Ontario review board orders reconsideration of decision against late cancer patient’s gynecologist

The Ontario Health Professions Appeal and Review Board asked the Inquiries, Complaints, and Reports Committee of the College of Physicians and Surgeons of Ontario to reconsider its decision to require a gynecologist to provide a report on Cancer Care Ontario’s guidelines. 

In Chu v M.R., 2025 CanLII 121544 (ON HPARB), a family physician referred a patient to the applicant, an obstetrician and gynecologist, in November 2014 for routine gynecological check-ups. 

On Mar. 11, 2019, the applicant conducted an in-office endometrial biopsy, which showed cancer in the form of stage-one endometrioid adenocarcinoma. The applicant referred the patient to Dr. L, a cancer surgeon at a community hospital. 

On May 9, 2019, Dr. L performed a hysterectomy and bilateral salpingo-oophorectomy. Dr. L referred the patient to the Odette Cancer Centre at Sunnybrook Hospital for potential adjuvant therapies. 

A radiation oncologist provided Dr. L with a June 26, 2019 consultation note, which stated that the patient would not need adjuvant therapies unless dramatic changes, as seen on the pathology review, would require additional treatment. The family physician and the applicant, as the patient’s primary gynecologist, both received copies of the note. 

Dr. L asked the applicant to follow the patient moving forward. On May 9, 2019, the patient underwent surgery. The applicant provided post-surgery care to the patient, as required. 

During an Oct. 26, 2022 visit, the patient notified the applicant that she was awaiting a second CT scan after a recent scan revealed possible lung cancer. 

The patient had a lung X-ray, a CT scan, a bronchoscopy, and a biopsy. She showed evidence of pulmonary metastases and a liver metastasis, a stage-four incurable malignancy. She underwent chemotherapy and palliative care. 

The respondent, the patient’s brother, filed an August 2023 complaint with the College concerning the care the applicant had provided to his sister. The respondent alleged that the applicant: 

• failed to properly refer the patient to a Toronto-based specialized oncology hospital, such as the Princess Margaret Cancer Centre, with available multidisciplinary approaches 
• did not provide follow-up advice for a certain period after the operation, given the possibility that the disease would recur 
• was inappropriately angry and surprised in 2020 or 2021 when the patient visited with complaints of vaginal oozing and discomfort 
• cleared the patient and considered the result normal after hurriedly performing a pelvic examination 
• advised no follow-up and ordered no tests to detect the potential recurrence of cancer 
• failed to investigate the oozing symptoms in 2020 or 2021 
• denied the presence of a uterine cancer recurrence in 2022 when the patient showed a lung X-ray that had found lesions 
• told the patient to meet with a chest physician because the lesions originated in the lungs 

The patient has since died. 

After investigating the complaint, the Inquiries, Complaints, and Reports Committee: 

• required the applicant to appear before it so that it could caution her regarding the postsurgical follow-up of patients with low-risk endometrial adenocarcinoma 
• expressed its expectation that physicians respectfully respond to patient concerns, even when the issues fell outside their medical field 
• asked the applicant to provide a two-to-four-page-long written report about her review of and comments on Cancer Care Ontario’s Guidelines on Endometrial Cancer Treatment and Follow-Up, specifically the follow-up of low-risk endometrial adenocarcinomas that did not require adjuvant therapy 

The applicant requested a review of the committee’s decision. Her counsel argued that: 

• The committee’s investigation and decision were procedurally unfair 
• The investigation was inadequate because the committee raised and ruled on a new issue, the Cancer Care Ontario guidelines, without allowing the applicant to respond 
• The committee specifically referred to the guidelines when deciding to caution the applicant, which amounted to a public and significant outcome 
• The applicant would have provided information on how she met the requirements in the guidelines if she had known about the new issue 

Reconsideration to follow

Under s. 35(1) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, the Ontario Health Professions Appeal and Review Board returned the decision to the committee and required it to reconsider after conducting an additional, adequate investigation. 

Specifically, the review board recommended that the committee state the specific guidelines involved and offer the parties an opportunity to make further submissions regarding this issue. 

First, the review board deemed the committee’s investigation inadequate. The review board noted that the applicable minimum standards of procedural fairness required the committee to: 

• notify the applicant of its specific concern about the Cancer Care Ontario guidelines 
• permit the applicant to respond to this issue before forming a substantial basis for its findings 

Second, the review board found it premature to determine whether the committee’s decision was reasonable, given that it considered the investigation procedurally unfair and insufficient.