Administrative law – Physicians and surgeons – Disciplinary proceedings – Billing matters – Decisions of administrative tribunals – College of Physicians and Surgeons – Failure to provide reasons – Test – Judicial review – Natural justice – Procedural requirements and fairness
Anstead v. Joint Medical Professional Review Committee,  S.J. No. 373, Saskatchewan Court of Queen’s Bench, May 27, 2005, Allbright J.
Dr. Anstead was paid by the Government of Saskatchewan, through the Department of Health, on a fee for service basis. Dr. Anstead agreed to be paid in accordance with the payment schedule and assessment rules applicable to the services he rendered to patients. On June 25, 2003, the chairman of the Committee forwarded to Dr. Anstead a copy of the Committee’s final report with respect to an assessment of Dr. Anstead’s billing practices. The report constituted approximately seven pages summarizing the proceedings which occurred at a hearing on February 15, 2003. The report concluded with the final order of the Committee. The Committee found that due to overservicing by Dr. Anstead, it was entitled to recover 40% of the fees paid out for certain services billed during the period under review. As well, the Committee ordered that, due to overservicing, all partial assessment services for patients seen more than five times be reduced to 82.5% of the payment schedule rate for the period under review. The reassessment order totalled $15,746.72. Dr. Anstead filed a notice of appeal with respect to this order.
The Court indicated that there are three fundamental requirements imposed on a Committee review process:
- that the hearing be undertaken by an impartial tribunal;
- that the hearing conducted must be a “fair” hearing; and
- that the process of the Committee throughout must be transparent to the physician and to an objective observer.
In this case, the Court held that the Committee did not observe the rules of natural justice by providing reasons for its decision. The Court noted that for reasons to be considered adequate, the reasons must be such as to enable the person concerned or an objective observer to assess the reasoning process, including an identification of the more relevant evidence to that process. One of the issues raised by Dr. Anstead was the use by the Committee of billing statistics and the details of the related peer group relied upon by the Committee. The Court noted that it was impossible to determine from the reasons whether or not the Committee did rely upon peer group billing statistics in making its decision. Therefore, the Court held that the reasons provided by the Committee were insufficient and referred the matter back to the Committee with the direction that the Committee reconsider its order and provide Dr. Anstead with supporting reasons for its decision.
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