Ontario · College of Physicians and Surgeons of Ontario

How to Respond to a CPSO Complaint

A letter from the College of Physicians and Surgeons of Ontario is one of the more unsettling pieces of post a physician can receive. But the Ontario complaints process is more predictable than it first appears, and one feature of it shapes everything else: in most cases the committee that decides your file will never meet you. It reads what you write. Understanding that changes how you should respond.

Who regulates physicians in Ontario

Physicians in Ontario are registered and regulated by the College of Physicians and Surgeons of Ontario (CPSO). Its authority comes from the Regulated Health Professions Act, 1991 (RHPA), the Health Professions Procedural Code — Schedule 2 to that Act — and the Medicine Act, 1991. In Ontario you do not hold a “licence” in the American sense: you hold a certificate of registration, and it is that certificate which is at stake in a regulatory matter.

Complaints are not decided by CPSO staff. They are screened by a statutory committee, the Inquiries, Complaints and Reports Committee (ICRC), made up of physicians and public members. The ICRC is the body whose decision you are ultimately writing for, and understanding that shapes everything about how you respond.

The College must investigate almost every complaint

Under section 25(1) of the Code, the CPSO is required to investigate and act on complaints. It has very limited discretion to decline. The ICRC may dismiss a complaint it considers frivolous, vexatious, made in bad faith, moot or otherwise an abuse of process — but before it does, it must give notice to both you and the complainant and allow 30 days for submissions.

The practical consequence is that receiving a complaint tells you almost nothing about its merit. The CPSO receives more complaints about physicians than any other regulator in Canada, and a large proportion end in no action or advice. A complaint is the opening of a file, not a finding against you.

The 30-day response — and why it usually matters more than anything else

You will normally receive a letter from the CPSO enclosing the complaint, and you will generally be asked to respond in writing within 30 days. Read that letter closely and diarise the deadline immediately. If you need more time, ask for it early rather than missing it.

Here is the point that physicians most often miss. The ICRC generally does not hold a hearing. It reviews the file on paper: the complaint, your written response, the investigator’s report and your records. In most complaint files, your written response is your only opportunity to make submissions. You will usually not get to sit in front of the panel and explain your reasoning, and you may not get a second chance to add what you left out.

What to do in the first week

1. Contact the CMPA immediately. This is the first call, not the last. Do not send a draft response to the College before you have taken advice.
2. Secure the record. Retrieve the complete chart. Never alter, add to or “tidy” a record after a complaint arrives — late amendments are discoverable, and they turn a care issue into a probity issue, which is far more serious.
3. Note the deadline and any request for records.
4. Do not contact the complainant. Approaching a patient who has complained about you can itself become the subject of a further complaint.

You may disclose the patient’s health records to the College without the patient’s consent; section 43(1)(b) of the Personal Health Information Protection Act, 2004 permits disclosure to a College for the purpose of an investigation.

What a strong response actually contains

An effective response is structured, complete and measured. It should set out the clinical context and your reasoning at the time, address each concern the complainant raised individually, and be supported by the record. Where something did go wrong, saying so plainly — and explaining what you have done about it — is almost always more persuasive than a defensive account that a panel can see through.

Note that even where the ICRC concludes your care was appropriate, it will still assess the quality of your documentation. Record-keeping is one of the most frequent grounds on which Ontario physicians attract ICRC action, and it is often the issue that turns an otherwise defensible complaint into a caution or a remedial order.

What the ICRC can decide

After the investigation and review, the ICRC may take no further action; issue written advice or recommendations; require you to appear before a panel to be cautioned in person; require you to complete a Specified Continuing Education or Remediation Programme (SCERP); accept an undertaking; refer allegations of professional misconduct or incompetence to the Ontario Physicians and Surgeons Discipline Tribunal; or refer the matter for an inquiry into your capacity to practise.

Transparency matters here. SCERPs, oral cautions and referrals to discipline are published on your profile on the CPSO Public Register, where patients, employers and hospitals can see them.

Timelines and review rights

Section 28 of the Code sets a target of 150 days from receipt of the complaint for the ICRC to dispose of it. That target can be extended, and in practice many files take longer.

If you or the complainant disagree with an ICRC decision on a public complaint, it can be reviewed by the Health Professions Appeal and Review Board (HPARB), an independent tribunal, within 30 days. HPARB’s jurisdiction is narrow: it looks only at the adequacy of the investigation and the reasonableness of the decision. It cannot review a decision that refers a matter to the Discipline Tribunal.

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.