The revocation of a physician’s licence is one of the most serious sanctions in Canadian professional regulation. The framework operates as the last resort where the conduct or capacity of the physician is incompatible with continued practice and where lesser sanctions (suspension, conditions, mandatory supervision) cannot adequately protect the public. The framework also recognizes that revocation is not always permanent. The Regulated Health Professions Act and the Medicine Act establish a framework under which a physician whose licence has been revoked can apply for reinstatement, subject to specific procedural and substantive requirements. The framework operates conservatively: reinstatement is the exception rather than the rule, and it requires demonstrated rehabilitation, ongoing patient safety considerations, and (in many cases) detailed conditions designed to manage any residual risk.
Doyle v College of Physicians and Surgeons of Ontario, 2026 ONPSDT 1, released by the Ontario Physicians and Surgeons Discipline Tribunal on January 12, 2026, is a recent application of the reinstatement framework. The applicant was a psychiatrist whose licence had been revoked in 2018 following findings of serious professional misconduct including boundary violations with vulnerable patients, poor judgment, inadequate record-keeping, and a pattern of concerning conduct over many years despite previous supervision and therapy. After more than seven years out of practice, he applied for reinstatement. The College of Physicians and Surgeons of Ontario opposed the application. After reviewing the evidence of rehabilitation, the expert risk assessments, and the framework for balancing residual risk against the public interest, the Tribunal granted reinstatement subject to detailed conditions.
The case is doctrinally important for several reasons. It is one of the recent applications of the reinstatement framework in Ontario physician discipline. It articulates the framework for what counts as meaningful evidence of rehabilitation following revocation for boundary violations and similar serious misconduct. It illustrates the role of independent expert assessments in the reinstatement analysis. It demonstrates the framework for using conditions to manage residual risk where the tribunal concludes that some risk remains but is not incompatible with a return to practice. And it provides a useful reference for understanding the framework for reinstatement following revocation more generally, which is a less frequently examined area of professional regulation in Ontario.
A note before the analysis. The underlying conduct in this case involved real harm to vulnerable patients. One patient was hospitalized following an inappropriate termination of care. The reinstatement decision in 2026 is not a comment on the seriousness of that underlying harm; the tribunal explicitly accepted that the misconduct was serious and harmful. The decision is about whether, after more than seven years of treatment, supervision, and rehabilitation, the framework for protecting current and future patients can accommodate a return to practice subject to specific conditions. The two questions (was the original harm serious; can current and future practice be safely conducted) are distinct, and the framework recognizes them as distinct. Patients who experienced the original harm may understandably view the reinstatement decision differently than the framework that produced it. Both perspectives are legitimate.
The legal framework — physician discipline and reinstatement
A brief overview of the regulatory framework is useful for the analysis.
The Regulated Health Professions Act framework. The Regulated Health Professions Act, 1991, SO 1991, c 18 (the RHPA) is the foundational legislation governing health profession regulation in Ontario. The Act establishes the structure of professional regulation including the colleges, the discipline process, and the appellate framework. The framework operates uniformly across most regulated health professions, with profession-specific provisions in the individual professional Acts (such as the Medicine Act, 1991, SO 1991, c 30 for physicians).
The Health Professions Procedural Code. Schedule 2 to the RHPA establishes the Health Professions Procedural Code, which governs the discipline and licensing procedures for all the regulated health professions. The Code includes the framework for revocation of certificates of registration (the formal term for licences) and the framework for reinstatement applications.
The discipline framework. Section 51 of the Code provides for the discipline framework, including the grounds for findings of professional misconduct or incompetence. Section 51(5) authorizes the discipline panel (the Ontario Physicians and Surgeons Discipline Tribunal in the case of physicians) to impose sanctions including revocation of the certificate of registration, suspension, conditions, reprimands, and fines. The framework is calibrated to the seriousness of the misconduct and the protective function of the regulatory regime.
