ONTARIO PHYSICIANS AND SURGEONS DISCIPLINE TRIBUNAL
Tribunal File No.: 24-029
BETWEEN:
College of Physicians and Surgeons of Ontario
College
- and -
Jai Jayaraman
Registrant
FINDING AND PENALTY REASONS
Heard: February 18, 2026
Panel:
Raj Anand (panel chair)
David Bird (public)
Vincent Georgie (public)
Julie Maggi (physician)
Susanna Yanivker (physician)
Appearances:
Robin Goldberg, for the College
Glynnis Burt and Mathew Zaia, for the registrant
RESTRICTION ON PUBLICATION
Pursuant to Rule 2.2.2 of the HPDT Rules of Procedure and ss. 45-47 of the Health Professions Procedural Code, no one shall publish or broadcast the names of patients or any information that could identify patients or disclose patients’ personal health information or health records referred to at a hearing or in any documents filed with the Tribunal. There may be significant fines for breaching this restriction.
The Ontario Physicians and Surgeons Discipline Tribunal is the Discipline Committee established under the Health Professions Procedural Code.
Introduction
1Since 2006, when the registrant, Dr. Jai Jayaraman, received a certificate of registration authorizing him to practise medicine independently, he has had extensive involvement with the Physician Health Program (PHP) of the Ontario Medical Association (OMA) because of a substance use disorder. At several points he has entered into contracts with the PHP for treatment and monitoring for alcohol consumption, as well as undertakings to the College that he would comply with those contracts. On a number of occasions Dr. Jayaraman has breached the contracts and his undertakings through missed or positive tests for alcohol use.
2Practising emergency medicine, the registrant responded to concerns outstanding as of November 2022 by entering into an undertaking with the College to participate in a treatment and monitoring program for at least five years. Between April 2023 and September 2024, Dr. Jayaraman breached that undertaking several times by consuming alcohol, receiving positive alcohol screening tests, missing screening tests without justification, and failing to attend appointments with his primary care physician. This referral to the Tribunal followed.
3At the hearing the parties agreed, and we found, that the registrant had engaged in acts of professional misconduct. His breaches of undertaking contravened a term, condition or limitation of his certificate of registration, and constituted acts or omissions that were reasonably regarded as disgraceful, dishonourable or unprofessional.
4Based on the parties’ joint submission, we ordered a reprimand and a four-month suspension of Dr. Jayaraman’s certificate of registration. We also directed the Registrar to place terms, conditions and limitations on his certificate requiring him to enrol in and comply with the recommendations and conditions of an appropriate health monitoring program.
5These are our reasons.
Professional misconduct
6The parties’ agreed statement of facts (ASF) on liability showed that Dr. Jayaraman entered into an undertaking with the College on November 17, 2022 in which he agreed to participate in a specified treatment and monitoring program for at least five years. The undertaking spanned a wide range of topics, including addictions medicine treatment, mental health and primary care, workplace monitoring, mutual help groups, abstinence from the use of alcohol and other substances of abuse, and random drug and alcohol screens.
7The registrant agreed for the duration of the undertaking:
a. to engage in a treating and monitoring relationship with an addictions medicine physician;
b. to attend regular appointments with a primary care physician at least twice a year;
c. to abstain from the consumption of alcohol or any other unauthorized substances of abuse, including fermented fruit juices, non-alcoholic beer or wine and medicinal or hygiene products that contain alcohol. Dr. Jayaraman acknowledged that a relapse could be considered a breach of the undertaking;
d. to participate in random drug and alcohol screening. A positive test sample or unexcused missed test would be considered a breach of the undertaking;
e. beginning in February 2023, to provide at least two weeks notice to his addictions medicine physician and primary care physician if he was planning a vacation or would otherwise be unavailable for testing.
8Dr. Jayaraman confirmed in the undertaking that any breach could constitute an act of professional misconduct and could result in the referral of specified allegations to the Tribunal.
9Between April 2023 and September 2024, the registrant breached his undertaking in a number of ways.
10On at least seven specific dates, Dr. Jayaraman consumed alcoholic drinks, and on one occasion, fermented fruit juice.
11He received positive alcohol screening tests of his urine and hair that were collected on nine different dates.
