Danger to Public Health or Public Safety

This section contains policy, procedures and guidance used by Immigration, Refugees and Citizenship Canada staff. It is posted on the Department’s website as a courtesy to stakeholders.

According the Regulations, before concluding whether a foreign national's health condition is likely to be a danger to public health or public safety, a medical officer who is assessing the foreign national's health condition shall consider any report made by a health practitioner or medical laboratory with respect to the foreign national, and:

  • For Public Health:  the communicability of any disease that the foreign national is affected by or carries; and the impact that the disease could have on other persons living in Canada. (R31(b-c))
  • For Public Safety: the risk of a sudden incapacity or of unpredictable or violent behaviour of the foreign national that would create a danger to the health or safety of persons living in Canada. (R33(b))

Overview

Conditions that are likely to be a danger to public health

Active Pulmonary Tuberculosis (TB) and untreated Syphilis are considered a danger to public health.  If the foreign national has either or both of these conditions, they will likely be found inadmissible on the grounds of danger to public safety, unless the foreign national is treated according to Canadian standards. Although the Human immunodeficiency virus (HIV) is not considered a danger to public health, CIC is committed to public health risk mitigation, and provides foreign nationals with HIV with important information that can reduce the risk of transmission.

Conditions that are likely to be a danger to public safety

Health conditions that are likely to cause a danger to public safety include serious uncontrolled and/or uncontrollable mental health problems such as:

  • certain impulsive sociopathic behaviour disorders;
  • some aberrant sexual disorders such as pedophilia;
  • certain paranoid states or some organic brain syndromes associated with violence or risk of harm to others;
  • applicants with substance abuse leading to antisocial behaviours such as violence, and impaired driving; and
  • other types of hostile, disruptive behaviour.
Wealth of the foreign national is not a relevant factor

Unlike excessive demand cases, the wealth of the foreign national is not a relevant factor for the visa/immigration officer to consider when the foreign national has a health condition that likely to cause a danger to public health or public safety:

“The chief responsibility of the medical officer in such cases is to assess the danger to public health or safety.  Wealth, regardless of how rich the applicant is, is irrelevant to this assessment.” (Hilewitz v. Canada, 2005 SCC 57, paragraph 88)

Instructions related to Procedural Fairness (danger to public health and public safety)

Note: These instructions also apply to cases of excessive demand on health services (other than for out-patient medications) since ability and willingness to defray costs are not relevant factors.

Visa/immigration officers are required to exercise procedural fairness. This includes stating the case to be met and reviewing all the information provided by the applicant in a fair and impartial manner. The applicant in turn is responsible for providing all the information requested by the CIC officer and any additional information which they would like to have considered. The onus is always on the applicant to provide the information necessary to overcome a potential decision of inadmissibility.

Medical and visa/immigration officers must consider all supporting evidence presented by an applicant in making a decision, and this consideration must be documented on file.  

Visa/immigration and medical officers should work closely together during the process and document this collaboration. If the immigration officer concludes that a medical opinion is unreasonable, incomplete, or based on insufficient information, the officer should seek clarification from the medical officer.  The medical officer should also be advised of the final decision.

Recording the decision and document retention

All steps in the decision-making process must be documented in the applicable electronic system (CAIPS, GCMS, FOSS or CPC), including all communications, the applicant’s representative, and the medical section.

Copies of the applicant’s response including all supporting documents and information, must be sent to the medical officer. The originals must remain in the immigration file.

Before entering a medical-admissibility decision, visa/immigration officers should always review the medical opinion, along with the material received from the applicant, and record the review process in the CAIPS, GCMS, FOSS or CPC system, as applicable.

Instructions for medical officers
  1. When a medical officer decides that a health condition will likely cause a danger to public health or public safety, the medical officer will:
    • write a medical narrative on the IMM 5365B Medical Notification; and
    • code the medical file as:
      • M4 (danger to public health);
      • M6 (danger to public safety);
      • M46 (danger to public health and public safety); or
      • M45/M56 if the foreign national has a health condition that might reasonably cause an excessive demand in addition to a condition that is likely to cause a danger to public health and/or public safety.

        Note: For M45/M56 cases, the applicant’s ability and willingness to mitigate excessive demand does not apply to the medical conditions which are likely to cause a danger to public health or public safety.

