Ontario · College of Physicians and Surgeons of Ontario

What Happens During a CPSO Investigation?

9 min readLast updated July 14, 2026

An investigation by the College of Physicians and Surgeons of Ontario can be opened without any patient ever complaining, can restrict your practice before any finding is made against you, and — depending on how it started — may leave you with no right of review at the end. Knowing which kind of investigation you are in, and what the College can and cannot do, is the difference between managing the process and being managed by it.

The first thing to establish: is this a public complaint under section 25, or a Registrar’s investigation under section 75? Your review rights at the end of the process depend on the answer. Contact the CMPA at the outset and ask.

Two ways an investigation starts

Not every CPSO investigation begins with a patient. There are two distinct routes, and the difference between them matters a great deal — not least because it determines whether you will have any right of review at the end.

1. A public complaint

Someone — usually a patient or a family member, sometimes a colleague, employer or another agency — files a complaint. Under section 25(1) of the Health Professions Procedural Code the College must investigate and act on it.

2. A Registrar’s investigation (section 75)

Where the Registrar has reasonable and probable grounds to believe a physician has committed an act of professional misconduct or is incompetent, the Registrar may appoint an investigator under section 75 of the Code. These investigations carry broader powers and often arise from a mandatory report, a hospital, another regulator, media coverage or the College’s own information — not from a complaint at all.

The distinction has real consequences. An ICRC decision arising from a public complaint can be reviewed by HPARB. An ICRC decision arising from a section 75 Registrar’s investigation cannot — there is no statutory right of review, and the only recourse is judicial review in the Divisional Court. Establish early which type of matter you are in.

What investigators can actually do

A College investigator may require the production of records, enter and inspect premises where the practice is carried on, copy documents, and interview you and other witnesses. The Investigations and Resolutions department gathers the material and compiles a report; that report, together with your response, goes to the ICRC panel.

Your duty to cooperate is not a formality. Failing to respond appropriately or within a reasonable time to a written inquiry from the College is itself a basis for a misconduct finding, and the Discipline Tribunal has treated failure to cooperate — and breach of an interim order — as disgraceful, dishonourable or unprofessional conduct in its own right. Cooperation and legal advice are not alternatives: take advice, then cooperate.

Interim orders: the part that can affect you immediately

Most physicians under investigation continue practising normally. But where the ICRC is of the opinion that your conduct exposes, or is likely to expose, patients to harm or injury, it may make an interim order under section 25.4 of the Code — suspending your certificate of registration or imposing terms, conditions and limitations on it while the investigation is still running.

An interim order can remain in place for the duration of the matter, which may be many months. You are entitled to make submissions before one is imposed in most circumstances, and this is a point at which representation is essential.

How long it takes

For public complaints, section 28 of the Code sets a target: the ICRC should dispose of the matter within 150 days of the complaint being filed. That deadline can be extended, and historically it has frequently been missed — a review of the CPSO process found the median time from receipt of a public complaint to decision was closer to 200 days.

Section 75 investigations have no equivalent statutory target and can run considerably longer, particularly where they involve expert review, multiple patients or a parallel police or hospital process.

The investigation is a two-way exchange

Your written response is not filed and forgotten. The complainant will normally be sent your finalised response and given the opportunity to reply to it. Investigators may also interview you and the complainant. Everything gathered goes into the investigator’s report for the ICRC.

Because of that, the tone of what you write matters as much as the content. A response that reads as dismissive of the patient’s experience — even where the clinical care was sound — frequently produces a worse outcome than one that engages seriously with the concern.

How the investigation ends

The ICRC panel reviews the file and decides. It may take no further action, issue advice or recommendations, require you to attend to be cautioned, order a SCERP, accept an undertaking, refer specified allegations to the Ontario Physicians and Surgeons Discipline Tribunal, or refer the matter to the Fitness to Practise Committee where incapacity is in issue.

Except where the matter is referred to discipline or for a capacity inquiry, you will normally receive written reasons for the decision.

Key takeaways

Investigations arise either from a public complaint (s.25) or from a Registrar’s investigation under section 75 — and only the former carries a right of review to HPARB.
Investigators can compel records, inspect premises and conduct interviews. Failing to respond appropriately to a written College inquiry can itself found a misconduct finding.
Under section 25.4 the ICRC can impose an interim suspension or restrictions on your certificate while the investigation is still under way, where patients may be exposed to harm.
The 150-day disposal target in section 28 applies to public complaints and is frequently extended; section 75 investigations have no equivalent target.
Your response is sent to the complainant, who may reply to it — so tone and engagement matter, not just clinical justification.
The ICRC can close the file, advise, caution, order a SCERP, take an undertaking, refer to the Discipline Tribunal, or refer to the Fitness to Practise Committee.

Related courses

Practical, self-paced CPD courses that map onto the issues in this guide. These are educational courses. They are not accredited by the CPSO and are not a substitute for legal advice.

Dealing With a Complaint or Investigation Professionally

How to conduct yourself through a College investigation, on the record and under scrutiny.

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Documentation for Healthcare Professionals

What investigators look for in the chart — and what strong records protect you from.

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Probity and Honesty for Healthcare Professionals

Honesty and candour under investigation. Concealment turns a care issue into a probity issue.

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Professionalism and Professional Standards for Doctors

The professional conduct and standards expected of registered physicians.

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Continue reading: Ontario doctors

How to respond to a CPSO complaint Remediation and reflection for Ontario doctors

Frequently asked questions

How long does a CPSO investigation take?

For a public complaint, section 28 of the Code sets a 150-day target from the date the complaint was filed for the ICRC to dispose of it, though this can be extended and often is — the median has historically run closer to 200 days. Registrar’s investigations under section 75 have no statutory target and can take considerably longer.

What is the difference between a complaint and a Registrar’s investigation?

A complaint comes from a member of the public and the College must investigate it under section 25(1). A Registrar’s investigation is opened under section 75 where the Registrar has reasonable and probable grounds to believe there has been professional misconduct or incompetence, often on information from a hospital, another regulator or a mandatory report. The crucial practical difference is that only an ICRC decision on a public complaint can be reviewed by HPARB.

Can the College suspend me before any hearing?

Yes. Under section 25.4 of the Health Professions Procedural Code, the ICRC may make an interim order suspending your certificate of registration or imposing terms, conditions and limitations on it during the investigation, where it is of the opinion that your conduct exposes or is likely to expose patients to harm or injury. Such an order can last for the duration of the matter.

Do I have to cooperate with a CPSO investigation?

Yes — but take advice first. Failing to respond appropriately or within a reasonable time to a written inquiry from the College, and breaching an interim order, have been treated by the Discipline Tribunal as disgraceful, dishonourable or unprofessional conduct in themselves. Cooperating and being represented are not alternatives; contact the CMPA and then engage properly.

Will the complainant see what I write?

Ordinarily yes. The complainant is generally provided with your finalised response and given the opportunity to reply to it. Assume everything you write will be read by the patient as well as the Committee.

Will I get written reasons for the outcome?

In most cases, yes. Except where the ICRC refers the matter to the Discipline Tribunal or for a capacity inquiry, a physician typically receives written reasons for the decision.

This article is general information for physicians registered with the College of Physicians and Surgeons of Ontario and does not constitute legal advice. Regulatory processes and the law change, and every case turns on its own facts. If you are the subject of a complaint or investigation, contact the Canadian Medical Protective Association (CMPA) or a lawyer experienced in professional regulation before you respond. Last updated July 14, 2026.