Something went wrong at the hospital. A diagnosis was missed, a surgery did not go as described, a parent deteriorated overnight and nobody called, or a family member died and the explanation you were given does not match what you saw. Someone at the hospital offers you a meeting with patient relations.
Almost every week, someone asks me some version of the same question: should I go, and what should I say? The answer is usually yes, go. But go understanding what the meeting is, what the hospital is required to tell you, what it is entitled to keep to itself, and what the meeting cannot do for you no matter how it goes.
This guide is about the meeting itself. If you have not yet raised the concern and are deciding how to do that, start instead with my guide to making a complaint about hospital care in Ontario.
What a Patient Relations Meeting Is, and What It Is Not
Every public hospital in Ontario is required by section 6 of the Excellent Care for All Act, 2010 to have a patient relations process and to make information about that process public. The process has to reflect the hospital’s own patient declaration of values. That is the legal floor. How each hospital builds on it varies considerably.
What the statute does not do is turn patient relations into an investigation. A patient relations meeting is a complaint resolution and service recovery process. Its purpose is to explain, to listen, and where appropriate to apologize and to fix something going forward. It is not a hearing. Nobody makes a finding of fault. Nobody is disciplined in that room. No money changes hands.
That distinction matters because patients often walk in expecting an accounting and walk out feeling managed. If you understand from the outset that you are there to obtain information and an explanation, and not a verdict, you will use the meeting far more effectively and be far less disappointed by it.
It is also worth knowing that you are not unusual. The Patient Ombudsman received 4,886 new complaints in 2024/25, the highest total since the office opened in 2016, and 57 per cent of them concerned public hospitals. Quality of care was the single most common hospital complaint subject, at 29 per cent, followed by discharges and transfers, and by diagnosis and treatment. Those figures are from the Patient Ombudsman’s 2024/25 annual report.
What the Hospital Must Tell You After a Serious Event
If what happened to you or your family member meets the definition of a critical incident, your entitlement to information is not a matter of the hospital’s goodwill. It is a legal requirement.
A critical incident, in broad terms, is an unintended event that occurs when a patient receives health care and that results in death or serious disability, injury, or harm, where the harm does not result primarily from the patient’s underlying medical condition or from a known risk inherent in the treatment. Regulation 965 under the Public Hospitals Act requires hospitals to disclose critical incidents to the affected patient, or to the substitute decision-maker if the patient is incapable, or to the estate trustee or the person who would have been the substitute decision-maker if the patient has died.
The disclosure has to include the material facts of what occurred and the consequences for the patient as they become known, along with the actions taken and recommended. Then, at an appropriate time afterward, the hospital must also disclose the systemic steps, if any, it is taking or has taken to reduce the risk of a similar incident happening again, and record what was said and when.
Read that last part again, because it is the provision patients most often do not know about. If the hospital reviewed what happened and changed a protocol, retrained staff, or altered a handover practice as a result, you are entitled to be told. If you are not told, ask directly and ask again in writing.
There is a practical caution attached to that. Hospitals often follow the initial disclosure with what they call a secondary disclosure meeting, and sometimes undertake to provide a written secondary disclosure report afterward. It does not always arrive. In an investigation completed in January 2025, the Patient Ombudsman dealt with a family who attended a secondary disclosure meeting after a patient died in hospital, were told they would receive a report, and were still waiting more than two years later. Get the commitment in writing, attach a date to it, and follow up.
What the Hospital Does Not Have to Show You
Here is where patients most often hit a wall, and it helps enormously to see it coming.
When something serious happens, an Ontario hospital will typically convene an internal quality of care review. The Quality of Care Information Protection Act, 2016 makes the material prepared for and by a quality of care committee, and the committee’s discussions and deliberations, privileged. That material is not disclosable and is not admissible in a legal proceeding. The policy rationale is that clinicians will speak candidly about error only if the conversation is protected.
What the Act deliberately carves out of that protection, however, is substantial. In respect of a critical incident, the following are not shielded: the facts of what occurred, what was identified as the cause or causes, the consequences for the patient as they become known, the actions taken and recommendations made to address those consequences, and the systemic steps the facility is taking or has taken. The fact that a review happened, and when, is also outside the privilege.
So the practical line is this. You can get the facts, the identified causes, the consequences, and the remedial steps. You generally cannot get the review report itself, the committee’s opinions, or who said what in the room.
Do not underestimate how firmly that line is held. In Algarawi v Berger, two birth injury actions, the hospital defendants did not even need to rely on the statute: the court found the quality review documents were protected by common law quality assurance privilege in any event. I wrote about that decision and why quality review records so rarely see daylight elsewhere on this site. The underlying facts, though, remain obtainable from the chart and from the disclosure obligations above. Ask for the facts. Do not waste the meeting demanding the report.
