ONTARIO PHYSICIANS AND SURGEONS DISCIPLINE TRIBUNAL
Tribunal File No.: 25-026
BETWEEN:
College of Physicians and Surgeons of Ontario
College
- and -
Zaira Azher
Registrant
FINDING AND PENALTY REASONS
Heard: February 24, 2026
Panel:
Raj Anand (panel chair)
Baraa Achtar (physician)
Jill Cross (public)
Joanne Nicholson (physician)
Linda Robbins (public)
Appearances:
Sayran Sulevani, for the College
Monika Steger and Amanda Smallwood, 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
1The registrant Dr. Zaira Azhar has been registered to practise in Newfoundland and Labrador since 2010, and in Ontario since 2012.
2In December 2024, the Adjudication Tribunal of the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) found that Dr. Azher had engaged in acts of professional misconduct. After receiving a complaint by a patient, she altered the medical record of that patient by making numerous revisions to the chart notes without dating her revisions or documenting why she made them. When she responded to the complaint, Dr. Azher misled the CPSNL by providing the altered record without disclosing the changes she had made.
3The CPSNL Adjudication Tribunal imposed a one month suspension, as well as a requirement to complete professional development courses in record-keeping and professional ethics. Relying on that finding, the CPSO then referred allegations of professional misconduct to the OPSDT.
4At our hearing, the registrant admitted that by virtue of the Adjudication Tribunal finding in another jurisdiction, she had also engaged in an act of professional misconduct under s. 51(1)(b) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, SO 1991, c. 18 (Code), as well as disgraceful, dishonourable or unprofessional conduct.
5We made that finding, and we also accepted the parties’ joint submission and imposed a two-month suspension, together with delivery of a reprimand at the hearing.
6These are our reasons.
Professional misconduct
7The registrant is a family physician who received her certificate of registration from the CPSO on April 11, 2012. She has also been licensed to practise in Newfoundland and Labrador since July 1, 2010.
8On November 15, 2021, a patient in Newfoundland and Labrador made a complaint to the CPSNL about Dr. Azher’s care. The registrant received notice from the CPSNL on December 19, 2021. The complaint was ultimately dismissed by the CPSNL’s Complaints Authorization Committee.
9Between December 26, 2021 and January 7, 2022, Dr. Azher accessed her electronic medical record (EMR) system at least once a day on seven different days. During that time she made at least one modification to each of the records for the patient’s nine clinic appointments between January 2018 and November 2021. Dr. Azher added, deleted or replaced portions of the text, sometimes several times in the same record.
10On February 1, 2022, Dr. Azher submitted a written response to the CPSNL, enclosing the altered medical records without disclosing the changes she had made.
11In that response, the registrant quoted a passage from the medical record, and made the following misleading statements:
a. “While I have a general recollection of my history with [the patient], I have relied primarily on my records in describing my involvement with [the patient]”; and
b. “I have no specific recollection of my treatment discussions with [the patient] in late 2018 and early 2019. As such, I am relying on what is documented in my medical records for that time period.”
12An audit trail obtained during the investigation revealed that the records had been amended after Dr. Azher was notified of the complaint. The CPSNL prepared comparison charts, which the parties provided to us, summarizing the registrant’s initial clinical notes and her subsequent edits. One chart shows a comparison of the initial and amended versions for each visit, while the other details the date, time and content of each amendment to the clinical notes.
13At the Adjudication Tribunal, the CPSNL and Dr. Azher submitted an agreed statement of facts and joint penalty submission. The registrant admitted that she had engaged in professional misconduct and conduct deserving sanction by amending the patient’s medical records without retaining any indication of the previous records or the nature and date of the amendments. She also admitted making a misrepresentation by submitting altered records and claiming they were accurate.
14The Adjudication Tribunal accepted the parties’ joint submission and ordered a reprimand, a one month suspension, completion of continuing professional development on medical record-keeping and professional ethics, and costs of $10,000 payable to the CPSNL. Dr. Azher completed the penalty terms and provided us with copies of the certificates of completion.
