Introduction
When something goes wrong with your medical care, the path forward can feel overwhelming. You may be dealing with the physical and emotional aftermath of a poor outcome while also asking yourself difficult questions. Was this a known risk, or was it a mistake? Should I speak up? And if so, where do I even start?
In Ontario, patients and families have a number of avenues to raise concerns about the care they have received. These range from internal hospital complaints, to oversight bodies like the Patient Ombudsman, to formal regulatory complaints against individual health professionals at their respective regulatory colleges. In cases involving death, the Office of the Chief Coroner may also become involved.
This guide is intended to help patients and families understand the options available to them, the process for each type of complaint, and how the outcome of a regulatory complaint may, or may not, intersect with a civil lawsuit for medical malpractice.
A note before we begin. Making a complaint is not the same thing as starting a lawsuit. The processes are completely separate, governed by different rules, and produce different outcomes. As discussed below, the running of the limitation period for a civil claim is not paused while you wait for a regulator to investigate. If you suspect that you may have a viable medical malpractice claim, you should consult with an experienced medical malpractice lawyer promptly to preserve your rights, regardless of any complaint you may also choose to file.
1. Hospital Internal Complaints (Patient Relations)
If your concern relates to care received in a public hospital, the first stop is usually the hospital’s own patient relations process.
Under the Excellent Care for All Act, 2010 and its regulations, every Ontario public hospital is required to have a patient relations process and a designated patient relations delegate. Hospitals must maintain a process for receiving, documenting, investigating, and responding to complaints from patients and families, and they must keep complainants informed of the progress of their complaint.
Most hospitals make their patient relations contact information available on their website. The process is typically initiated by a phone call, email, or completion of an online form. The hospital will then assign someone to look into the complaint, gather relevant records, speak to the staff involved where appropriate, and provide a written or verbal response.
Why Start With the Hospital?
There are several reasons to begin at the hospital level:
- It is generally the fastest way to receive an explanation of what happened.
- Some hospitals will offer a meeting with the treating team or a senior administrator to walk you through the events.
- If your concern relates to systemic issues, like wait times, communication breakdowns, or discharge planning, the hospital is best positioned to take corrective action.
- Many other oversight bodies, including the Patient Ombudsman, expect that you will have first attempted to resolve your complaint at the hospital level.
Limitations of Hospital Complaints
Hospital patient relations processes are inherently internal. The investigators report to the same institution that you are complaining about, which can create a perception that the process is not entirely neutral. Hospitals also generally cannot impose discipline on individual physicians, who are often independent contractors and not employees, although they can address the conduct of staff nurses, residents, and other employed health professionals.
Importantly, internal hospital investigations and quality of care reviews are often protected by the Quality of Care Information Protection Act, 2016 (QCIPA). Information generated solely for the purpose of a quality of care review may not be admissible in a civil lawsuit. This protection is not absolute, but it is broad, and patients should not assume that a hospital’s internal investigation file will become available during litigation.
2. The Patient Ombudsman of Ontario
If a hospital’s response is unsatisfactory, the next step may be the Patient Ombudsman of Ontario.
Established under the Excellent Care for All Act, 2010, the Patient Ombudsman is described as a body of last resort. It receives and investigates complaints about:
- Public hospitals;
- Long-term care homes;
- Home and community care services delivered through Ontario Health atHome (formerly the Local Health Integration Networks); and
- Community surgical and diagnostic centres (a category added to the Patient Ombudsman’s mandate in 2023).
The Patient Ombudsman generally requires that the complainant first try to resolve the matter through the organization itself. The office focuses on fairness, communication, and the patient experience. It does not regulate individual health professionals and does not have jurisdiction over clinical decisions made by physicians, nurses, or other regulated health professionals on a personal basis.
The Patient Ombudsman can:
- Facilitate early resolution between a patient or family and the health sector organization;
- Conduct formal investigations; and
- Make recommendations to the organization, which are not legally binding but are often taken seriously.
In recent years the office has handled record numbers of complaints, with quality of care and communication consistently among the top concerns. Complaints can be made through the Patient Ombudsman’s website at patientombudsman.ca.
A Patient Ombudsman complaint is not a substitute for a regulatory college complaint when the concern is about an individual professional, and it is not a substitute for a civil lawsuit when the concern is about compensation for harm.
3. The Ontario Ombudsman
The Ontario Ombudsman is a separate office and should not be confused with the Patient Ombudsman.
