Provincial Dental Board of Nova Scotia v. Dr. Clive Creager,

• Jurisdiction: Nova Scotia
• Judge: Saunders, Freeman and Fichaud, JJ.A.
• Neutral Citation: 2005 NSCA 9
• Citation: (2005), 230 N.S.R.(2d) 48 (CA),2005 NSCA 9,[2005] NSJ No 32 (QL),230 NSR (2d) 48,729 APR 48,729 A.P.R. 48,(2005), 230 NSR(2d) 48 (CA),230 NSR(2d) 48,230 N.S.R.(2d) 48,[2005] NS.J. No 32 (QL)
• Date: 01 February 2005
• Court: Court of Appeal of Nova Scotia (Canada)

Creager v. Provincial Dental Bd. (2005), 230 N.S.R.(2d) 48 (CA);

 729 A.P.R. 48

MLB headnote and full text

Temp. Cite: [2005] N.S.R.(2d) TBEd. FE.017

Dr. Clive Creager (appellant) v. Provincial Dental Board (respondent)

(CA 216913; 2005 NSCA 9)

Indexed As: Creager v. Provincial Dental Board (N.S.)

Nova Scotia Court of Appeal

Saunders, Freeman and Fichaud, JJ.A.

February 1, 2005.

Summary:

A finding that a dentist was guilty of unprofessional conduct respecting his treatment of six patients for temporo-mandibular disorders was upheld by the Discipline Committee of the Provincial Dental Board. Additionally, the Committee ordered the dentist to pay $90,000 towards the cost of the hearing. The dentist appealed, submitting that the Committee failed to articulate and apply an appropriate standard of care, erred in finding that he breached the Code of Ethics and erred in making the costs order.

The Nova Scotia Court of Appeal allowed the appeal in part. There was no reviewable error in finding unprofessional conduct respecting treatment choice and lack of informed consent. The Committee lacked jurisdiction to find a breach of the Code of Ethics based on the wording of the Notice of Charge. The Committee erred in making a substantial costs award without written reasons. The matter of costs was remitted to the Committee to provide written reasons.

Editor's Note: Certain names in the following case have been initialized or the case otherwise edited to prevent the disclosure of identities where required by law, publication ban, Maritime Law Book's editorial policy or otherwise.

Medicine - Topic 7243

Dentists - Discipline - Powers of disciplinary body - A Notice of Charge against a dentist listed a breach of the Code of Ethics as a particular of "unprofessional conduct" - Breach of the Code of Ethics was an offence separate from the offence of unprofessional conduct - The Nova Scotia Court of Appeal held that the Committee lacked jurisdiction to find a breach of the Code of Ethics based on the wording of the Notice of Charge - The Notice of Charge did not give written notice of the provision of the Act or Regulations which created a per se offence for breaching the Code of Ethics - The court stated that "the particulars in the Notice of Charge were limited to 'unprofessional conduct', meaning Regulations 3(a), 4(1)(c) and (d) which do not create a per se offence from a breach of the Code of Ethics" - In any event, a finding of unprofessional conduct for breaching the Code of Ethics violated the rule against duplicative convictions, where there was not a single element under this charge that was not already subsumed in the other charges of unprofessional conduct - See paragraphs 64 to 79.

Medicine - Topic 7245

Dentists - Discipline - Professional misconduct - What constitutes - A finding that a dentist was guilty of unprofessional conduct for, inter alia, inappropriate treatment for six patients for temporo-mandibular disorders, and lack of informed consent, was upheld by the Discipline Committee of the Provincial Dental Board - The dentist submitted that the Committee erred in articulating and applying the standard of care - The dentist submitted that his treatment choice was one of two differing schools of thought, amounted to a professional judgment within the standard of care and that his patients gave informed consent - The Nova Scotia Court of Appeal held that the Committee did not err - The Committee did not choose between competing treatment theories - There was a body of expert evidence that the treatment chosen was not appropriate - The Committee did not fail to articulate the standard of care it used and did not base that standard on their personal backgrounds (subjective) rather than from objective sources - Further, there was no error in finding that the patients were not informed of the material risks of the treatment choice - There were no grounds to interfere with the finding of unprofessional conduct - See paragraphs 28 to 65.

