Guide to the Tribunal Process

What is the Ontario Physicians and Surgeons Discipline Tribunal?

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

The Tribunal is independent from the College. The Tribunal is like a court in that 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 discipline process starts when the College files a notice of hearing (Form 4) with the Tribunal. The notice of hearing includes the College’s allegations against the physician, provides information about the Tribunal’s authority to hold the hearing, and contains a warning that, if the physician doesn’t attend, the hearing may proceed in their absence.

Both the notice of hearing and a summary of the allegations are posted on the College’s Public Register, which can be searched by the physician’s last name. The Tribunal’s Upcoming Hearings page lists hearings that will take place within the next 60 days, and also includes a summary of the allegations in those hearings.

The Tribunal’s Outcomes page tells you about matters where the Tribunal has made a decision and provides links to the published reasons.

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 College 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 the College. 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 that come before the Tribunal. Practice Directions provide more detailed descriptions of the Tribunal’s procedures and assist participants to understand the hearing process. Parties are expected to be familiar with the Tribunal’s Rules and Practice Directions.

Three main kinds of Tribunal hearings and decisions

1. Merits hearing

A merits hearing deals with the allegations against a physician. The College and the physician (the parties) present their evidence, and each makes arguments about what they say is the right result. The Tribunal, after listening carefully and considering everything the parties present to it, decides whether the College 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. 

3. Penalty Hearing

If, in its merits decision, the Tribunal decides the physician committed professional misconduct or is incompetent, it must also decide the penalty. Some misconduct, such as certain kinds of sexual abuse of a patient, results in the mandatory revocation of the physician’s certificate of registration. In other cases, the Tribunal must consider what penalty is appropriate. This happens at the penalty hearing and is called the penalty decision. The Tribunal gives 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, the Tribunal will usually 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: requests for a publication ban broader than the automatic ban on patient names and personal health information; requests for documents held by non-parties (third party records); requests that a witness participate from another location; requests to stop the hearing permanently (a stay); or requests 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 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 case by cross-examining its witnesses. The physician may present their own witnesses and documents. Where the Tribunal decides the College 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” a 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. This means the parties agree on what the penalty should be. 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. Occasionally, the College and the physician agree on some, but not all, the allegations. More often, the parties agree on the merits but disagree about the penalty.

Merits 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 on request. However, parties can always reach an agreement at the last minute. Please contact 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 and/or requiring training or monitoring;
• reprimand the physician;
• require the physician to pay a fine of up to $35,000 to the Minister of Finance; and/or
• if the misconduct was the sexual abuse of a patient, require 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 and must revoke the certificate in the 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; or
• direct the College’s Registrar to impose “terms, conditions and limitations” on the physician’s certificate of registration, such as limiting the physician’s practice and/or requiring training or monitoring.

What is a joint submission on penalty?

When the parties agree on what the penalty and costs should be, they present a joint submission to the Tribunal at the penalty hearing. The Tribunal cannot reject a joint submission unless the proposed penalty would bring the administration of justice into disrepute or is not in the public interest.

What is a reprimand?

In a reprimand, the panel speaks directly to the physician about their misconduct. In cases where a physician is found to have committed sexual abuse of a patient, the Tribunal must require the physician to attend before it and be reprimanded. The Tribunal may also decide to order and deliver a reprimand in other cases where it considers this an appropriate penalty.

Costs

The Tribunal can order the physician to pay costs of the hearing and investigation to the College. If the Tribunal decides the proceedings were unwarranted, it may order the College to pay costs to a physician. While not part of the penalty, costs are usually considered during the penalty phase of the hearing.

The Tribunal may also order costs against a party or participant whose conduct has been unreasonable, frivolous or vexatious or who has acted in bad faith.   

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 presents their case first and must prove that reinstatement of their certificate is suitable when considering public protection 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 based on a number of factors, including the requirements of the Health Professions Procedural Code, representation and areas of expertise.

Each hearing panel on the merits must include at least two members of the public and at least one physician who are members of the College’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 assigned to lead the panel as its chair.

Find out about the Tribunal members on the Adjudicators page.