The Ontario Ombudsman is an independent officer of the Legislative Assembly of Ontario who oversees provincial government bodies. In the health context, the Ontario Ombudsman can address concerns about:
- OHIP coverage and billing decisions;
- The Ontario Drug Benefit Program;
- The Assistive Devices Program;
- Decisions of the Ministry of Health and Long-Term Care; and
- Other provincial health programs.
The Ontario Ombudsman does not investigate hospitals, long-term care homes, or individual health professionals. If you complain to the Ontario Ombudsman about something outside its jurisdiction, the office will typically redirect you to the appropriate body.
The Ontario Ombudsman’s complaint process is free and confidential. Information is available at ombudsman.on.ca.
4. Involvement of the Office of the Chief Coroner
When a patient has died and there are concerns that the death may be related to the care provided, the Office of the Chief Coroner of Ontario may become involved.
Under the Coroners Act, certain categories of death must be reported to a coroner. These include unnatural deaths, deaths that are sudden or unexpected, deaths during or shortly after a medical procedure, and deaths in long-term care homes. Health care workers and police are the most common reporters, but anyone, including a family member, may report a death to a coroner where reporting is required.
The coroner’s role is to answer five questions:
- Who was the deceased?
- How did the deceased come to their death?
- When did the deceased come to their death?
- Where did the deceased come to their death?
- By what means did the deceased come to their death?
In a hospital or other health care setting, the coroner may order an autopsy, request medical records, interview health care providers, and ultimately issue a written investigation statement that includes findings on the medical cause of death and the manner of death. In some cases, the coroner may convene an inquest, which is a public hearing before a five-person jury whose role is to make findings of fact and recommendations to prevent similar deaths in the future. Inquests are mandatory in some circumstances, such as deaths in custody, and discretionary in others.
When Coroner Involvement Helps Families
For families considering civil action, a coroner’s investigation can be valuable for several reasons:
- It often results in the production of a comprehensive autopsy report, which may be central to a medical malpractice claim involving a death.
- The coroner has the authority to obtain medical records that families might struggle to access on their own.
- Inquest recommendations, while not legally binding and not in themselves admissible to prove negligence, can highlight systemic concerns that align with theories of liability in a civil case.
- The Chief Coroner is required to refer matters of suspected professional misconduct, incompetence, or other quality concerns to the College of Physicians and Surgeons of Ontario, which may trigger a parallel regulatory investigation.
Families can also raise concerns about how a death investigation was conducted with the Death Investigation Oversight Council (DIOC), an independent body that oversees coroners and forensic pathologists in Ontario and administers a public complaints process.
5. The College of Physicians and Surgeons of Ontario (CPSO)
The College of Physicians and Surgeons of Ontario regulates the practice of medicine in Ontario. Every physician practising in Ontario must be a member of the CPSO.
The CPSO will investigate complaints made by members of the public about a physician’s care or conduct. The complaint process is started by submitting a complaint online at cpso.on.ca, or by mail. The CPSO will assign an investigator who will obtain medical records, request a written response from the physician, and, where necessary, retain an independent expert to provide an opinion.
Almost invariably, a physician faced with a CPSO complaint will contact the Canadian Medical Protective Association (CMPA), which will in turn engage a lawyer to assist the physician in responding. The physician’s response is generally professionally drafted and may be accompanied by an independent expert opinion.
The materials are then reviewed by the Inquiries, Complaints and Reports Committee (the ICRC), which deliberates in private and issues a written Decision and Reasons. The ICRC may decide to take no action, issue advice or a caution, require the physician to complete remedial education (sometimes called a Specified Continuing Education or Remediation Program, or SCERP), or refer the physician to discipline proceedings before the Ontario Physicians and Surgeons Discipline Tribunal (OPSDT). The OPSDT, which became independent of the CPSO under that name in 2021, hears cases of alleged professional misconduct and incompetence in formal proceedings that resemble a trial.
The process from complaint to ICRC decision typically takes 8 to 12 months, although complex matters can take longer.
The Decision and Reasons of the ICRC will typically include the following type of language:
The Committee cannot award or recommend financial compensation. The Committee does not determine liability or causation and its function is not to punish physicians.
After the ICRC issues its decision, either the complainant or the physician may seek a review by the Health Professions Appeal and Review Board (HPARB), which can confirm the decision, refer the matter back to the ICRC for further investigation, or in limited circumstances refer it to discipline.
