hearing before the Hospital Board, and ultimately
a full quasi-judicial hearing before HPARB.
HPARB's decision in this case is therefore an important one.
It confirms the authority of a Hospital's administration to
govern the conduct of its professional staff, requiring them to
adhere to codes of conduct to which other members of Hospital
personnel are held. The decision also suggests that where a
Hospital adheres to a fair process in disciplining and ultimately,
if necessary, terminating a physician's privileges as a result
of intransigent disruptive conduct, HPARB will not displace the
Interestingly, however, HPARB noted that had Dr. Khan testified
at the hearing in order to acknowledge his intemperate conduct and
provide assurances that it would not recur, their decision might
have been different. This is concerning given the extensive
resources involved in governing disruptive physicians and
ultimately terminating their privileges, a decision not lightly
undertaken by a physician's peers at the Medical Advisory
Committee or by a Hospital Board.
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