The reinstatement framework. Section 72 of the Code permits a member whose certificate has been revoked to apply for reinstatement (for revocations other than for certain categories of sexual abuse, which are subject to a different framework). The minimum waiting period is one year from the revocation. The applicant must demonstrate that reinstatement is consistent with the public interest and that the applicant is fit to practise.
The “public interest” test. The reinstatement framework operates on the principle that the public interest is the paramount consideration. The framework asks whether the applicant has demonstrated that reinstatement (with appropriate conditions where required) is consistent with the safety of patients and the broader public interest. The framework does not require the elimination of all risk; it requires the management of residual risk to a level that is acceptable under the public interest standard.
The Tribunal’s structure and authority. The Ontario Physicians and Surgeons Discipline Tribunal is the independent administrative tribunal that adjudicates physician discipline matters. The Tribunal operates with three-member or five-member panels including both physicians and public members. The framework supports independent adjudication informed by professional expertise and public perspective. Appeals from Tribunal decisions can be taken to the Divisional Court on questions of law.
The clinical context — psychiatric practice and professional boundaries
A brief clinical overview is useful for the analysis. Psychiatric practice operates in a clinical context with specific professional boundary considerations.
The nature of psychiatric practice. Psychiatric practice involves long-term, therapeutically intensive relationships between physicians and patients. The therapeutic alliance is itself part of the treatment framework, and the patient often shares deeply personal information including emotional, sexual, and relational content. The framework requires the psychiatrist to maintain professional boundaries that protect the integrity of the therapeutic relationship and the well-being of the patient.
The vulnerable patient framework. Many patients in psychiatric care are clinically vulnerable. Depression, anxiety, trauma, dependency, and other clinical presentations can affect the patient’s capacity for autonomous decision-making. The framework imposes heightened scrutiny on professional boundaries in these contexts because the power asymmetry between psychiatrist and patient is more acute, and because the consequences of boundary violations can be more severe.
The boundary violation framework. Professional boundary violations in psychiatric practice can include:
- Personal or social relationships with current or former patients
- Inappropriate self-disclosure by the psychiatrist
- Financial transactions outside the professional relationship
- Sexual relationships or sexualized communication
- Inappropriate termination of care
- Excessive availability or under-availability outside professional norms
- Other conduct that undermines the structured professional relationship
The framework for evaluating boundary violations distinguishes between minor variations from optimal practice (which may not constitute misconduct) and serious violations that compromise the therapeutic relationship and put the patient at risk. The framework also recognizes that patterns of boundary issues are typically more serious than isolated lapses, and that boundary violations with vulnerable patients are more serious than equivalent conduct with patients who have greater capacity for independent decision-making.
The “inappropriate termination of care” framework. The framework for ending a therapeutic relationship in psychiatric practice includes specific professional responsibilities. The psychiatrist is expected to provide appropriate notice, to support the transition of care to another provider where indicated, to manage the patient’s risk during the transition period, and to avoid termination that exposes the patient to foreseeable harm. Termination that fails to meet these standards can produce significant clinical harm, including emotional distress, deterioration of the underlying condition, and (in serious cases) hospitalization or worse.
The professional regulation response. The framework for regulatory response to boundary violations and similar misconduct includes a range of sanctions from supervision to suspension to revocation, calibrated to the seriousness of the misconduct, the harm caused, and the protective considerations going forward. Where the misconduct represents a pattern over time and lesser sanctions have not produced sustained behavior change, the framework can support revocation.
The 2018 revocation
The reinstatement application addressed an applicant who had been removed from practice through the discipline framework in 2018.
The findings supporting the 2018 revocation included:
- Professional boundary violations with patients. The framework for boundaries in psychiatric practice was breached in multiple respects across multiple patients.
- Poor judgment in dealing with vulnerable patients. The decisions about how to engage with patients in clinically vulnerable circumstances fell below the professional standard.
- Inadequate medical records. The framework for documentation in psychiatric practice was not consistently met.
- Improper handling of patient care and termination of treatment. The framework for managing the therapeutic relationship, including its conclusion, was not consistently met.