For a more detailed discussion of the CPSO complaint process and its strategic role in screening potential medical malpractice claims, see our previous post on this topic.
6. The College of Nurses of Ontario (CNO)
Concerns about nursing care can be raised with the College of Nurses of Ontario, which regulates registered nurses, registered practical nurses, and nurse practitioners.
A complaint to the CNO follows a process that is structurally similar to the CPSO process, both of which operate under the Regulated Health Professions Act, 1991 (RHPA) and the Health Professions Procedural Code attached to it. A complaint is filed online or in writing through the CNO’s website at cno.org. The nurse is given notice and is generally required to respond in writing within 30 days. The matter is then reviewed by the CNO’s own Inquiries, Complaints and Reports Committee, which has the same range of options as the CPSO ICRC, including no further action, advice, a caution, a SCERP, or referral to discipline.
The CNO also operates an Alternative Dispute Resolution process for less serious complaints, which is a confidential, voluntary process designed to resolve concerns without a formal investigation.
When something goes wrong in a hospital setting, it can be useful to consider both a CPSO complaint and a CNO complaint together, particularly where care was shared between physicians and nursing staff. The two colleges investigate independently, and both responses can shed light on different aspects of the same event.
7. Other Regulated Health Professional Colleges
The CPSO and CNO are the two best known health regulators in Ontario, but they are far from the only ones. Ontario has 26 regulatory colleges that oversee 29 regulated health professions, governing close to 400,000 health professionals across the province.
If your concern is about a health professional other than a physician or nurse, your complaint should be directed to the relevant regulatory college. Each college has a public-facing complaints process, and the procedural framework is largely the same across all colleges because of the Health Professions Procedural Code.
A non-exhaustive list of these regulators includes:
- College of Audiologists and Speech-Language Pathologists of Ontario
- College of Chiropodists of Ontario
- College of Chiropractors of Ontario
- College of Dental Hygienists of Ontario
- College of Dental Technologists of Ontario
- College of Denturists of Ontario
- College of Dietitians of Ontario
- College of Early Childhood Educators (related supports, separate framework)
- College of Homeopaths of Ontario
- College of Kinesiologists of Ontario
- College of Massage Therapists of Ontario
- College of Medical Laboratory Technologists of Ontario
- College of Medical Radiation and Imaging Technologists of Ontario
- College of Midwives of Ontario
- College of Naturopaths of Ontario
- College of Nurses of Ontario
- College of Occupational Therapists of Ontario
- College of Opticians of Ontario
- College of Optometrists of Ontario
- College of Pharmacists (Ontario College of Pharmacists)
- College of Physicians and Surgeons of Ontario
- College of Physiotherapists of Ontario
- College of Psychologists and Behaviour Analysts of Ontario
- College of Psychotherapists of Ontario
- College of Respiratory Therapists of Ontario
- College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario
- Royal College of Dental Surgeons of Ontario
If you are unsure which college regulates the professional involved in your care, the umbrella organization Health Profession Regulators of Ontario maintains a directory.
The complaint process at each of these colleges follows the same general arc:
- The complainant submits a written complaint.
- The college obtains the relevant records and a response from the member.
- The complaint is reviewed by an Inquiries, Complaints and Reports Committee.
- A written decision is issued, with possible outcomes ranging from no action to discipline referral.
- Either party may seek review by HPARB.
8. How Regulatory Complaints Can Assist a Civil Lawsuit
For patients who believe they may have been harmed by negligent medical care, the most common question is whether a regulatory complaint can be used to support a civil claim for compensation. The short answer is that the complaint itself, and any decision that comes out of it, is generally not admissible as evidence in a civil proceeding. The longer answer is more nuanced.
What the Statute Says
Section 36(3) of the Regulated Health Professions Act, 1991 states:
No record of a proceeding under this Act, a health profession Act or the Drug and Pharmacies Regulation Act, no report, document or thing prepared for or statement given at such a proceeding and no order or decision made in such a proceeding is admissible in a civil proceeding other than a proceeding under this Act …
The Ontario courts have interpreted this provision strictly. As we have written before, what happens at the College stays at the College.
The same limitation applies, in different statutory forms, to many of the other processes discussed in this guide. Quality of care information generated for hospital quality reviews is generally protected under QCIPA. Coroner’s investigation statements are admissible to prove cause of death but not to prove negligence on the civil standard. Patient Ombudsman reports do not determine civil liability.