Medicine - Topic 7252

Dentists - Discipline - Hearing - Costs - The Discipline Committee of the Provincial Dental Board, without written reasons, ordered that a disciplined dentist pay $90,000 towards the costs of the hearing - The Nova Scotia Court of Appeal held that the Dental Board's power to enact regulations covering "all or part" of the costs was not limited to a party and party costs scale designed for courtroom litigation - The costs award must be reasonable - Given the substantial award, the absence of written reasons for the quantum of the award precluded the court from reviewing the award on the reasonableness standard - The court remitted the matter to the Committee to supply reasons for the decision - See paragraphs 81 to 109.

Medicine - Topic 7255

Dentists - Discipline - Complaint or charge - General - [See Medicine - Topic 7243 ].

Medicine - Topic 7290

Dentists - Regulation - Judicial review (incl. standard of review) - A finding that a dentist was guilty of unprofessional conduct was upheld by the Discipline Committee of the Provincial Dental Board - Section 38(1) of the Dental Act provided for an appeal only on a "point of law" - The Nova Scotia Court of Appeal stated that "the more critical factors to determine the standard of review are the expertise of the tribunal, purpose of the legislation and nature of the question. ... the application of a standard of care by a professional discipline tribunal should be reviewed based on a standard of reasonableness. ... After considering the four contextual factors of the functional and practical approach ... the standard of review should be as follows: (a) For matters related to the selection, articulation and application of the standard of care for unprofessional conduct, the standard of review should be reasonableness ... (b) For matters related to the quantum of costs, I would apply the reasonableness standard of review." - Legal matters outside the Committee's core of expertise were subject to the correctness standard - See paragraphs 13 to 20.

Cases Noticed:

Housen v. Nikolaisen et al., [2002] 2 S.C.R. 235; 286 N.R. 1; 219 Sask.R. 1; 272 W.A.C. 1, refd to. [para. 14].

Dr. Q., Re, [2003] 1 S.C.R. 226; 302 N.R. 34; 179 B.C.A.C. 170; 295 W.A.C. 170, refd to. [para. 15].

Ryan v. Law Society of New Brunswick, [2003] 1 S.C.R. 247; 302 N.R. 1; 257 N.B.R.(2d) 207; 674 A.P.R. 207, refd to. [para. 15].

Solicitor Y v. Nova Scotia Barristers' Society (2004), 225 N.S.R.(2d) 239; 713 A.P.R. 239; 2004 NSCA 75, refd to. [para. 17].

Nolan v. Association of Land Surveyors (N.S.) (2003), 219 N.S.R.(2d) 318; 692 A.P.R. 318; 2003 NSCA 145, refd to. [para. 17].

Barrie Public Utilities et al. v. Canadian Cable Television Association et al., [2003] 1 S.C.R. 476; 304 N.R. 1, refd to. [para. 19].

Voice Construction Ltd. v. Construction & General Workers' Union, Local 92 (2004), 318 N.R. 332; 346 A.R. 201; 346 W.A.C. 201 (S.C.C.), refd to. [para. 19].

Pushpanathan v. Canada (Minister of Citizenship and Immigration), [1998] 1 S.C.R. 982, addendum [1998] 1 S.C.R. 1222; 226 N.R. 201, refd to. [para. 19].

Toronto (City) et al. v. Canadian Union of Public Employees, Local 79 et al., [2003] 3 S.C.R. 77; 311 N.R. 201; 179 O.A.C. 291, refd to. [para. 19].

Alberta Union of Provincial Employees et al. v. Lethbridge Community College, [2004] 1 S.C.R. 727; 319 N.R. 201; 348 A.R. 1; 321 W.A.C. 1, refd to. [para. 19].

Moreau-Bérubé v. New Brunswick (Judicial Council) - see Conseil de la magistrature (N.-B.) v. Moreau-Bérubé.