12He missed screening tests, without being excused by his addictions medicine physician or primary care provider, on 13 different days.
13Twice, the registrant failed to attend appointments with his primary care physician.
14After submissions by the parties, the panel accepted their agreement that Dr. Jayaraman’s multiple breaches of his undertaking to the College contravened a term, condition or limitation on his certificate of registration, and also constituted acts or omissions relevant to the practice of medicine that would reasonably be regarded by registrants as disgraceful, dishonourable or unprofessional.
Penalty and costs
15At the hearing, we accepted the parties’ joint position on penalty, comprising a four-month suspension, delivery of a reprimand, and imposition of a health monitoring program targeted at Dr. Jayaraman’s rehabilitation and protection of the public interest. After reviewing the parties’ ASF on penalty and their submissions, we did not regard the joint submission as bringing the administration of justice into disrepute or otherwise being contrary to the public interest test: see R. v. Anthony-Cook, 2016 SCC 43 at paras 25 and 32-34, applied to the Ontario regulatory context by the Divisional Court in Bradley v. Ontario College of Teachers, 2021 ONSC 2303 at paras 9-12.
16In our view, the penalty terms, taken as a whole, meet the overriding objectives of maintaining public confidence in the medical profession and in its self-regulation in the public interest.
17Non-compliance with a physician’s signed undertaking to the College is a serious matter. Dr. Jayaraman’s conduct necessitates a penalty that will signal to this registrant that such misconduct must not be repeated, and to the profession as a whole that it is unacceptable to breach such an agreement with the regulator.
18The evidence shows that in the first two years of his 2022 undertaking, while practising as an emergency room physician, the registrant repeatedly failed to comply with his agreement on treatment, testing and monitoring. These measures were carefully calibrated to allow him to exercise the privilege of practising his profession while assuring the College and the public that he was diligently attending to his own medical needs and protecting the public from potential harm. His non-compliance reflected a disregard for his duty as a registrant to comply with the promises he made to allow the College to monitor his treatment, as well as a disregard for his ongoing risk to the public. Dr. Jayaraman’s actions had the potential to place the public in a position of jeopardy.
19The November 2022 undertaking was part of a long string of regulatory actions taken by the College to minimize the risk to the public as a result of Dr. Jayaraman’s medical condition. This was in fact the third of four times in sequence that the College had initiated a capacity inquiry as part of its public protection mandate and then agreed to resolve the matter in return for Dr. Jayaraman’s agreement to specified treatment, monitoring and/or testing.
20We will summarize the steps taken by the College over the last 20 years short of discipline. This history puts the events of 2022 and following into context, and also makes clear that Dr. Jayaraman had ample notice of the importance of adhering to his commitments to the College.
21In 2004, the registrant’s residency director referred Dr. Jayaraman to the PHP after the registrant presented at work with alcohol on his breath. In November 2006, Dr. Jayaraman entered into a Substance Dependence Monitoring Contract with the PHP.
22In July 2011, that contract was prematurely terminated due to the registrant’s non-compliance with the contract. He had positive alcohol and substance screenings, missed random alcohol and drug screenings without reasonable excuse, and failed to complete the required treatment and monitoring. The Inquiries, Complaints and Reports Committee (ICRC) began inquiries into his capacity to practise medicine. Those inquiries were resolved in January 2012, about two months after Dr. Jayaraman signed a new Substance Dependence Monitoring Contract with the PHP and a concurrent undertaking to the College.
23The registrant’s November 2011 undertaking required him to remain a participant in the PHP and to comply with his contract. Dr. Jayaraman agreed that non-compliance with the contract could constitute a breach of his undertaking and an act of professional misconduct. These terms were repeated in a replacement undertaking that he executed in March 2015.
24In a decision dated March 14, 2016, the ICRC noted that Dr. Jayaraman had missed a urine drug screen in December 2015 and had a positive test in February 2016. The ICRC required the registrant to attend at the College to be cautioned “with respect to his unprofessional conduct in breaching his undertaking with the College.”
25The ICRC also decided on March 14, 2016 to proceed with an incapacity inquiry, based on information about cocaine dependency, alcohol abuse, relapses during monitoring and no sustained periods of abstinence.
26Two months later, the PHP notified the College that Dr. Jayaraman had breached his PHP contract by using a substance and receiving a positive substance screening. The PHP suspended the contract to allow him to focus on treatment.