- A pattern of concerns despite years of supervision and therapy. Previous interventions by the College, including supervision and required therapy, had not produced sustained behavior change.
In one specific case, a vulnerable patient experienced severe emotional distress and was hospitalized following an inappropriate termination of care. The case illustrated the practical consequences of the framework’s failure: a patient who had relied on a therapeutic relationship was harmed by the breakdown of that relationship.
The 2018 discipline panel concluded that patients were not safe in the applicant’s care, even with conditions or other lesser sanctions short of revocation. Revocation was imposed as the appropriate response to the pattern of misconduct and the protective considerations.
The 2026 reinstatement application
The applicant applied for reinstatement under the Section 72 framework after more than seven years out of practice.
The evidence of rehabilitation. The applicant presented substantial evidence of efforts undertaken since the revocation, including:
- Years of intensive psychotherapy addressing the underlying issues
- Participation in a specialized physician rehabilitation program focused on boundaries, ethics, and judgment
- Independent expert assessments concluding that the applicant did not currently suffer from a mental illness affecting competence
- Ongoing work in health-care settings without direct patient contact, providing some demonstration of professional engagement under controlled circumstances
- Evidence of greater insight into the underlying issues, accountability for the past misconduct, and stability in personal and professional life
The framework treats this category of evidence as the principal indicator of whether meaningful change has occurred. The framework recognizes that rehabilitation in the relevant sense requires not just time but active engagement with the underlying issues, professional capacity for safe practice, and life circumstances that support continued change.
The College’s opposition. The College opposed the reinstatement application on several grounds:
- The misconduct occurred repeatedly over decades, supporting a substantial concern about whether change is durable
- Previous interventions including supervision and therapy had not prevented further misconduct
- Evidence indicated that the applicant had continued giving advice to former patients during the period of suspension and revocation, suggesting that the framework for boundary-respecting conduct had not been fully internalized
- Some expert assessments rated the risk of future misconduct at low to moderate (rather than negligible)
The College’s framework treated patient safety as the paramount consideration. The framework for opposing reinstatement in cases involving boundary violations and similar misconduct tends to emphasize the difficulty of measuring genuine change versus surface compliance, and the catastrophic consequences of misjudgment in this area.
The expert evidence. The framework supported by independent expert evidence on both sides indicated that some risk of future misconduct remained but that it could be managed through appropriate conditions. The expert framework distinguished between:
- Risk that could not be managed through conditions (which would support continued exclusion from practice)
- Risk that could be managed through conditions (which could support conditional reinstatement)
- Risk that had been substantially eliminated through rehabilitation (which would support reinstatement without significant conditions)
The expert assessments in this case fell into the second category. Some risk remained, but it could be managed through tight controls on the scope and circumstances of practice.
The Tribunal’s decision
The Tribunal granted reinstatement subject to detailed conditions. The reasoning proceeded along several principal axes.
The rehabilitation evidence assessment. The Tribunal found that the applicant had made significant efforts to change. The years of intensive therapy, the specialized rehabilitation program, the independent expert assessments, the controlled clinical engagement, and the evidence of insight and accountability collectively supported the finding that meaningful rehabilitation had occurred.
The residual risk assessment. The Tribunal found that some risk of future misconduct remained. The framework did not require the elimination of all risk; it required the management of residual risk to an acceptable level. The Tribunal accepted the expert framework that the residual risk could be managed through appropriate conditions.
The conditions framework. The Tribunal imposed conditions designed to manage the residual risk, including:
- Limits on the type of care that can be provided
- Ongoing oversight of the applicant’s practice
- Specific safeguards around patient boundaries
- Other framework elements designed to prevent recurrence
The conditions framework is the operative tool for managing residual risk in cases where reinstatement is appropriate but where complete elimination of risk has not been demonstrated. The framework allows the regulatory body to maintain ongoing supervision while permitting the applicant to provide some forms of care.