Conseil de la magistrature (N.-B.) v. Moreau-Bérubé, [2002] 1 S.C.R. 249; 281 N.R. 201; 245 N.B.R.(2d) 201; 636 A.P.R. 201, refd to. [para. 24].

Canadian Union of Public Employees et al. v. Ontario (Minister of Labour), [2003] 1 S.C.R. 539; 304 N.R. 76; 173 O.A.C. 38, refd to. [para. 24].

Baker v. Canada (Minister of Citizenship and Immigration), [1999] 2 S.C.R. 817; 243 N.R. 22, refd to. [para. 24].

Bell Canada v. Canadian Telephone Employees Association et al., [2003] 1 S.C.R. 884; 306 N.R. 34, refd to. [para. 25].

Imperial Oil Ltd. v. Quebec (Minister of the Environment) - see Compagnie pétrolière Impériale ltée v. Québec (Ministre de l'Environnement).

Compagnie pétrolière Impériale ltée v. Québec (Ministre de l'Environnement), [2003] 2 S.C.R. 624; 310 N.R. 343, refd to. [para. 25].

Director of Investigation and Research, Competition Act v. Southam Inc. et al., [1997] 1 S.C.R. 748; 209 N.R. 20, refd to. [para. 30].

Galaske v. O'Donnell et al., [1994] 1 S.C.R. 670; 166 N.R. 5; 43 B.C.A.C. 37; 69 W.A.C. 37, refd to. [para. 30].

Ingles v. Tutkaluk Construction Ltd. et al., [2000] 1 S.C.R. 298; 251 N.R. 63; 130 O.A.C. 201, refd to. [para. 30].

St-Jean v. Mercier, [2002] 1 S.C.R. 491; 282 N.R. 310, refd to. [para. 30].

Brett et al. v. Board of Directors of Physiotherapy (Ont.) (1991), 48 O.A.C. 24 (Div. Ct.), affd. (1993), 64 O.A.C. 152; 104 D.L.R.(4th) 421 (C.A.), refd to. [para. 36].

Hallam v. College of Physicians and Surgeons (Ont.) (1993), 61 O.A.C. 143 (Div. Ct.), refd to. [para. 36].

Thompson v. Chiropractors' Association of Saskatchewan (1996), 145 Sask.R. 35 (Q.B.), refd to. [para. 36].

Krop v. College of Physicians and Surgeons (Ont.) (2002), 156 O.A.C. 77 (Div. Ct.), refd to. [para. 36].

Aronov v. Royal College of Physicians and Surgeons (Ont.), 2002 CarswellOnt 5117 (Div. Ct.), refd to. [para. 36].

ter Neuzen v. Korn - see Neuzen v. Korn.

Neuzen v. Korn, [1995] 3 S.C.R. 674; 188 N.R. 161; 64 B.C.A.C. 241; 105 W.A.C. 241, refd to. [para. 36].

Huerto v. College of Physicians and Surgeons (Sask.) (1994), 124 Sask.R. 33; 117 D.L.R.(4th) 129 (Q.B.), affd. (1996), 141 Sask.R. 3; 114 W.A.C. 3; 133 D.L.R.(4th) 100 (C.A.), refd to. [para. 53].

Bennet v. Registered Psychiatric Nurses' Association (Man.), [2003] 10 W.W.R. 472; 173 Man.R.(2d) 267; 293 W.A.C. 267 (C.A.), refd to. [para. 53].

Groves v. College of Dental Surgeons (B.C.) (1976), 63 D.L.R.(3d) 744 (B.C.C.A.), leave to appeal refused (1976), 9 N.R. 178; 63 D.L.R.(3d) 744 (S.C.C.), refd to. [para. 54].

Reibl v. Hughes, [1980] 2 S.C.R. 880; 33 N.R. 361, refd to. [para. 60].

Malette v. Shulman (1990), 37 O.A.C. 281; 72 O.R.(2d) 417 (C.A.), refd to. [para. 60].

Seney v. Crooks et al. (1998), 223 A.R. 145; 183 W.A.C. 145 (C.A.), refd to. [para. 60].

Harris v. Law Society of Alberta, [1936] 1 D.L.R. 401 (S.C.C.), refd to. [para. 75].

