The Complaints Process

One important responsibility of the College of Physicians and Surgeons of Ontario is to respond to concerns and to investigate complaints from members of the public about doctors licensed to practice medicine in Ontario. In all that we do, the College must act first and foremost in the best interest of the public.

The following are answers to commonly asked questions about the College’s complaints process.

What should you do if you wish to file a complaint?

If you have a concern about communication, records, or if you have questions about the treatment you've received, we strongly encourage you to first speak with your doctor or hospital, if possible, before contacting the College. This is often the most direct way to get the answers that you need. If this is not possible or successful, then we urge you to contact the College for assistance.

If your concerns or questions are about the quality or appropriateness of care received, please call our Public Advisory Department at 416-967-2603 or 1-800-268-7096 extension 603. Staff may be able to answer your questions; clarify which questions to take back to your doctor; and/or answer questions about how the health care system works.

If this does not address your concerns, please follow the steps below.

How do you begin the complaints process?

The College must receive your complaint in writing or in another permanent form, such as a tape, film or disk. Please include the doctor's name and address, a description of the events that led to the complaint, the date and location, and any other information that may help the College in its review. A complaint form which may be completed electronically, printed out and mailed to the College is provided here for your convenience.

The patient's relevant personal health information will be obtained as part of the investigation. The patient must sign the consent form to obtain medical records from a hospital, nursing home or other health professionals. When a patient makes a complaint about his/her physician, the physician is permitted, according to Section 43 (1)(b) of Personal Health Information Protection Act, 2004 (PHIPA), to disclose the patient/complainant's medical information to the College for the purpose of the administration of the Regulated Health Professions Act, 1991. Therefore, the patient/complainant/s written consent is not required for the College to obtain personal health information from the physician.

If the complainant is not the patient, a written consent from the patient is required before the physician who is complained about, can disclose personal health records in his/her possession. The consent form which may be completed electronically, printed out, signed and mailed to the College is provided here for your convenience. Link to Patient Consent Form. Link to Trustee Consent Form.

Complaints can be sent by e-mail, and should contain your contact information and your telephone number. After receiving the first e-mail correspondence, we will communicate with you by telephone and/or in writing. All correspondence from us will be sent by regular mail to preserve confidentiality.

Please state clearly your questions or concerns. You can add the names of people who witnessed the events or who may have useful information. We are required to send a copy of your letter to the doctor you are making the complaint about. Once we review your concerns, College staff will contact you either by telephone or letter to discuss your concerns, answer questions, and/or obtain additional information. Where appropriate, we will try to address your concerns.

How are complaints addressed?

College staff often try to answer questions and clear up misunderstandings between patients and doctors.

In order to answer your questions and address your concerns, staff may review your medical records, discuss your concerns with the doctor, and ask him or her to respond to them.

College staff may also arrange to meet with you, and possibly with you and the doctor(s) – perhaps even hospital administrators – to communicate and clarify issues. This gives you the opportunity to tell the doctor and others about your concerns.

This process provides a forum for you to have your concerns heard and acknowledged by the doctor and/or hospital representatives, and is done only with both your and the doctor’s agreement. Occasionally, an improvement to the way in which health care is delivered has come about as a result of these discussions.

What happens if my complaints cannot be addressed?

College staff will begin an investigation on behalf of the Inquiries, Complaints and Reports Committee. The Regulated Health Professions Act (RHPA) sets out the complaints process, including that the doctor will be told that a complaint has been received. The doctor will also be given an opportunity to respond. Following are important steps in the investigation process:

1. Obtaining consent for the release of confidential medical information

Because all medical information is confidential, consent is needed from the person who is authorized to release it, to assist us in our review. A consent form must be signed by one of the following persons: the patient himself/herself; the legal guardian of the patient; the power of attorney for personal care; or the executor of the patient's will. Consent is required to obtain information from the doctor who is the subject of the complaint, other doctors or health care professionals, and health care facilities.

When a patient makes a complaint about his/her physician, the physician is permitted, according to Section 43 (1)(b) of Personal Health Information Protection Act, 2004 (PHIPA), to disclose the patient/complainant's medical information to the College for the purpose of the administration of the Regulated Health Professions Act, 1991. Therefore, the patient/complainant/s written consent is not required for the College to obtain personal health information from the physician.

Written consent from the patient is still required to obtain personal health information from other doctors, health care professionals and health care facilities.

Even without consent from the appropriate person, the Inquiries, Complaints and Reports Committee of the College (whose task it is to direct the investigation) can obtain medical information under the authority of a Registrar's investigation, if it is thought to be important.

2. Requesting a response from the doctor

Staff may ask the doctor to respond in writing to your complaint. This is an opportunity for the doctor to provide an explanation of his or her care or conduct.

3. Obtaining relevant medical information

Any other relevant medical information needed to conduct a complete investigation will be obtained. This may include asking other physicians and health care facilities for information.

