On March 11, 2026, the Ontario Physicians and Surgeons Discipline Tribunal released its reasons in College of Physicians and Surgeons of Ontario v Maharaj, 2026 ONPSDT 9. The tribunal revoked Dr. Ashwin Maharaj’s certificate of registration after finding that his care of 17 patients fell below the standard of practice and that he was incompetent. The decision is a useful, if unsettling, illustration of how several issues that recur in medical malpractice work look when a regulator examines them all at once: informed consent, evidence-based treatment, accurate diagnosis, recordkeeping, and privacy.
The physician and the referral
Dr. Maharaj obtained his certificate of registration in 1993 and practised proctology and gastroenterology at out-of-hospital premises in Toronto and Thornhill. The referral concerned his treatment of 17 patients. Seven were the subject of patient complaints; the College Registrar later initiated an investigation that brought in the charts of ten more. The College retained Dr. Marcus Burnstein, a colorectal surgeon, to review the care. For all 17 patients his opinion was the same: the care fell below the standard of practice and showed a lack of knowledge and judgment that exposed patients to a risk of harm.
The tribunal relied on an uncontested statement of facts and a plea of no contest. It found that Dr. Maharaj failed to maintain the standard of practice, was incompetent, contravened a term, condition or limitation on his certificate, breached a regulation under the Medicine Act, 1991 by misrepresenting his title, and engaged in disgraceful, dishonourable or unprofessional conduct.
What the care looked like
The deficiencies the tribunal accepted, drawn from Dr. Burnstein’s review, paint a consistent picture. Dr. Maharaj performed flexible sigmoidoscopies under propofol sedation in almost every anorectal examination, where they were not indicated and at times contraindicated, exposing patients to the risks of sedation for no clinical reason. He performed anal dilatations that were not clinically indicated. On the expert’s evidence, dilatation is a discredited treatment for anal pathologies other than anal stenosis, because it can damage the sphincter muscles and cause incontinence, and none of these patients had anal stenosis.
He also misdiagnosed patients and then operated where surgery was not indicated, and he carried out procedures the expert described as neither recognized, accepted nor evidence-based: excising skin tags and hemorrhoids with a hot snare, treating skin tags and external hemorrhoids with laser hemorrhoidoplasty, and closing a fissure with a suture. In one instance he repeated a laser hemorrhoidoplasty and excised two hemorrhoids only three months after an ineffective laser procedure on the same patient, rather than revisiting the diagnosis.
The decision describes one patient, identified only as Patient C, who was misdiagnosed with advanced hemorrhoidal disease she did not have. Her actual complaint was anal itch, which the expert noted virtually never responds to surgery, and she was still recovering from an operation performed five weeks earlier. The unindicated surgery split her external skin. The tribunal accepted that operating on her was a gross error in judgment that injured her.
Consent, privacy, and a misused title
The consent findings are worth dwelling on, because they go to a principle that matters in every malpractice file. In several cases Dr. Maharaj obtained a blanket consent before examination and diagnosis, then decided on and performed procedures while patients were sedated, without consent for the specific treatment delivered. The tribunal held that a blanket consent to treat whatever is found, by whatever technique the physician chooses, does not meet the standard for informed consent. Consent has to be specific and informed. A general sign-off is not enough.
Two further strands rounded out the misconduct. Dr. Maharaj stored patients’ intimate photographs and images of their faces on his personal phone, and he shared one patient’s sensitive health information, including a video of treatment, without consent. He also held himself out on various websites as a “surgeon” and “general surgeon” although he is not certified by the Royal College in any surgical specialty, which contravened a regulation under the Medicine Act, 1991.
He had signed an undertaking with the College in April 2024 to stop performing procedures that are not evidence-based. He breached it at least eight times between August 2024 and March 2025.
The penalty, and a long paper trail
The parties jointly proposed revocation, a reprimand, and $6,000 in costs. A tribunal’s role is limited where the parties agree on penalty: it should depart from a joint submission only where the result would bring the administration of justice into disrepute (R v Anthony Cook, 2016 SCC 43). The tribunal accepted the proposal, concluding that “revocation is the only appropriate penalty that adequately protects the public.”
What gives the decision its weight is the history behind it. Between 2003 and 2024, the College’s complaints and inquiries committees dealt with Dr. Maharaj repeatedly over the same themes: informed consent, documentation, communication, and performing procedures that were not indicated. He had been cautioned, required to complete remediation, and bound by an earlier undertaking. The tribunal gave little weight to rehabilitation, finding no evidence it would now be effective.
Why it matters for patients
A discipline decision is not a compensation decision. The tribunal’s job is to protect the public and uphold confidence in the profession, and revocation does exactly that by removing a physician’s licence. It does not put anything in the hands of a patient who was harmed. A patient injured by care of this kind would have to pursue a separate civil claim to recover damages, and that claim has its own requirements.
In particular, a regulatory finding does not by itself establish civil liability. The civil standard of care is a question for the court on expert evidence, the issues and the burden differ from a discipline proceeding, and a no-contest plea is generally not an admission for civil purposes. That said, a published decision like this one, together with the underlying records and the kind of expert review the College commissioned, can be a sound starting point for a patient who suspects something went wrong and wants to understand whether they have a case.
The consent point is the one most patients can use directly. You are entitled to know what is being done to you and why, and to agree to a specific procedure rather than to whatever a physician decides once you are sedated. Where consent was never really obtained, that is not a technicality. It is one of the things the law is there to protect.
The full decision is available on CanLII: College of Physicians and Surgeons of Ontario v Maharaj, 2026 ONPSDT 9.
