When a Letter Arrives From the CPSO
This page is for physicians practising in Ontario who have been told that the CPSO has received a complaint, has opened an investigation, or intends to limit their practice while a matter is investigated. It may also help physicians who have been referred to a discipline hearing and want to understand what lies ahead.
Illustrative example, not an actual CPSO letter
“The College has received a complaint from a former patient about the care you provided during appointments in the spring. A copy of the complaint is enclosed. You may provide a written response, together with the patient’s complete medical record, for the Inquiries, Complaints and Reports Committee to consider.”
Not every matter starts with a patient. The Registrar can appoint investigators when there are reasonable and probable grounds to believe a physician has committed professional misconduct or is incompetent, with the approval of the Inquiries, Complaints and Reports Committee, or without that approval in an emergency where patients may be at risk (Code, s. 75). The results of that kind of investigation go to the committee as a report rather than a complaint. A hospital that restricts or revokes a physician’s privileges for reasons of professional misconduct, incompetence or incapacity must also report that to the College within 30 days (Code, s. 85.5).
Who Investigates and Who Decides
- Regulator
- The College of Physicians and Surgeons of Ontario, continued under the Medicine Act, 1991. Its complaint, investigation and discipline procedures are set out in the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991 (“the Code”), which applies to every regulated health profession in Ontario.
- Who investigates
- College investigators. In a Registrar’s investigation, physicians must co-operate fully with the investigator (Code, s. 76(3.1)).
- Who decides at the investigation stage
- A panel of the Inquiries, Complaints and Reports Committee (ICRC). The panel reviews the investigation file, the physician’s written submissions and the physician’s prior College history, then decides what happens next (Code, s. 26).
- Who holds hearings
- Discipline hearings are conducted by the Ontario Physicians and Surgeons Discipline Tribunal (OPSDT), which has its own Rules of Procedure and Practice Directions. Concerns that a physician is incapacitated by a health condition go to the Fitness to Practise Committee instead.
- Who reviews or hears appeals
- The Health Professions Appeal and Review Board (HPARB) reviews many ICRC decisions on complaints. Appeals from discipline and fitness to practise decisions go to the Divisional Court.
Key timelines in the Code
- The Registrar must notify you of a complaint or report within 14 days of receiving it, and include copies of your prior College decisions, other than decisions that an earlier complaint was frivolous, vexatious or an abuse of process (Code, s. 25(6)).
- You may make written submissions to the committee within 30 days of receiving that notice. The committee can set a shorter period if it believes, on reasonable and probable grounds, that your conduct exposes or is likely to expose patients to harm (Code, s. 25.2).
- The committee is expected to dispose of a complaint within 150 days. If it does not, the Registrar must give the complainant a new expected date no more than 60 days later (Code, s. 28).
- With both the complainant’s and your consent, the Registrar can refer a complaint to alternative dispute resolution, but not if the complaint involves an allegation of sexual abuse or has already been referred to discipline (Code, s. 25.1).
Your practice, your clinic and your hospital
The Code regulates you as an individual registrant. Clinic owners, health profession corporations and hospitals have their own obligations, and a hospital privileges dispute runs separately under the Public Hospitals Act, with hearings before HPARB. A College matter and a hospital or employment matter can run at the same time, and what you say in one may be seen in the other.
Common Issues in Physician Investigations
Standard of care and clinical judgment
Allegations of a missed or delayed diagnosis, inadequate follow-up of abnormal test results, or a referral that was never completed. The College often obtains an opinion from a physician in the same field about whether the care met the expected standard.
Prescribing
Concerns about opioids and other controlled substances, early or repeated refills, prescribing without an adequate assessment, or prescribing for yourself or family members. Prescribing concerns can lead to a Registrar’s investigation even when no patient has complained.
Medical records
Incomplete, illegible or late notes, and especially records changed after a complaint was made. Electronic records keep audit trails that show when an entry was created or edited. A properly dated addendum is very different from an altered entry.
Communication and professionalism
Complaints about dismissive or disrespectful communication, how a physician–patient relationship was ended, social media posts, or conduct toward colleagues and staff.
Boundary violations and sexual abuse allegations
These are treated as the most serious category. Alternative dispute resolution is not available, interim restrictions are more likely, and certain findings require revocation of the certificate of registration (Code, ss. 25.1, 51(5)).
CPSO policies set out the College’s expectations in many of these areas. Check the version of any policy that was in force at the time of the events, as well as the current version, on the CPSO website.
What Can Happen Next
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Complaint or Registrar’s investigation
After investigating and considering your submissions, an ICRC panel may do one or more of the following (Code, s. 26):
- take no further action;
- give advice or recommendations, or take other action consistent with the legislation;
- require you to complete a specified continuing education or remediation program (SCERP);
- require you to appear before a panel to be cautioned;
- refer specified allegations of professional misconduct or incompetence to the Discipline Tribunal; or
- refer you for incapacity proceedings.
If the panel considers a complaint frivolous, vexatious, made in bad faith, moot or an abuse of process, it must give notice and allow 30 days for written submissions before declining to act (Code, s. 26(4)–(5)).
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Interim restrictions
At any time after a complaint is received or an investigator is appointed, the committee can order an interim suspension or terms, conditions or limitations on your certificate if it believes your conduct exposes or is likely to expose patients to harm or injury (Code, s. 25.4(1)). You must normally receive notice and at least 14 days to make written submissions first (s. 25.4(6)). In urgent cases the order can be made without notice, and you can make submissions while it is in place (s. 25.4(7)). An interim order lasts until it is varied or the matter is finally resolved (s. 25.4(4)).