4. Review and decision by the Inquiries, Complaints and Reports Committee

When the pertinent information has been obtained, the documents are submitted for review by the Inquiries, Complaints and Reports Committee. Both you and the doctor will be notified by letter of the date when the Committee will meet. At that time, the Committee decides whether additional information is required or makes a decision if it has enough information to reach a conclusion.

Do you or the doctor meet with the Committee?

The Inquiries, Complaints and Reports Committee is authorized to conduct a review of the documentation only. Neither you nor the doctor are required or allowed to meet with the Committee.

Who sits on the Inquiries, Complaints and Reports Committee?

The Inquiries, Complaints and Reports Committee is made up of physicians and government appointed public members. A panel from among the members of the Committee is selected to direct each investigation, consider the doctor's response to the complaint, and make a reasonable effort to consider all relevant records and documents.

What are the possible outcomes?

When all the information has been reviewed, the Inquiries, Complaints and Reports Committee will decide to do one of the following:

  • take no further action, if the doctor's conduct or the care provided was appropriate;
  • advise or caution the doctor in writing, if the Committee believes the doctor would benefit from some advice or direction as to how to conduct him or herself in the future;
  • require the doctor to appear before a panel of the Inquiries, Complaints and Reports Committee in Toronto to be cautioned. At that appearance, the Committee will discuss with the doctor the steps it believes the doctor must take to avoid future difficulties. Doctors who are required to appear before the Committee are often asked to prepare for the meeting by making practice changes, reviewing relevant literature or taking other steps;
  • direct or accept the doctor's agreement to participate in training or educational programs to improve his or her practice;
  • refer the doctor to a panel of the Committee if there are concerns about the doctor's health that may be affecting her or his ability to practise;
  • refer the concerns about the doctor to the Discipline Committee; or
  • decide not to investigate because the complaint is frivolous, vexatious, made in bad faith or is an abuse of process.

Are you and the doctor given the Committee's decision?

The Inquiries, Complaints and Reports Committee prepares a written decision that is sent to you and the doctor within six to eight weeks of its meeting unless the matter is referred to the Discipline Committee or the doctor is referred to a panel of the Committee because of concerns about the doctor's health that affect her or his ability to practice.

Am I allowed to appeal the Inquiries, Complaints and Reports Committee's decision?

Almost all complaint decisions of the College's Inquiries, Complaints and Reports Committee can be appealed by you or the doctor to an independent government body, called the Health Professions Appeal and Review Board. The only decisions that cannot be appealed are those in which the matter is referred to the College's Discipline Committee or the doctor is referred to a panel of the Committee because of concerns about the doctor's health. The College sends contact information for the Health Professions Appeal and Review Board with every Inquiries, Complaints and Reports Committee decision.

If the ICRC decision is appealed, the personal health information and other information collected during the investigation must be disclosed to the Health Professionals Review and Appeal Board, which is a public forum.

Does the Inquiries, Complaints and Reports Committee investigate all complaints?

The Inquiries, Complaints and Reports Committee investigates the majority of complaints received.

The law permits the Committee to decline to investigate complaints it considers to be frivolous, vexatious, made in bad faith or an abuse of process. This decision rests solely with the Committee.

In such cases, the Committee provides notice to the complainant and the doctor that it intends not to investigate. Both the complainant and doctor have the right to make written submissions to the Committee within 30 days of being given such notice. If, after considering any written submissions, the Committee is satisfied that a complaint is frivolous, vexatious, made in bad faith or an abuse of process, it will not investigate. Only a very small percentage of complaints meet the requirements for this exception.

As stated above, your concerns may be addressed during the investigative process by the investigator with information from the physician and/or upon review of the medical records. If your concerns are addressed during the investigative process, the Inquiries, Complaints and Reports Committee will decide that no further action is required for the investigation.

Are there limitations to the complaints process?

The College cannot compel a doctor to change his or her opinion or report. Corrections to a medical record may be made by the physician to ensure accuracy of the information and must be done according to the College's policy on Medical Records.

The College cannot provide diagnoses, referrals, treatment recommendations, or direct a patient's care.

The College cannot compel a doctor to apologize (although once a matter is brought to their attention, some doctors do).

The College does not have the authority to award financial compensation.

Is there a time limit to filing a complaint?

There is no time limit, but the College recommends that concerns or complaints be made as soon as possible after the event. The earlier a complaint is received, the fewer problems are encountered in the investigation. For example, it is more likely that relevant documents still exist, witnesses can be more easily located, memories have not faded, and evidence is not missing.

How long does it take to complete the complaints process?

In the vast majority of cases, the process takes from three to 10 months to complete.

Can information gathered by the College be used in Court?

No. In accordance with Section 36(3) of the Regulated Health Professions Act, no report or decision of a proceeding is admissible in a civil proceeding.

Contact the College

If you would like to talk to someone about the care or conduct of a physician or about the complaints process, please contact our Public Advisory department:

Telephone: 416-967-2603 or 1-800-268-7096 ext. 603

E-mail: ir@cpso.on.ca

Mail:

The Registrar
c/o Investigations and Resolutions Department
College of Physicians and Surgeons of Ontario
80 College Street
Toronto, ON, M5G 2E2