The legal force of the policies
 The Policies have been adopted by the CPSO as policies of
general application. The Policies establish broad expectations of
physician behaviour and are intended to have normative force.
They articulate what the CPSO believes the tenets of medical
professionalism require independently of CPSO policy. There is
no issue that the Charter applies to the Policies.
 However, the Policies have not been adopted pursuant to
the authority granted to the CPSO under the RHPA to enact regulations. Nor are the Policies a “code, standard or guideline relating to standards of practice of the profession” adopted pursuant
to s. 95(1.1) of the Code of which compliance is required pursuant
to such provision. Accordingly, non-compliance with the Policies is
not a specific act of professional misconduct under the professional misconduct regulation of the CPSO, being Professional
Misconduct, O. Reg. 856/93. The Policies also do not provide for a
penalty for non-compliance with their terms and no mandatory
consequences flow from their breach.
 This raises the applicability of the Policies in respect of any
allegation of professional misconduct involving a breach of a provision of the Policies by a physician. Whether a physician’s
actions amount to such misconduct would require a determination by the Discipline Committee of the CPSO, having regard to
the standards of practice and professionalism. The Policies may
be used as evidence of such professional standards, and of the
conduct expected of a physician in particular circumstances, in
support of an allegation of professional misconduct. However, a
physician remains entitled to seek to lead contrary evidence and
to argue that failure to adhere to the Policies’ guidance did not,
on the particular facts, constitute professional misconduct.
The application of the effective referral requirements of the
policies in practice
 Before proceeding, it is important to add some clarity to
the content of the effective referral requirements of the Policies.
In this respect, two features of the Policies are significant. First,
the Policies do not require that a referring physician provide
a formal letter of referral to, and arrange an appointment for
a patient with, another physician. The CPSO says that the intent
of the Policies is to ensure only that patients are not left to finding
a willing physician on their own without any assistance from the
physician from whom they first sought care. Accordingly, the spirit
of the requirements is that the physician take “positive action”
to connect a patient with a physician, another health care