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Guide to the Tribunal Process

This Guide will help you understand the Ontario Physicians and Surgeons Discipline Tribunal (OPSDT or Tribunal). It contains general information but does not provide legal advice.

For an alternative format or a paper copy, contact the Tribunal at tribunal@opsdt.ca.

You can find explanations of terms used in this Guide in the Glossary.

The Tribunal provides accommodation to hearing participants where required by the Human Rights Code. Please tell us about your accommodation request as soon as possible. You may be asked for documentation to support your request.

What is the Ontario Physicians and Surgeons Discipline Tribunal?

Complaints about a physician are made to the College of Physicians and Surgeons of Ontario (CPSO or College). After investigating the complaint, the CPSO’s Inquiries, Complaints and Reports Committee (ICRC) may decide to refer allegations of physician misconduct or incompetence to the Tribunal for a hearing.

The Tribunal is independent from the College. The Tribunal is like a court because it holds hearings and makes decisions, but it has special expertise and understanding of physician conduct and competence.

Until August 31, 2021, the Tribunal was called the Discipline Committee of the College of Physicians and Surgeons of Ontario.

What is the Notice of Hearing?

The Notice of Hearing starts the discipline process at the Tribunal. CPSO issues the Notice of Hearing, which contains information about the OPSDT’s authority to hold the hearing and a warning that if the physician doesn’t attend, the hearing may proceed in their absence. It also includes the College’s allegations against the physician.

Both the Notice of Hearing and a summary of the allegations are posted on the CPSO’s Public Register, which can be searched by the physician’s last name. The OPSDT’s Upcoming Hearings page also includes a summary of allegations against a physician with hearings within the next 60 days.

Additionally, the Tribunal’s Outcomes page tells you about matters where the hearing ended and provides links to the published decisions.

What does the Tribunal decide?

Most hearings before the Tribunal are about a physician’s conduct. For example, the Tribunal might be asked to decide whether a physician failed to meet the standard of practice, sexually abused a patient, engaged in disgraceful, dishonourable or unprofessional conduct or failed to cooperate with a CPSO investigation. The Tribunal also decides allegations that a physician is incompetent.

Applications by a physician to reinstate their revoked or suspended certificate of registration are also decided by the Tribunal.

Can I make a complaint directly to the Tribunal about a doctor?

No. A member of the public cannot start a Tribunal case. Complaints about physicians must be filed with CPSO. More information about filing a complaint is available on the College’s website.

Rules of Procedure and Practice Directions

The Tribunal has Rules of Procedure as well as Practice Directions. The Rules support fair and transparent hearings by clearly defining expectations and obligations of all parties. Parties are expected to be familiar with the Tribunal’s Rules and Practice Directions.

Three kinds of Tribunal hearings and decisions

  1. Merits hearing

    At the merits hearing, the CPSO and the physician (the parties) present their evidence, and each makes arguments about the right result. After listening carefully and considering everything the parties present to it, the Tribunal decides whether the CPSO has proven some or all the allegations against the physician. This is called the merits decision. Written reasons for the merits decision are usually sent to the parties and released to the public within 12 weeks of the merits hearing.

    Where the Tribunal decides the College did not prove its case, the hearing ends — unless the physician seeks costs from the College, in which case a costs hearing is scheduled.  

  2. Penalty Hearing

    If the Tribunal decides the physician committed professional misconduct or was incompetent, it must also decide what penalty is appropriate in the circumstances. This happens at the penalty hearing and is called the penalty decision. The Tribunal will give written reasons for the penalty decision.

    When the parties agree, or the physician does not contest the merits, the penalty hearing often happens on the same day as the merits hearing. Otherwise, the penalty hearing happens after the Tribunal gives its reasons for the merits decision.  

    Whether the physician should pay costs of the hearing to the College, and what amount of costs, is usually included in the penalty hearing, although costs are not part of the penalty.

    In many cases, the written reasons on merits, penalty and costs are released together. The Outcomes page has links to the Tribunal’s reasons for decisions.

    If the Tribunal orders a reprimand as part of the penalty and the physician waives their right to appeal the Tribunal’s decision, the Tribunal will deliver the reprimand at the end of the hearing.

  3. Motions

    The Tribunal also decides motions. Parties may make a motion for a decision from the Tribunal about an issue affecting the hearing. Some of the most common motions decided by the Tribunal are: a request for a publication ban; a request for documents not in control of a party (third party records); a request that a witness participate from another location; a request to stop the hearing permanently (a stay); or a request to adjourn the hearing to another day or until another hearing or event concludes. A motion can be heard and decided before the merits hearing begins or within the merits or penalty hearing.

    The Tribunal does not always provide written reasons for its decision on a motion. The Outcomes page has links to all the Tribunal’s published reasons including reasons on motions.

Contested, uncontested, or partially contested hearings

In a contested hearing the physician denies the College’s allegations. The College must prove the allegations on a balance of probabilities by calling witnesses and presenting documents. The physician tests the College’s evidence by cross-examining their witnesses and may present their own witnesses and documents. Where the Tribunal decides CPSO did not prove its case, the hearing ends. If the Tribunal decides the College proved some or all the allegations, it will hold a penalty hearing.