27In September 2016, an independent medical examiner concluded that the registrant met the criteria for active substance and alcohol dependence disorders. In December 2016, the ICRC referred the allegation of incapacity to the Fitness to Practise Committee. The same month, the PHP prematurely terminated its contract with him, and in April 2017, Dr. Jayaraman entered into a Concurrent Disorders Monitoring Contract with Moderate to Severe Substance Use Disorder with the PHP.
28In May 2018, the 2016 referral of the allegation of incapacity was resolved when the registrant signed a concurrent undertaking to the College, replacing the March 2015 undertaking. Again he agreed that non-compliance with the PHP contract could constitute a breach of undertaking and an act of professional misconduct.
29In June 2021, the PHP terminated the April 2017 contract because of the registrant’s non-compliance, including receipt of a number of positive screening tests. The PHP’s Clinical Advisory Panel was concerned with Dr. Jayaraman’s pattern of unexplained toxicology results, and agreed that the PHP could not provide a robust monitoring program for him. The PHP noted unspecified “dynamics in the rigour of its monitoring program that had been a challenge for Dr. Jayaraman.”
30In December 2021, the College proceeded for a third time with inquiries into the registrant’s capacity, and directed him to submit to a medical examination. In April 2022, the independent medical examiner (IME) concluded that Dr. Jayaraman met the criteria for mild alcohol use disorder and a substance use disorder in sustained full remission.
31Once again, in order to resolve the capacity inquiry, the ICRC accepted the November 2022 undertaking from Dr. Jayaraman that is central to this hearing.
32In January 2023, the ICRC required the registrant to appear so that he could be cautioned with respect to diligently following PHP contracts and College undertakings. However, the breaches that led to this Tribunal referral followed, occurring between April 2023 and September 2024.
33In March 2024, the ICRC proceeded with a fourth inquiry into Dr. Jayaraman’s capacity. Following a May 2024 assessment, the independent medical examiner diagnosed him with mild alcohol use disorder and a substance use disorder in sustained remission. Once again, in September 2024, the ICRC resolved the capacity inquiry by accepting a further undertaking from Dr. Jayaraman. This time, the undertaking required the registrant to cease practice if he breached any of its provisions.
34The registrant breached the September 2024 undertaking in November 2024 by consuming alcohol, and in January and February 2025, by consuming alcohol and receiving several positive alcohol screenings.
35Ultimately, the College directed Dr. Jayaraman to cease practice in accordance with his undertaking in February 2025. He has not returned to practice since then, but he consumed alcohol and received positive alcohol screenings several times between March and August 2025.
36It is clear from this chronology that the registrant has no prior disciplinary history, but his multiple interactions with the College and its regulatory concerns leave no doubt that Dr. Jayaraman knew or ought to have known about the meaning and importance of his undertaking, and that it was incumbent on him to abide by signed obligations, which in most cases enabled him to avoid more formal proceedings before the present hearing.
37Dr. Jayaraman has several mitigating factors in his favour. He showed acknowledgment, remorse and understanding by admitting his misconduct. His agreement on all issues before us facilitated a short hearing and spared the College and potential witnesses expense and inconvenience.
38During its penalty submissions, the College argued that the registrant’s professional misconduct “cannot entirely be attributed or connected to health concerns,” pointing to “conduct and personality issues” that were diagnosed in the registrant’s May 2024 independent medical examination. The registrant, on the other hand, argued that the non-compliance was “complicated by a personal health issue,” which was not the sole cause. He did not put forward his health to excuse his conduct.
39The parties’ ASF does not contain sufficient evidence to allow us to reach any conclusion on the reasons for Dr. Jayaraman’s non-compliance that led to this misconduct referral. There is no specific information about the linkage, if any, between Dr. Jayaraman’s repeated failures between April 2023 and September 2024 to adhere to the agreed conditions in his undertaking, and his ongoing medical condition during that period. We did not receive the IME report, and a general statement in the ASF on penalty about personality traits having “played a role in lack of compliance” does not give us sufficient evidence.