Get Your Records Before You Sit Down
This is the single most useful thing you can do, and most people do it in the wrong order.
Under section 52 of the Personal Health Information Protection Act, 2004, you have a right of access to your own health records. Section 54 requires the hospital to respond as soon as possible and no later than thirty days, with one permitted extension of up to a further thirty days in defined circumstances. That timeline is why you should request the records the day the meeting is offered, not after it.
Ask for everything, not just the discharge summary. That means physician and nursing notes, medication administration records, physician orders, laboratory and diagnostic imaging reports and the images themselves, monitoring strips, consultation notes, and any incident report concerning the patient. Records held by other custodians, including the family doctor, the specialist’s office, and the ambulance service, are separate requests.
On fees, no dollar figure is fixed by regulation. The governing benchmark comes from the Information and Privacy Commissioner, which set thirty dollars for the first twenty pages plus twenty-five cents per page thereafter. The hospital must give you an estimate before incurring the cost. If access is refused, delayed beyond the statutory timeline, or overcharged, the complaint route is the Information and Privacy Commissioner. I have set out the full process in a separate guide on how to get your medical records in Ontario.
Walking into a patient relations meeting having read the chart changes the meeting entirely. You stop asking what happened and start asking why the note at 03:40 says what it says.
How to Prepare
Very little of what follows is a legal entitlement. Most of it is simply what works, and in my experience hospitals accommodate almost all of it when asked.
Ask in advance who will attend and in what capacity. It is a reasonable question and the answer tells you a great deal. A meeting with a patient relations specialist and the unit manager is a different conversation from one that includes the treating physicians, and different again from one where risk management is present.
Send your questions in writing beforehand and ask for an agenda. Written questions are harder to talk around, and they give the hospital the chance to arrive with answers rather than promises to follow up.
Write out a chronology before you go. Dates, times, who said what, what you observed. Grief and anger compress memory, and a written timeline keeps you anchored when the conversation moves quickly.
Bring someone. A second set of ears is worth more than you expect, and having one person listen while the other takes notes is a sensible division of labour. Hospitals routinely permit a support person. Whether they will accommodate a lawyer varies, and no statute entitles you to bring counsel to a patient relations meeting.
Ask about interpretation or accessibility accommodation in advance if you need it. Hospitals have interpreter services, and accommodation obligations arise under Ontario’s accessibility and French language services legislation for designated agencies.
Finally, ask for a written summary or follow-up letter afterward. Hospitals commonly provide one, and the regulatory framework requires that complainants be kept informed, but ask expressly rather than assuming.
Questions Worth Asking
The most useful questions are narrow and factual. Broad questions invite broad answers.
What was the sequence of events, hour by hour? Who was involved at each point, by name and role? What was the working diagnosis, and when did it change? Was a critical incident review conducted, and when? What did the hospital identify as the cause or causes? What corrective actions were taken? What systemic steps has the hospital taken or is it taking to prevent recurrence? Who holds the remaining records I have not received?
Ask each one and write down the answer. If a question is deflected, note that too. A pattern of deflection is itself information.
Recording the Meeting
Patients ask about this often, so it is worth addressing squarely.
Under the Criminal Code, it is not an offence to record a conversation you are a party to. That is the one party consent exception in section 184(2)(a). You do not need anyone else’s permission for the recording to be lawful.
Lawful is not the same as advisable. Many hospitals have policies against recording and may decline to proceed if you insist. A covert recording, if discovered, tends to reset the relationship to something adversarial at exactly the point where you want candour. My usual advice is to ask openly at the outset whether you may record for your own accuracy. If the answer is no, bring a second person and take detailed notes instead. You lose very little.
An Apology Is Not an Admission of Fault
The Apology Act, 2009 provides that an apology does not constitute an admission of fault or liability, does not void insurance coverage, and cannot be taken into account in determining fault or liability. An apology is generally inadmissible in civil proceedings as evidence of fault. There is a narrow exception for an apology made while testifying.
The point cuts both ways, and patients should understand both directions. If a physician apologizes sincerely at your meeting, that apology is not evidence that anyone was negligent, and it will not carry you anywhere in a claim. Equally, if nobody apologizes, that is not an admission that nothing went wrong. Hospitals and clinicians in Ontario are legally free to apologize, and the better ones do.
Who Is Actually in the Room
Understanding the institutional structure explains a lot of behaviour that otherwise reads as evasion.