Cameron v. Law Society of British Columbia (1991), 3 B.C.A.C. 35; 7 W.A.C. 35; 81 D.L.R.(4th) 484 (C.A.), refd to. [para. 75].

K.C. v. College of Physical Therapists (Alta.), [1999] 12 W.W.R. 339; 244 A.R. 28; 209 W.A.C. 28; 157 D.L.R.(4th) 31 (C.A.), refd to. [para. 78].

Roberts v. College of Dental Surgeons (B.C.) (1999), 119 B.C.A.C. 126; 194 W.A.C. 126; 171 D.L.R.(4th) 104 (C.A.), refd to. [para. 84].

Beaini v. Association of Professional Engineers of Nova Scotia (2004), 227 N.S.R.(2d) 115; 720 A.P.R. 115; 2004 NSCA 122, refd to. [para. 85].

Brand v. College of Physicians and Surgeons (Sask.) (1990), 86 Sask.R. 18; 72 D.L.R.(4th) 446 (C.A.), refd to. [para. 89].

Barik v. College of Physicians and Surgeons (Sask.) (1992), 100 Sask.R. 26; 18 W.A.C. 26 (C.A.), refd to. [para. 89].

Lambert v. College of Physicians and Surgeons (Sask.) (1992), 100 Sask.R. 203; 18 W.A.C. 203 (C.A.), refd to. [para. 89].

Hamilton v. Open Window Bakery Ltd. et al., [2004] 1 S.C.R. 303; 316 N.R. 265; 184 O.A.C. 209, refd to. [para. 94].

Northwestern Utilities Ltd. v. Edmonton (City), [1979] 1 S.C.R. 684; 23 N.R. 565; 12 A.R. 449, refd to. [para. 100].

Supermarchés Jean Labrecque Inc. v. Flamand - see Supermarchés Jean Labrecque Inc. v. Tribunal du Travail.

Supermarchés Jean Labrecque Inc. v. Tribunal du Travail, [1987] 2 S.C.R. 219; 78 N.R. 201; 9 Q.A.C. 161, refd to. [para. 100].

R.D.R. Construction Ltd. v. Rent Review Commission (N.S.) (1982), 55 N.S.R.(2d) 71; 114 A.P.R. 71 (C.A.), refd to. [para. 104].

R. v. Sheppard (C.), [2002] 1 S.C.R. 869; (2002), 284 N.R. 342; 211 Nfld. & P.E.I.R. 50; 633 A.P.R. 50, refd to. [para. 106].

R. v. Chittick (D.S.) (2004), 228 N.S.R.(2d) 81; 723 A.P.R. 81; 2004 NSCA 135, refd to. [para. 106].

Hatfield v. Nova Scotia Barristers' Society (1978), 30 N.S.R.(2d) 386; 49 A.P.R. 386 (C.A.), refd to. [para. 109].

Congrégation des témoins de Jéhovah de St-Jerôme-Lafontaine v. Lafontaine (Village), [2004] 2 S.C.R. 650; 323 N.R. 1, refd to. [para. 109].

Statutes Noticed:

Dental Act Regulations (N.S.), Discipline Regulations, sect. 3 [para. 69]; sect. 4(1)(c), sect. 4(1)(d) [para. 71]; sect. 16(1)(a) [para. 73]; sect. 28(1) [para. 99]; sect. 29(1)(i) [para. 86].

Discipline Regulations - see Dental Act Regulations (N.S.).

Authors and Works Noticed:

Casey, James T., The Regulation of Professions in Canada, pp. 6-1 to 6-5 [para. 75]; 15-5, 15-6 [para. 33].

Counsel:

Alan Stern, Q.C., and Cheryl Hodder, for the appellant;

Michael Wood, Q.C., and Jennifer Ross, for the respondent.

This appeal was heard on December 6, 2004, at Halifax, N.S., before Saunders, Freeman and Fichaud, JJ.A., of the Nova Scotia Court of Appeal.

On February 1, 2005, Fichaud, J.A., delivered the following judgment for the Court of Appeal.