  2. When reviewing the information submitted in response to the procedural fairness letter, the medical officer:
    • will acknowledge receipt of the applicant’s response, and keep a confirmation of receipt in the medical file;
    • will review the entire medical file, as well as the newly submitted material, before an opinion is provided and documented in the record;
    • may take into consideration a variety of factors, except financial factors since the ability and willingness to mitigate excessive demand costs is irrelevant to health conditions that are likely to cause a danger to public health or public safety;
    • determine whether the health condition of the applicant would still likely cause a danger to public health or public safety; and
    • provide a medical opinion to the visa/immigration officer, who will review it and record the process in the CAIPS, GCMS, FOSS or CPC system.

      Note: The onus is always on the applicant to provide the information necessary to overcome a decision of inadmissibility. The information provided by the applicant must be of a quality and standard that permits an appropriate assessment.

Instructions for visa/immigration officers
  1. Upon receipt of this opinion from the medical officer that the foreign national has a health condition that is likely to cause a danger to public health or public safety, the visa/immigration officer will:
    • forward or send the Procedural Fairness Letter (medical refusal) and the relevant sections of the Immigration and Refugee Protection Regulations to the applicant. This letter invites the applicant to provide the additional information required to overcome the finding of inadmissibility.

      Note: The applicant may then decide to:

      • accept the medical opinion and not respond to the procedural fairness letter; or
      • challenge the medical opinion.
  2. In cases where applicants contact the office prior to the end of the given time-frame to indicate that they intend to make submissions but require additional time (to gather the required information), the visa/immigration officer should review the request and consider granting an extension.
  3. Upon receipt of the applicant’s response to the procedural fairness, the visa/immigration officer will:
    • review the response to the procedural fairness letter;
    • send a copy of the pertinent medical information in the applicant’s response to the medical officer; and
    • keep a confirmation of the medical officer’s receipt of the applicant’s response in the immigration file.

Procedural fairness outcomes for different scenarios

The applicant does not respond to the procedural fairness letter

The visa/immigration officer will proceed to finalize the application based on the existing information on file.

The applicant challenges the medical opinion, the medical office may do one of the following:
  1. the medical officer withdraws the opinion of inadmissibility and requests additional information when the applicant’s submission are insufficient to reach a medical opinion;
    • The applicant will have provided information that leaves the medical officer in doubt regarding the initial medical assessment; however, the applicant has provided insufficient information to make a final decision. The medical officer will withdraw the current opinion of inadmissibility and request additional information from the applicant in order to reach a new medical assessment.
      OR
  2. the medical officer maintains the original medical assessment;
    • The applicant will not have provided information sufficient to overcome the initial medical assessment. The medical officer will communicate to the visa/immigration officer that the original medical assessment remains in effect.
    • The visa/immigration officer finalizes the application based on the existing information on file, considering all the circumstances of the case and, if appropriate, the case may be refused based on inadmissibility on health grounds.
      OR
  3. the medical officer reviews the applicant’s submission and issues a new medical opinion of inadmissibility;
    • The applicant is notified of the new inadmissibility, and applicable procedural fairness procedures apply.
      OR
  4. the medical officer determines that the applicant is no longer inadmissible
    • The applicant or applicant’s family member is no longer inadmissible and the file proceeds as per standard procedures.
The applicant does not challenges the medical opinion but submits a declaration of ability and intent as well as supporting documentation to mitigate the excessive demand on Canadian health and social services:

Ability and intent to mitigation the excessive demand on Canadian health and social services is irrelevant for health conditions that are likely to cause a danger to public health or public safety. Therefore, the visa/immigration officer will proceed to finalize the application based on the existing information on file.

Procedural Fairness Algorithm

Procedural Fairness Algorithm described below
  1. Medical Officer sends to Immigration/Visa Officer:
    • Medical opinion of danger to public health and/or public safety; or excessive demand on health services (other than out-patient medication)
  2. Immigration/Visa Officer sends applicant:
    • Procedural Fairness Letter (medical refusal)
    • Immigration and Refugee Protection Regulations
      Applicant responds within 60 days
      • Applicant challenges medical opinion
      • Immigration/Visa Officer and/or Medical Officer: Review all submitted material
        1. Insufficient information?
          • Medical officer: Withdraws the opinion of inadmissibility and requests additional information
        2. Challenge unsuccessful?
          • Medical officer: maintains original assessment
          • Inadmissible A38(1)(a-c)
          • Refusal Letter
            Or
          • Medical officer: issues new medical opinion of inadmissibility
          • New medical inadmissibility
          • New procedural fairness Letter
        3. Challenge successful?
          • Medical officer: determines that the applicant may no longer be inadmissible
          • Process toward finalization
      Applicant does NOT respond within 60 days
      • InadmissibleA38(1)(c)
      • Refusal Letter
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