Most physicians who work in Ontario hospitals are not hospital employees. They are independent practitioners with hospital privileges. The practical consequence is that a hospital cannot compel a physician who is not its employee to attend your patient relations meeting, and that the hospital is generally not vicariously liable for that physician’s negligence. Nurses and other staff are a different matter: for them, the hospital is responsible.
The insurance architecture follows the same split. Physicians are defended by the Canadian Medical Protective Association, a mutual defence organization that is known for defending claims vigorously. Hospitals, nurses, and staff are covered separately, most often through the Healthcare Insurance Reciprocal of Canada or another insurer. Those are different interests with different counsel, which is part of why hospitals and physicians so often respond cautiously even when everyone in the room is acting in good faith.
None of this means people are lying to you. It means the person across the table may be genuinely constrained in what they can say, and it explains why “we cannot speak to Dr. X’s care” is sometimes an accurate statement rather than a dodge.
One more caution. Nothing you say at a patient relations meeting is privileged. If a claim is a realistic possibility, be factual, ask questions, and resist the temptation to advance theories about who was at fault.
The Clock Keeps Running
This is the part I most want patients to take away, because it is where real harm is done.
A patient relations process can take months. A quality of care review can take longer. A College complaint can take a year or more. None of it pauses a limitation period. There is nothing in the Excellent Care for All Act, 2010, the Quality of Care Information Protection Act, 2016, or anywhere else that stops the clock while you work through the hospital’s process.
The basic limitation period under the Limitations Act, 2002 is two years, running from the day the claim is discovered, and the Act presumes discovery on the day the act or omission occurred unless you prove otherwise. There is also a fifteen year ultimate limit. The clock does not run against a minor who has no litigation guardian, or against a person who is incapable and unrepresented.
Where a patient has died, the trap is sharper and less forgiving. Section 38(3) of the Trustee Act gives two years from the date of death for claims by or against an estate, and Ontario courts have consistently held that this period is not subject to discoverability. It runs from the death itself, whatever you knew or did not know. Waschkowski v Hopkinson Estate and Levesque v Crampton Estate are the appellate authorities. I have seen meritorious cases lost this way, by families who did everything the hospital asked of them and were still working through the complaint process when the two years expired.
If a death is involved, or if you are approaching two years from the events, get legal advice before the patient relations meeting rather than after it. My guide to limitation periods in Ontario medical malpractice claims sets out the framework in more detail.
If the Meeting Does Not Resolve Things
Several routes run in parallel to the hospital process, and none of them awards compensation. I have mapped all of them in a patient’s guide to making complaints about health care in Ontario; the short version follows.
The Patient Ombudsman handles complaints about public hospitals, long-term care homes, home and community care, and community surgical and diagnostic centres. It is a body of last resort, so you must generally try to resolve matters with the organization first. It can investigate and make recommendations, but it cannot award compensation, cannot make findings of negligence, and does not deal with the conduct of an individual regulated health professional.
A College complaint is the route for concerns about an individual practitioner’s conduct or competence. For physicians, the College of Physicians and Surgeons of Ontario screens complaints through its Inquiries, Complaints and Reports Committee, which does not make findings of professional misconduct but decides what, if anything, should happen next. Either party can seek review by the Health Professions Appeal and Review Board within thirty days. I have written separately on whether to file a CPSO complaint and what it can realistically achieve.
Where a death may have involved negligence, the Office of the Chief Coroner may already be involved, and families can ask a regional supervising coroner to review a decision not to hold an inquest. See my guide to coroner’s investigations for Ontario families.
If the issue is records access, the Information and Privacy Commissioner is the route.
And a civil claim is the only one of these that can result in compensation. It is also the only one that requires proof of a breach of the standard of care and proof that the breach caused the injury, both of which turn on expert evidence. Those are separate questions from whether the hospital handled your complaint well. A hospital can respond to a complaint badly and still not be liable, and it can respond impeccably and still be liable.
The Honest Summary
Go to the meeting. Request your records first and read them. Send your questions in writing. Bring someone. Ask for the facts, the identified causes, and the systemic steps, because you are entitled to those. Do not expect the quality review report, an admission, or an offer of money, because none of those are on the table.
And watch the calendar. The hospital’s process runs on the hospital’s timeline. The limitation period runs on its own.
If you are working through a hospital complaint and are not sure whether what happened is also a legal claim, that is a question worth asking early rather than late. My overview of suing for medical malpractice in Ontario sets out what a claim actually requires. If you would like me to look at your situation, you can request a free consultation. The first thing I will look at is the calendar.