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Discipline hearing
A hearing is a formal legal proceeding with evidence and witnesses. The panel decides whether professional misconduct or incompetence is proven (Code, ss. 51(1), 52). If misconduct is found, the panel may revoke or suspend your certificate, impose terms, conditions and limitations, order a reprimand, or order a fine of up to $35,000 (s. 51(2)). Findings of sexual abuse carry mandatory orders, including revocation for the conduct listed in s. 51(5).
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Review or appeal
HPARB review. Either the complainant or the physician may ask HPARB to review an ICRC decision on a complaint, except a decision to refer allegations to discipline or to refer the physician for incapacity proceedings (Code, s. 29(2)). The request must be made within 30 days after receiving the notice of the right to request a review that comes with the decision (s. 29(3)). HPARB cannot extend that time by more than 60 days (s. 29(4)).
Divisional Court appeal. A party to a discipline or fitness to practise hearing may appeal to the Divisional Court on questions of law, fact or both (Code, s. 70). Some orders take effect immediately even if appealed, including orders based on incompetence, incapacity or certain sexual abuse findings, and orders in matters where an interim order was already in place (ss. 25.4(5), 71, 71.1). The time limit for starting an appeal comes from the court’s rules and should be confirmed as soon as a decision is received.
A complaint is not a finding. Most matters are resolved at the ICRC stage. An interim order is a temporary, risk-based measure made before the facts are decided. Only a discipline panel, after a hearing, can find professional misconduct or incompetence.
Checklist: Responding to a CPSO Notice
Documents to gather
- The College’s letter, with the envelope or email showing when it arrived
- The complete chart for each patient involved, including lab and imaging results, consult letters and portal messages
- EMR audit logs for the relevant entries
- Appointment and billing records showing when the patient was seen
- Clinic or hospital policies, call schedules and any incident reports from the time
- Any prior College decisions sent with the notice
- Your CV and continuing professional development records
Details to check in the notice
- Is this a complaint or a Registrar’s investigation? Review rights differ.
- The date your 30-day submission period started, and whether it has been shortened
- Whether an interim order is proposed, and when submissions are due
- Whether investigators want records, an interview or access to your office
- Whether alternative dispute resolution has been offered
- Exactly which patients, dates and allegations are identified
Rules and resources to consult
- Health Professions Procedural Code, ss. 25–29, 51–52, 70–71 and 75–76
- The Medicine Act, 1991 and its regulations
- CPSO policies that relate to the allegations
- OPSDT Rules of Procedure and Practice Directions, if the matter is referred to a hearing
- HPARB’s Consolidated Rules of Practice and Procedure (in effect May 4, 2026), if you are seeking or responding to a review
- Your professional liability protection provider, if you have one, to ask what assistance is available for College matters
Do not change existing records. If something needs clarifying, add a clearly dated addendum and keep the original entry intact.
Frequently Asked Questions
Do I have to respond to a complaint?
The Code says you may make written submissions (s. 25.2), but the panel will decide on whatever information it has, so a silent file rarely helps. A Registrar’s investigation is different: physicians must co-operate fully with the investigator (s. 76(3.1)).
Will the complaint appear on the CPSO public register?
The Code requires the register to show cautions, SCERPs, acknowledgements and undertakings, and matters referred to discipline together with the allegations (s. 23(2)). College by-laws can add further items. Check the register rules that apply to your outcome before agreeing to any resolution.
Can I keep practising while the College investigates?
Usually, yes. Your certificate is unaffected unless the committee makes an interim order, you give an undertaking that limits your practice, or another body, such as a hospital, restricts your privileges.
I disagree with a caution or SCERP. What can I do?
If the decision came from a complaint, you can ask HPARB to review it within 30 days after receiving the notice of your right to request a review (s. 29(3)). The complainant has the same right if the committee takes no action. A referral to discipline cannot be reviewed by HPARB (s. 29(2)).
What is a SCERP?
A specified continuing education or remediation program: a course, coaching, practice monitoring or similar remediation that the committee can require instead of, or as well as, other outcomes (s. 26(3)). It is not a disciplinary finding, but it appears on the public register.
Sources
Statutory references are to the provisions listed below, as consolidated on e-Laws when this page was prepared.
- Regulated Health Professions Act, 1991, S.O. 1991, c. 18, Schedule 2 (Health Professions Procedural Code), ss. 23, 25–29, 51–52, 70–71, 75–76, 85.5 — e-Laws consolidation period beginning January 1, 2026; checked November 10, 2026.
- Medicine Act, 1991, S.O. 1991, c. 30, s. 5 — e-Laws consolidation period beginning January 1, 2026; checked November 10, 2026.
- CPSO, “CPSO Committees” (ICR Committee; discipline proceedings conducted by OPSDT) — Checked November 10, 2026.
- Ontario Physicians and Surgeons Discipline Tribunal (Rules of Procedure, Practice Directions) — Linked from the CPSO committees page; the tribunal site could not be loaded for this draft.
- Health Professions Appeal and Review Board (role; Consolidated Rules of Practice and Procedure in effect May 4, 2026) — Checked November 10, 2026.