In 2019, amendments to Alberta’s Health Professions Act, RSA 2000, c H-7 enacted a zero-tolerance policy between regulated health care practitioners and their patients. New provisions mandated license cancellation where unprofessional conduct is found based, in whole or in part, on sexual abuse. Regulators were required to develop standards around, among other things, when a sexual relationship may occur between patient and a regulated member.
In Ahmed v Alberta College of Pharmacy, 2026 ABCA 15, the Court of Appeal of Alberta reviewed the College of Pharmacists’ finding that a registrant had committed unprofessional conduct relating to sexual abuse of a patient with whom he had been in a pre-existing sexual relationship. It found that the regulator erred in interpreting its standards of practice and remitted the decision for further consideration.
The regulator’s Standards of Practice regarding sexual abuse and sexual misconduct (the “Standards”) allowed regulated members to provide professional services to a person with whom they were in an existing sexual relationship if that service was “episodic”, constituted an “activity of daily living”, or if another appropriate professional was “not readily available” to provide such services (“Standard 7”). In this case, the pharmacist commenced a sexual relationship with another individual and subsequently prescribed medication to her on five occasions. The regulator found that this contravened the Standards and revoked his registration. The decision was upheld on initial appeal to a Panel before being considered by the Court of Appeal.
The Court found that the regulator did not adequately interpret Standard 7 in its full context. While it is reasonable to assume that its limitations are meant to minimize the risk of creating or aggravating power imbalances, it is not reasonable to assume as a starting point that most existing sexual relationships are characterized by or prone to such power imbalances. It is therefore illogical to jump from finding a breach of Standard 7 to a conclusion of professional misconduct based in whole or in part on sexual abuse. There must be further evidence linking the breach to exploitation of vulnerability or power imbalance in the sexual relationship. The regulator’s interpretation that the pharmacist’s conduct constituted sexual abuse simply because it fell outside of the Standard 7 limits was “not in keeping with societal norms or common sense” and would create a “minefield” for well-intentioned registrants who provide services to established spouses or other intimate partners. A registrant who exceeds Standard 7 limitations in providing services to an existing sexual partner does not, “without more”, commit unprofessional conduct warranting cancellation of licensure in accordance with the governing legislation.
The Court also turned its attention to the limitations set out in Standard 7 and rejected the regulator’s interpretation that “episodic professional service” meant a registrant could prescribe to a sexual partner on more than one occasion, but that each service must be limited to a single encounter (i.e., the patient must have no expectation of further services at the time of that encounter). The Court found that this also created absurdity in application to long-term sexual partners. The regulator also held that the registrant could not have reasonably expected that his prescribing would be limited to single encounters, as the relevant prescribing standard required him to develop follow-up plans for the drugs provided. The Court found that the regulator had relied upon a breach of the prescribing standard that was not identified to the registrant among the charges of unprofessional conduct. The registrant therefore had no notice or opportunity to respond to this argument, which is contrary to the principles of procedural fairness.
Similarly, the Court criticized the regulator’s interpretation of what it meant for another professional to be “not readily available” for prescribing. The regulator had defined “not readily available” to mean that another professional remained inaccessible despite reasonable efforts to obtain care (e.g., taking time away from other obligations, waiting a reasonable amount of time, travelling reasonable distances, etc.). However, there was insufficient evidence about whether such reasonable efforts were pursued, and the regulator’s findings against the registrant in the absence of such relevant evidence should not be upheld.
The Ahmed decision acknowledged that the Standards were relatively new when this matter arose, and that it was the first time the regulator had been required to interpret and apply the newly legislated sexual abuse provisions and the Standards. While BC’s incoming Health Professions and Occupations Act does not mandate any similar zero-tolerance policy, it does introduce legislated definitions for “sexual misconduct” and “sexual abuse”, both of which constitute an “act of misconduct” (see our blog post on the new provisions here). “Sexual misconduct” notably includes an exception for some acts of a sexual nature if the patient is a consenting spouse (including common-law), and the HPOA requires regulators to make bylaws regarding prohibitions, limits, and conditions on sexual relationships between licensees and patients or former patients.
Many BC health regulators currently have a zero tolerance policy for sexual misconduct, though additional standards may be developed to specifically provide additional guidance around the new definitions in the legislation, and when the spousal exceptions apply. In preparing such standards, regulators should consider the numerous relationship contexts to which they may apply and be aware of when interpretations may potentially produce absurd or unreasonable outcomes. If a definition is adopted regarding language the standards, regulators must also ensure that decision-making based on that interpretation is supported by relevant evidence. Despite new legislation, decision-making should remain, as always, reasonable and adherent to the principles of procedural fairness.
Ahmed v Alberta College of Pharmacy, 2026 ABCA 15
Sabrina Zhu