The refusal of an application for registration on grounds of fitness by the Ontario College of Physicians and Surgeons, which refusal was confirmed by the Health Professions Appeal and Review Board (or HPARB), was also affirmed on a review of the HPARB decision by an Ontario court in the Ahmed case (2011 ONSC 4217). The applicant asserted a failure of HPARB to provide procedural fairness and natural justice, including a failure to provide adequate reasons.
The applicant, a graduate from Bangladesh and practising in the United States for some time, sought a certificate of registration through one of two avenues, namely, the College’s Practice Assessment Program, also known as “RPA” (Registration through Practice Assessment). The College required, however, certain non-exemptible standards, including the applicant being mentally competent to practise medicine, and having sufficient knowledge, skill and judgment to engage in the kind of medical practice authorized by the certificate. The applicant received a restricted certificate that would expire if supervisor performance reviews were unsatisfactory, or if his supervisor resigned. The College appointed Dr. Z as his supervisor. Dr. Z identified large gaps in the applicant’s knowledge, noted that the applicant claimed to be receiving payments from other health care providers for referrals, that the applicant considered certain people in power were in fact “aliens,” and his making comments like, “the Queen is drinking human blood and eating babies”. Dr. Z recommended, and the registration committee directed, the applicant undergo education upgrading, and a Physician Review and Enhancement Program (PREP) assessment. After the applicant commented that Dr. Z “was connected with the Italian mafia” and that “Dr. [Z] could kill me,” Dr. Z resigned as supervisor, and the applicant’s certificate terminated.
The committee advised that if the applicant wished to be reinstated, he had to attend the PREP assessment and undergo a psychiatric assessment. The applicant underwent a PREP assessment, which disclosed severe deficiencies, and he ultimately refused to attend for a psychiatric examination. The committee concluded the applicant failed to meet several non-exemptible standards, including mental competence.
In response to the applicant’s assertion the registration committee could not require a PREP assessment, the court disagreed: “The Committee is entitled to require any reasonable mode of assessment in furtherance of fulfilling its mandate to assess competence in meeting the prerequisites to obtaining a certificate of registration through the RPA.”  The court also found procedural fairness,  adequate reasons,  and a reasonable decision due to the applicant failing to demonstrate skills, knowledge and judgment required to practise medicine in Ontario, to demonstrate he is mentally competent, and to demonstrate he can communicate effectively and display an appropriate professional attitude. 
Ahmed v. Ontario (Health Professions Appeal and Review Board), 2011 ONSC 4217