On March 30, 2026, the Ontario Physicians and Surgeons Discipline Tribunal released its reasons in College of Physicians and Surgeons of Ontario v Konasiewicz, 2026 ONPSDT 12. Dr. Stefan Konasiewicz, a neurosurgeon who practises pain medicine, was reprimanded and suspended for six months, with an extensive remediation plan attached, after the tribunal found three things: that he failed to maintain the standard of practice across much of his chronic pain practice, that his care of a patient who died after receiving nerve blocks fell below the standard, and that he breached a College order restricting the injections he was allowed to perform. This is the rare discipline case with a patient death at its centre, and it shows clearly where the discipline system stops and where a civil claim would have to begin.
The reassessment
The background matters. In July 2022, after an investigation into his clinical practice, Dr. Konasiewicz undertook to complete twelve months of clinical supervision followed by a reassessment. The reassessor, Dr. Philip Chan, reviewed fifteen patient charts and concluded that the care fell below the standard of practice in twelve of them. According to Dr. Chan, Dr. Konasiewicz repeated injections on the same schedule even when there was evidence the treatment was not working, attached identical follow-up notes to multiple visits, and ordered urine drug screens at every encounter for patients on opioids regardless of their individual risk. Dr. Chan’s opinion was that, while these particular patients were not exposed to harm, the charts showed a lack of judgment, skill or knowledge in roughly half of them, including nerve blocks performed where they were not indicated.
A patient’s death
Patient A, a chronic pain patient Dr. Konasiewicz had treated with injections since 2015, died after a procedure on October 31, 2024. The patient, then seventy and with a cardiac history, collapsed after receiving a series of nerve blocks and could not be revived despite resuscitation. The College’s Premises Inspection Committee, which oversees out-of-hospital premises, raised concerns about the number and indication of the blocks (sixteen over about ten minutes) and about the documentation of the pre-procedure assessment, the blocks themselves, and the resuscitation. The Office of the Chief Coroner investigated and was of the opinion that the patient had received an inadvertent intrathecal injection of local anaesthetic.
The College retained Dr. Geoff Bellingham to review the care. His opinion was that Dr. Konasiewicz’s technique for image-guided cervical facet injections did not meet accepted standards, because needles were directed toward the spinal canal rather than the intended target without confirming their final position on the required views or ensuring adequate imaging. He also raised concerns about alcohol neurotomy in the cervical spine without image guidance, the use of nerve blocks not indicated for chronic pain, and performing many injections in a single session without weighing the risks. He concluded the care of Patient A fell below the standard of practice and showed a lack of knowledge, skill and judgment.
It is important to be precise about what this decision does and does not establish. The tribunal found, on admitted facts, that the care fell below the standard of practice. It did not make a finding that the technique caused the death. The coroner’s view about an inadvertent intrathecal injection is an opinion from that investigation, not a civil verdict on causation. That distinction matters, and it is exactly the kind of question a separate proceeding would have to resolve.
The breach of the restriction order
After receiving the reassessment report and the information about Patient A, the College’s Inquiries, Complaints and Reports Committee imposed restrictions on January 31, 2025. Among other things, Dr. Konasiewicz was barred from performing “injections along or near the spinal column” for adult chronic pain. A patient then wrote to the College reporting that he had performed injections of that kind on three dates in March and April 2025. The College obtained her records, confirmed the injections, and on May 12, 2025 the committee suspended his certificate. Although Dr. Konasiewicz would have said he read the order differently, he did not contest that he breached it. The tribunal found the breach was both a contravention of a restriction on his certificate and conduct that the profession would reasonably regard as disgraceful, dishonourable or unprofessional, describing non-compliance with such an order as a serious disregard of a physician’s obligations.
The penalty
The penalty was a joint submission, which narrows the tribunal’s role: it must implement the agreement unless doing so would bring the discipline system into disrepute (R v Anthony-Cook, 2016 SCC 43). The order is built around remediation. Dr. Konasiewicz received a six-month suspension and a reprimand, and before returning to independent practice he must complete a hands-on cervical injection skills course and an ethics program, then practise under tiered clinical supervision for at least twelve months. That supervision is unusually intensive: at the highest level the supervisor directly observes hundreds of his procedures, many of them image-guided, reviews the corresponding charts and imaging, and reports to the College weekly, with a further reassessment to follow. The tribunal noted that he had already been suspended for more than eight months under the interim order, and that this supervision, unlike his earlier one, requires direct observation of his technique, which is what the expert evidence said was deficient.
Why it matters for patients
For a family that has lost someone, this is the case that exposes the limits of professional discipline most starkly. The tribunal’s task is to protect the public going forward and to maintain confidence in the profession, and here it did that through suspension and a detailed plan to retrain and watch a physician’s technique. What it does not do, and cannot do, is compensate a family or decide that a physician’s care caused a death. Those questions belong to a civil claim, where wrongful death and the standard of care have to be proven on their own evidence, including expert evidence specific to interventional pain medicine.
That is not a reason to treat a decision like this as irrelevant to a potential claim. A coroner’s investigation, a College expert’s report, the premises inspection findings, and the admitted facts in a discipline proceeding can all be a starting point for understanding what happened and whether a case exists. They are a place to begin, not a substitute for the proof a court would require.
Two further points are worth drawing out. First, in interventional pain medicine the technique is the safety issue: where a needle goes near the spinal column, confirming its position with proper imaging is part of doing the procedure safely, and the expert evidence here was that this did not happen. Second, when a regulator restricts what a physician may do and the physician carries on anyway, that defiance is itself treated as serious misconduct, separate from the underlying care.
The full decision is available on CanLII: College of Physicians and Surgeons of Ontario v Konasiewicz, 2026 ONPSDT 12.