In an uncontested hearing, the physician agrees with the facts that support the allegations and admits they amount to misconduct or incompetence.

A physician may also plead “no contest” to the allegations. That means the physician doesn’t admit or deny the facts but isn’t “contesting” the finding of misconduct or incompetence.

Where the parties present agreed or uncontested facts and an agreed finding of misconduct or incompetence, they may also make a “joint submission” to the Tribunal about the penalty. Uncontested hearings nearly always finish in a day or less and the Tribunal issues an order at the end of the hearing.

There are two kinds of partially contested hearings. Sometimes the College and the physician agree on some, but not all, the allegations. More often, the parties agree on the findings, but disagree about the penalty.

Hearings that last one day or less are usually uncontested or partially contested. Hearings that last more than one day are usually contested. If the Tribunal knows whether a hearing is contested, it will provide that information. However, parties can always reach an agreement at the last minute. Please email the Tribunal Office at tribunal@opsdt.ca for details. 

What penalties can the Tribunal order?

If the Tribunal decides the physician engaged in professional misconduct, it can:

  • revoke the physician’s certificate of registration, which means they can no longer work as a physician.
  • suspend the physician’s certificate of registration, which means they cannot work as a physician for a set time.
  • impose “terms, conditions and limitations” on the physician’s certificate of registration, such as limiting the physician’s practice, requiring training or monitoring.
  • reprimand the physician.
  • require the physician pay a fine of up to $35,000 to the Minister of Finance.
  • if the act of professional misconduct was the sexual abuse of a patient, requiring the member to reimburse the College for funding provided to that patient.

Where the Tribunal finds certain types of sexual abuse occurred, it must immediately suspend the physician’s certificate of registration, which will be revoked in the penalty decision.

CPSO’s Investigations, Complaints and Reports Committee can also order immediate suspension of a physician’s certificate or impose terms, conditions and limitations, which remain in place until the Tribunal dismisses the allegations or makes its penalty decision.

If the Tribunal decides a physician is incompetent, it can:

  • revoke the physician’s certificate of registration, which means they can no longer work as a physician.
  • suspend the physician’s certificate of registration, which means they cannot work as a physician for a set time.
  • direct the CPSO Registrar to impose “terms, conditions and limitations” on the physician’s certificate of registration, such as limiting the physician’s practice, requiring training or monitoring.

What is a joint submission on penalty?

This means the parties agree on the penalty and costs they ask the Tribunal to order. They present their proposed joint submission to the Tribunal at the penalty hearing. The Tribunal can reject a joint submission only if it concludes the proposed penalty would bring the administration of justice into disrepute or is not in the public interest.

What is a reprimand?

The Tribunal may require a physician to appear before the hearing panel to be reprimanded. In a reprimand, the panel speaks directly to the physician about their wrongdoing.

Costs

Costs are usually decided as part of the penalty hearing but are not part of the penalty. The Tribunal can order the physician to pay costs of the hearing and investigation to CPSO. The Tribunal may also order the College to pay costs to a physician if it decides the proceedings were unwarranted.

Costs are not the same as a fine. The Tribunal also has the power to order a physician to pay a fine to the Ministry of Finance.

What is a reinstatement hearing?

A physician whose certificate of registration was revoked or suspended as the result of disciplinary or incapacity proceedings may apply to have it reinstated by the Tribunal so they can return to the practice of medicine. A reinstatement hearing is like a merits hearing, except the physician goes first and must prove reinstatement of their certificate is suitable when considering protection of the public and public confidence in the profession’s ability to self-regulate. The complainant in the original hearing must be given notice of the reinstatement application.

Who is at the Tribunal hearing?

The Panel
Tribunal members, or “adjudicators,” are like judges. The Tribunal Chair assigns Tribunal members to hearing panels. The panel that hears and decides the merits also hears and decides the penalty. Panels are assigned after considering factors, including the requirements of the Health Professions Procedural Code, representation and areas of expertise.

Hearing panels must include at least two members of the public and at least one physician who are part of CPSO’s Council. Most panels consist of two physicians and three members of the public, one of whom is a person with experience in adjudication (usually a lawyer). When the panel consists of more than one member, the experienced adjudicator is usually assigned to lead the panel as its chair.

Find out about the Tribunal members on the Adjudicators page.

The Parties
The physician and the CPSO are called the parties to the hearing. The College is always represented by a lawyer, who may be called the prosecutor. The physician is usually represented by a lawyer or may choose to represent themself. Their lawyer may be called the defence counsel.

The Complainant
A member of the public whose complaint was considered by ICRC when deciding to refer allegations to the Tribunal is called the complainant. The complainant may be a witness for CPSO and may attend the hearing — unless witnesses are excluded. The complainant does not otherwise participate in the hearing unless the Tribunal allows it. 