Why Make a Complaint at All?
Despite these admissibility limitations, a regulatory complaint can still be enormously helpful in screening and developing a potential medical malpractice claim. The advantages include:
Identifying areas of concern. Many medical malpractice claims look uncertain on a first review of the records. A college’s investigation, particularly one that includes an independent expert, can help identify areas where the standard of care may have been breached, even if those breaches are not obvious from the records alone.
Obtaining records. The college will obtain the relevant medical records as part of its investigation. While patients are entitled to their own records under privacy legislation, the college process can be a more efficient and affordable way to assemble a comprehensive file.
Previewing the defence theory. A response from the physician or nurse, prepared in conjunction with experienced regulatory counsel, often foreshadows the defence theory that will be advanced if a civil claim is later filed. Knowing the defence theory early allows you and your legal team to test it against your own experts before significant litigation costs are incurred.
Information about the practitioner. A regulatory complaint can sometimes reveal a history of prior complaints or concerns about the same practitioner that would not be apparent from a public registry search alone.
Cost. Filing a regulatory complaint is free, and you do not need a lawyer to do it. For a patient or family considering whether to invest in a civil claim, the regulator’s review can serve as a low-cost preliminary screen.
Why a Complaint Is Not Determinative of a Civil Claim
It is important to understand what a regulatory complaint cannot do.
It does not determine causation. Most regulators, including the CPSO, expressly avoid making findings on causation. They focus on whether the standard of care was met, not whether any breach actually caused the patient’s injury. In medical malpractice law, causation is often the most difficult and most contested element of the claim.
It does not determine civil liability. A finding of professional misconduct or a breach of a standard at the college level is not the same as a finding of negligence in a civil court. The standards, the burden of proof, and the procedural rules are different.
It cannot award compensation. No regulator and no ombudsman in Ontario can order a health professional or hospital to pay damages to a patient. Civil compensation can only be obtained through a settlement or a court judgment in a civil lawsuit.
It does not pause the limitation period. Under the Limitations Act, 2002, a civil claim must generally be commenced within two years of the date the patient knew or ought to have known of the claim. A college investigation that takes 8 to 12 months can consume a substantial portion of that limitation period. Patients who wait for a college decision before consulting a lawyer may find that they have lost the ability to sue altogether.
For these reasons, a regulatory complaint is best understood as a complementary tool rather than an alternative to a civil claim.
9. Practical Considerations Before You File
Before deciding which body to complain to, and whether to complain at all, it is worth thinking through a few practical considerations.
Identify what you want. If your goal is an explanation, an apology, or a change in the way care is delivered in the future, a hospital complaint or Patient Ombudsman complaint may be the most direct route. If your goal is to hold a particular professional accountable through their regulator, a college complaint is the appropriate avenue. If your goal is financial compensation for harm caused, only a civil lawsuit can deliver that outcome.
Consider the doctor-patient relationship. A college complaint will almost always end the relationship between you and the physician complained against. If you depend on continuity of care, you may want to first establish care with another professional before filing.
Preserve records and notes. As soon as you suspect that something has gone wrong, write down what you remember while it is fresh. Note the dates, the names of the people involved, and what was said. Request a copy of your records.
Get advice early. Many medical malpractice lawyers, including our firm, offer free initial consultations. Even a short conversation with a lawyer can help you understand the limitation period, the strengths and weaknesses of a potential claim, and whether a regulatory complaint would be useful in your particular situation.
Conclusion
Ontario offers patients several distinct paths to raise concerns about medical care, ranging from internal hospital complaints, to oversight by the Patient Ombudsman or the Ontario Ombudsman, to investigations by the Office of the Chief Coroner, to formal complaints against individual professionals at one of the province’s 26 regulatory colleges. Each of these processes plays a different role and produces a different kind of outcome.
For patients and families who believe they may have a viable medical malpractice claim, a regulatory complaint can be a useful screening tool, a source of records, and a window into the defence theory that will eventually be advanced in civil litigation. It is rarely, however, a substitute for a civil claim, and it is never a reason to delay consulting a lawyer.
This blog post is intended for general information only and does not constitute legal advice. The law and the practice of regulatory bodies in Ontario can change. If you are considering filing a complaint or pursuing a claim, please consult directly with a lawyer.