40Moreover, the parties only briefly referred to the legal implications, if any, of the reasons for Dr. Jayaraman’s breaches of his 2022 undertaking. There was no suggestion, for example, that his non-compliance being “entirely…attributed or connected to health concerns” or “complicated by a personal health issue” should be the operative test for purposes of penalty. The parties provided a decision in the criminal context, R. v. Barham 2014 ONCA 797, in which the Court of Appeal indicated that for a condition to be a mitigating factor, there had to be a “link between those conditions and the commission of the offences in question.” Given the additional context of this hearing – a joint submission based on ASFs on liability and penalty – and the limited scope for Tribunal inquiry into the parties’ agreement, this is not a case in which we can say anything definitive about the registrant’s state of mind or the reason for his non-compliance.
41The parties’ joint book of authorities provided us with three cases to indicate a proper range of penalties for breaches of undertakings, although two of them followed joint submissions, which diminishes their precedential impact. In all of the cases, the Tribunal ordered the delivery of a reprimand and a suspension; two of the decisions imposed terms, conditions and limitations as well.
42College of Physicians and Surgeons of Ontario v. Egles, 2015 ONCPSD 18 involved additional types of misconduct beyond the several breaches of one undertaking that we see in Dr. Jayaraman’s case. Dr. Egles’ misconduct, for which the Tribunal accepted a joint submission for a two-month suspension, included dishonestly writing a prescription and working while prohibited by the PHP contract. While there was a history of non-compliance, it was not as extensive as Dr. Jayaraman’s. In College of Physicians and Surgeons of Ontario v. Sweet, 2012 ONCPSD 11, the registrant received a four-month suspension. In three prior proceedings, he had admitted professional misconduct, including several breaches of Tribunal orders, and he had received progressively increasing penalties including a two-month suspension.
43The third case, College of Physicians and Surgeons of Ontario v. Fenton, 2020 ONCPSD 11, was a contested matter in which the registrant repeatedly breached a 2016 undertaking to meet regularly with his psychiatrist, and a 2017 Tribunal order to take various educational courses. He also ignored College correspondence, failed to remedy his breaches and repeatedly deflected responsibility for his actions. In the face of a College request for revocation, he did not have the mitigating benefit of showing acknowledgment and insight, as Dr. Jayaraman did, through an admission or a joint submission. Dr. Fenton received a nine-month suspension, together with extensive terms, conditions and limitations on his certificate of registration including supervision and monitoring of his practice.
44In Dr. Jayaraman’s case, the agreed four-month suspension is within the appropriate range of penalties. The suspension emphasizes his and every registrant’s obligation of strict compliance with undertakings made to the College, where adherence is important to the public interest, and to public confidence in the medical profession and its self-regulation. The reprimand we delivered to Dr. Jayaraman demonstrated the panel’s disapproval of his actions and the serious consequences of breach of such agreements.
45The parties’ joint submission also promotes public confidence and Dr. Jayaraman’s continued rehabilitation by requiring his enrolment in a College-approved health monitoring program and compliance with its recommendations and terms of continued enrolment, failing which his certificate of registration may again be suspended.
46Under the Anthony-Cook test, we therefore accepted the parties’ joint penalty submission.
47We also made the agreed tariff costs order, awarding the College costs of $6,000 for a half day hearing.
Order
48We made the following order:
Penalty
The Tribunal requires the registrant to appear before the panel to be reprimanded.
The Tribunal directs the Registrar to:
a. Suspend the registrant’s certificate of registration for four (4) months commencing February 19, 2026 at 12:01 a.m.
b. Place the following terms, conditions and limitations on the registrant’s certificate of registration effective February 19, 2026 at 12:01 a.m.:
i. The registrant shall enrol in a health monitoring program acceptable to and approved by the College (“health monitoring program”), or such other program as may be agreed upon by the College, and will abide by the recommendations and terms and conditions of his continued enrolment made by any health monitoring program or other program as may be agreed upon by the College, failing which the College may immediately suspend Dr. Jayaraman’s certificate of registration until Dr. Jayaraman provides proof, satisfactory to the College, of his enrolment in a health monitoring program or such other program as may be agreed upon by the College; and,
ii. The registrant shall cooperate with the College and in any manner requested by the College for the purpose of monitoring his compliance with this Order.
Costs
- The Tribunal requires the registrant to pay the College costs in the amount of $6,000.00 by March 20, 2026.