The Parties

The physician and the College 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 paralegal or may choose to self-represent. Their representative may be called defence counsel.

Complainants

Members of the public whose complaints were considered by the ICRC when deciding to refer allegations to the Tribunal are called complainants. A complainant may attend the hearing unless they are a witness for the College and the Tribunal has ordered that witnesses be excluded from the hearing. Complainants do not otherwise participate in the hearing unless the Tribunal allows it.

Witnesses

Witnesses 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 need to summons a witness. The Practice Direction on How to Summons a Witness explains how to obtain and serve a summons on a witness.

Members of the Public

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

What is a publication ban?

In every Tribunal hearing there is an automatic publication ban prohibiting the publication or broadcast of the name, other identifying information and medical information concerning a patient unless the Tribunal orders otherwise. See Tribunal rule 2.2.2. A patient can ask the Tribunal to lift this order.

The Tribunal may also order a broader publication ban. See rules 2.2.8(c) and 2.2.10. 

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 may 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 for an adjournment of the hearing would usually be “heard” in writing, but a motion to obtain records from a person or organization that is not a party might be heard by videoconference. Hearings that will take place within the next 60 days are listed on the Upcoming Hearings page, which includes the format.

Attending a Hearing

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

The Tribunal may hold some hearings, or portions of a hearing, in person.

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.

Hearings usually begin at 9:00 a.m. and finish at 4:00 p.m. 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 notice of hearing is made an exhibit.
• The physician is asked to respond to the allegations in the notice of hearing by admitting, denying or not contesting them.
• The agreed statement of facts is made an exhibit.
• The parties make submissions.
• The panel may have questions.
• The panel leaves to decide in private. It returns and announces its decision.
• The 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.
• Where the penalty includes a reprimand, the panel will speak to the physician directly about the misconduct.
• The hearing ends.

Contested cases

• The chair opens the hearing.
• The notice of hearing is made an exhibit.
• The physician is asked to respond to the allegations in the notice of hearing by admitting, denying or not contesting them.
• The parties make opening statements. The physician may choose to do this after the College has presented its evidence.
• The College presents its case:
  • the College’s witness(es) (examination-in-chief by College Counsel, cross-examination by the physician or their counsel, re-examination by College counsel); and
  • panel members may ask questions.
• The physician presents their case:
  • the physician’s witness(es) (examination-in-chief by the physician or their counsel, cross-examination by College counsel, re-examination by the physician or their counsel); and
  • panel members may ask questions.
• The College may present “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, which means the decision and reasons are released later.
• If the panel finds the College proved some or all of its case, a penalty hearing will be scheduled.

How do I access hearing documents?

You may access the Tribunal’s public record of the proceeding by contacting the Tribunal Office. The public record of the proceeding contains the notice of hearing or notice of application, agreed statements of fact, notices of motion, motion records, application records, books of authorities, factums and written submissions, exhibits, case management directions, orders and reasons, and any other documents the Tribunal orders part of the public record.

Generally, any document that identifies a patient or victim of alleged sexual abuse, contains personal health information or is otherwise affected by a publication ban, must be filed with the Tribunal in two versions – one public, one not public. The party filing the document must redact the identifying information from the public version of the document, which is made part of the public record. However, if redacting identifying information makes the document meaningless or would be onerous, the Tribunal may not require the party to file a public version.  

A person seeking documents filed prior to January 1, 2023, other than the notice of hearing and hearing transcripts, must make a motion to the Tribunal using the Tribunal’s Form 2B. The motion will proceed in writing and will be allowed unless, within one week, the College and/or physician objects and shows good reason why access should be denied. See rule 2.3.2. Where a publication ban was made in the hearing, the Tribunal will review the document(s) and remove information that is covered by the ban before providing it to the requestor.

How do I access hearing transcripts?

Hearing transcripts – a printed version of everything that was said in a hearing – are part of the Tribunal’s public record. If you would like to purchase transcripts for hearings please contact us.

The Tribunal will review transcripts provided to non-parties to ensure compliance with publication bans.

Tribunal decisions and reasons

Links to 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.