15Based on this evidence, the registrant admitted, and we found, that she engaged in an act or omission that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional under para 1(1)33 of Ontario Regulation 856/93 made under the Medicine Act, 1991, SO 1991, c. 30 (Professional Misconduct Regulation).
16We also accepted her admission that the governing body of a health profession outside Ontario had found she engaged in an act of professional misconduct (in this case, falsifying a medical record relating to her practice) that would be an act of professional misconduct as defined in the regulations (in this case, para 1(1)16 of the Professional Misconduct Regulation).
Penalty and costs
17At the hearing, we accepted the parties’ joint submission, comprising a two month suspension and delivery of a reprimand. After reviewing the parties’ penalty submissions, we concluded that the joint submission did not cross the high bar of 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.
18In our view, the proposed penalty meets the overriding objectives of maintaining public confidence in the medical profession and its self-regulation in the public interest. The joint submission promotes public protection and serves the interests of deterring Dr. Azher and other registrants from engaging in a serious form of misconduct.
19Diligent and honest record-keeping by registrants is essential to safe and competent health care, and the suspension, together with the reprimand that Dr. Azher received from our panel, underline the importance of professional integrity and the profession’s and the public’s abhorrence of what took place here.
20At the same time, the penalty is proportional to the circumstances. Dr. Azher has already served a one month suspension in Newfoundland and Labrador, and she has also completed education on record-keeping and professional ethics that will promote her rehabilitation. She has facilitated the hearing through her admission and joint submission, and her cooperation has reduced unnecessary time, cost and inconvenience for the College and all participants, including potential witnesses. Her remorse and acknowledgment of her misconduct are significant mitigating factors to be taken into consideration in any penalty determination.
21The parties jointly submitted three Tribunal decisions involving record-keeping and honesty issues, as well as findings in another jurisdiction. The registrants in all three cases admitted or did not contest allegations of professional misconduct and made joint submissions on penalty, which reduces their precedential value. Though the cases also relied on different mitigating and aggravating circumstances, together they suggest a range of one to three month suspensions as penalties in roughly similar circumstances.
22In College of Physicians and Surgeons of Ontario v. Fiorillo, 2006 ONCPSD 15, the registrant altered medical records after receiving a patient complaint and submitted them to the College without disclosing the changes he had made. He received a three month suspension, two months of which was suspended if he completed ethics and record-keeping courses.
23College of Physicians and Surgeons of Ontario v. Price, 2016 ONCPSD 30 also involved altering medical records and misleading the College about the timing of the entries the physician had made. Dr. Price was well aware of his obligations, since he had been cautioned in an earlier investigation about record-keeping, and required to take a remedial course. He received a three month suspension.
24College of Physicians and Surgeons of Ontario v. Abrahim, 2022 ONPSDT 1 featured a complaint against the physician in Florida, and regulatory findings against him in both North Carolina and Ontario for failing to disclose the Florida complaint. The Tribunal made the same findings that we have reached in Dr. Azher’s case: disgraceful, dishonourable or unprofessional conduct; and engaging in professional misconduct in another jurisdiction that would also constitute professional misconduct in Ontario. There was no intentional misleading by Dr. Abrahim, but there were six consecutive annual failures to inform the CPSO about the Florida complaint. The OPSDT imposed a two month suspension as well as a requirement to complete medical ethics instruction.
25In our view, the general range of penalties ordered by the Tribunal supports the jointly submitted penalty in Dr. Azher’s case. She will receive a significant Ontario suspension, and she has already completed the educational aspect of the Newfoundland and Labrador penalty order.
26We also accepted the parties’ joint submission on the appropriate costs order, which requires the registrant to pay the College the standard tariff rate for a half day hearing.
Order
27We 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 two (2) months commencing on February 25, 2026 at 12:01 a.m.
Costs
- The Tribunal requires the registrant to pay the College costs in the amount of $6,000 by March 24, 2026.