In a recent decision, College of Physicians and Surgeons of Ontario v. Nahas, the Ontario Physicians and Surgeons Discipline Tribunal imposed a four-month suspension on an Ottawa-based physician practising chronic pain management, along with significant practice restrictions and mandatory supervision.
This case highlights recurring issues seen in medical malpractice claims: failure to meet the standard of care, poor documentation, inappropriate procedures, and lack of informed consent.
Dr. Richard Nahas, a family physician focusing on chronic pain management, faced two separate but related proceedings:
Failure to meet the standard of practice across multiple patients
Inappropriate touching without adequate consent or explanation
The Tribunal ultimately accepted a joint submission for penalty, concluding that the proposed sanctions were reasonable and necessary to protect the public.
he Tribunal relied heavily on expert evidence from a pain management specialist who reviewed 19 patient charts. The findings were troubling.
Dr. Nahas was found to have demonstrated:
A lack of knowledge and clinical skill
Poor clinical judgment in multiple cases
Practices that exposed patients to risk of harm
Key deficiencies included:
Performing nerve block injections when not medically indicated
Using inadequate anesthetic volumes
Relying on outdated, non-image-guided techniques
Failing to take proper patient histories or conduct adequate examinations
Applying a “one-size-fits-all” approach rather than individualized care
Prescribing steroids unnecessarily
Performing injections in inappropriate anatomical locations
Failing to communicate with referring physicians
Maintaining incomplete and inaccurate medical records
The Tribunal concluded that these deficiencies represented multiple and serious departures from the standard of care.
In addition to clinical concerns, the Tribunal found that Dr. Nahas engaged in disgraceful, dishonourable, or unprofessional conduct in his interactions with a patient.
Specifically, he:
Touched the patient’s gluteal region without adequate warning or explanation
Made contact with the patient’s pelvic area without proper consent
Failed to ensure the patient understood what procedures were being performed
The patient reported feeling upset and uncomfortable, and the Tribunal emphasized a critical principle:
Proper communication and informed consent are as important as the procedure itself.
What makes this case particularly significant is that this was not an isolated incident.
Dr. Nahas had:
Multiple prior ICRC cautions relating to:
Record-keeping
Consent
Clinical practice standards
A previous discipline finding involving inappropriate touching without adequate explanation
Despite prior education, supervision, and discipline, the same issues persisted.
The Tribunal applied the principle of progressive discipline, noting that penalties must increase when prior corrective measures fail.
The Tribunal ordered:
4-month suspension of medical licence
Prohibited from:
Performing injections near the spinal column
Administering injections to patients on certain medications
Prescribing systemic corticosteroids
Cannot act as a medical director of a clinic
Minimum 6 months of clinical supervision
Direct observation of patient care and chart reviews
Ongoing reporting to the College
Formal reassessment after supervision
Unannounced inspections
Ongoing compliance monitoring
Ordered to pay $6,000 in costs
This decision reinforces several important patient safety principles:
Even commonly used procedures like injections must be:
Properly indicated
Performed using accepted techniques
Tailored to the individual patient
Incomplete or inaccurate records are often a red flag for substandard care.
Patients have the right to:
Understand what will be done
Receive clear explanations
Provide informed consent, especially for sensitive examinations or procedures
Regulators and courts take prior complaints and discipline seriously. Repeated issues can significantly increase consequences.
While discipline decisions do not automatically mean there is a viable civil lawsuit, they can be highly relevant.
Cases like this may support a claim where:
A patient suffered actual harm or injury
The care fell below the standard expected of a reasonable physician
There is a causal link between the substandard care and the injury
Examples could include:
Complications from unnecessary injections
Delayed diagnosis due to poor assessment
Psychological harm arising from boundary violations
This decision is a clear reminder that patient safety depends on both technical competence and professional conduct.
Where physicians fail to meet these standards, especially repeatedly, regulatory bodies will intervene with increasingly serious consequences.
For patients, it underscores the importance of asking questions, understanding your care, and speaking up if something feels wrong.
Decision Date: March 4, 2026
Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal
Citation: College of Physicians and Surgeons of Ontario v. Nahas, 2026 ONPSDT 8 (CanLII)
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