Witnesses
Witnesses are people who tell the Tribunal relevant information about the issues it must decide. The Witness Guide provides more information about being a witness in a Tribunal hearing. Contact the Tribunal Office at tribunal@opsdt.ca if you require a summons.

Members of the Public
Tribunal hearings are open to the public, except in very rare situations where the Tribunal makes an order closing the hearing.

What is a publication ban?

Where the Tribunal must consider highly personal information, for example a patient’s medical history or details of sexual abuse, it may be asked to make an order that prohibits the publication or broadcast of the person’s name or other identifying information. 

What languages are used in hearings?

Vous avez le droit d’utiliser le français dans vos rapports avec le Tribunal. Veuillez nous aviser si vous désirez participer en français.

The Tribunal provides interpretation services to parties or witnesses in languages other than English or French, including American Sign Language and Quebec Sign Language. Parties who require interpretation services for themselves or a witness should inform the Tribunal as soon as possible so it has time to retain qualified interpreters.

What is the format of hearings?

Tribunal hearings can be held in-person, by videoconference or in writing. The format of the hearing depends on what needs to be decided. For example, a motion from a member of the public for access to hearing documents is “heard” in writing, but a motion to obtain records from a person or organization that is not a party might be heard by videoconference. Merits and penalty hearings are always heard in person or by videoconference. A hearing about costs, if not part of the penalty hearing, might be heard in writing.

Dates for in-person and videoconference hearings at the Tribunal are listed on the Upcoming Hearings page.

Attending a Hearing

Since March 2020, the Tribunal has held all its hearings by videoconference. They are broadcast on YouTube through a private link obtained from the Tribunal Office. To get the YouTube link for a hearing, email tribunal@opsdt.ca.

The Tribunal may return to holding some hearings in person once it is considered safe to gather indoors again.

Whether attending a videoconference or in-person hearing, you are expected to act in a respectful and courteous manner and follow the panel’s instructions.

What happens in the merits hearing?

The College presents its evidence first, followed by the physician. When the panel has heard all the evidence and submissions, it leaves the room to privately discuss or deliberate about what was heard.

Usually there is a fifteen-minute break in the morning, a lunch break of one hour and a fifteen-minute break in the afternoon.

Hearings often follow this process:

Uncontested cases

  • The chair opens the hearing.
  • The panel may order a publication ban.
  • The Notice of Hearing is filed as an exhibit.
  • The physician is asked to respond to the allegations in the Notice of Hearing by admitting, denying or not contesting them.
  • Agreed Statement of Facts and Admissions is filed as an exhibit.
  • Parties make submissions.
  • The panel may have questions.
  • The panel leaves to decide in private. It returns and announces its decision.
  • Parties make a joint submission on penalty and costs.
  • The panel leaves to decide in private. It returns and announces its penalty and costs decision.
  • If the physician waives their right to appeal, the panel may reprimand them if the penalty order included a reprimand.
  • The hearing ends.

Contested cases

  • The chair opens the hearing.
  • The panel may make orders excluding witnesses or for a publication ban.
  • The Notice of Hearing is filed as an exhibit.
  • The physician is asked to respond to the allegations in the Notice of Hearing by admitting, denying or not contesting them.
  • CPSO presents its case:
    • College opening statement;
    • College’s evidence (examination-in-chief by CPSO, cross-examination by physician or their counsel, re-examination by College counsel); and
    • Panel members may ask questions.
  • The physician presents their case:
    • Physician’s opening statement;
    • Physician’s evidence (examination-in-chief by physician or their counsel, cross-examination by CPSO counsel, re-examination by physician or their counsel); and
    • Panel members may ask questions.
    • CPSO may call “reply evidence.”
  • Both parties make submissions about the evidence and law.
  • The panel leaves to discuss the case in private. In most contested cases, the panel reserves its decision, and the decision and reasons are released together at a later date.
  • If the panel finds CPSO proved some or all its case, a penalty hearing will be scheduled.

How do I access hearing documents?

The Notice of Hearing and hearing transcript are available to the public.

A member of the public who wants access to any other document used in a hearing must make a motion to the Tribunal using Rule 12.03 and the Tribunal’s Form 5A. The motion must be delivered to both parties as required by the Rules. Either party can respond to the motion. A Rule 12.03 motion is heard and decided in writing by the Tribunal Chair or a panel appointed by the Tribunal Chair.  

Where a publication ban is in effect, the Tribunal will review the document and may have to remove information that is subject to the publication ban before providing access to it. 

All hearings are audio recorded to make a transcript of the proceedings. If you’d like to purchase hearing transcripts, please contact us to find out which court reporting company recorded the hearing. If a publication ban was ordered, the Tribunal will need time to ensure the released transcript complies with its terms.

Tribunal Decisions and Reasons

Recent Tribunal decisions and reasons are found on our Outcomes page. 

Tribunal reasons and decisions, including decisions of the Tribunal’s predecessor, the Discipline Committee of the College of Physicians and Surgeons of Ontario, are freely accessible and searchable on the Canadian Legal Information Institute’s (CanLII) website.