The public interest balance. The Tribunal concluded that conditional reinstatement would not undermine public trust in the medical system. The framework for the public interest analysis considered both the protective dimension (will patients be safe?) and the broader systemic dimension (does the regulatory framework maintain credibility?). The Tribunal found that the rehabilitation evidence, the framework of conditions, and the years of separation from practice collectively supported the public interest in conditional reinstatement.
The conclusion. The Tribunal granted reinstatement subject to the conditions framework. The decision was not a statement that the original misconduct was acceptable; the Tribunal explicitly accepted that the misconduct was serious and harmful. The decision was that the framework for protecting current and future patients could accommodate a return to practice under specific conditions, after more than seven years of demonstrated rehabilitation.
The doctrinal anchors
Several doctrinal anchors emerge from the case.
The reinstatement framework. Section 72 of the Health Professions Procedural Code permits a member whose certificate has been revoked to apply for reinstatement after at least one year, subject to the public interest test. The framework operates conservatively, with the burden on the applicant to demonstrate that reinstatement is consistent with the public interest. Doyle v CPSO is the principal recent cluster authority on the framework.
The “patient safety as paramount” framework. The reinstatement analysis treats patient safety as the central consideration. The framework operates on the principle that the regulatory regime exists primarily to protect patients, and that reinstatement decisions must be consistent with that protective function.
The rehabilitation evidence framework. The framework for evaluating rehabilitation evidence includes the duration of treatment, the nature of the rehabilitation program, the independent expert assessments, the evidence of insight and accountability, and the demonstration of professional capacity for safe practice. Doyle v CPSO illustrates the operative framework with detailed reference to each of these categories.
The “conditions can manage residual risk” framework. Where the rehabilitation evidence supports meaningful change but some residual risk remains, the framework supports conditional reinstatement with conditions designed to manage the residual risk. The framework operates as a middle path between outright reinstatement (which requires substantial elimination of risk) and continued exclusion from practice (which is appropriate where the residual risk cannot be managed through conditions).
The boundary violations framework in psychiatric practice. Professional boundary violations in psychiatric practice are treated with particular seriousness given the vulnerability of many psychiatric patients and the centrality of the therapeutic relationship to psychiatric treatment. The framework supports robust sanctions for serious boundary violations and rigorous evaluation of rehabilitation evidence in subsequent reinstatement applications.
The vulnerable patient framework. Where the original misconduct involved vulnerable patients, the framework for reinstatement applies heightened scrutiny. The framework recognizes that the consequences of misconduct in this context can be severe and that the framework for protecting future patients must be calibrated accordingly.
The one-year minimum waiting period. Section 72 of the Code establishes one year as the minimum waiting period from revocation to the first reinstatement application. The framework operates as a procedural floor; in practice, successful applications typically follow much longer periods of demonstrated rehabilitation.
The “public interest” test. The framework for the public interest analysis includes both protective considerations (patient safety) and systemic considerations (regulatory credibility and public confidence). Doyle v CPSO applies the framework with explicit reference to both dimensions.
The “would undermine trust in the medical system” framework. Where conditional reinstatement is being considered, the framework asks whether granting it would undermine public trust in the medical regulatory regime. Where the framework of conditions adequately protects patients and the rehabilitation evidence is robust, the framework typically supports the conclusion that conditional reinstatement does not undermine trust.
The expert assessment framework. Independent expert assessments are central to the reinstatement analysis. The framework typically includes assessments by physicians with expertise in physician rehabilitation, by mental health professionals where the underlying issues include mental health considerations, and by other specialists relevant to the underlying misconduct. The framework supports robust expert evidence on both sides of the reinstatement question.
The “continued misconduct during suspension” framework. Where the regulatory record indicates that the applicant continued conduct of concern during the period of suspension or revocation (such as advising former patients during a period when the framework for the professional relationship had been terminated), the framework treats this as a serious factor weighing against reinstatement. The framework operates on the principle that compliance with regulatory orders during the period of exclusion from practice is itself evidence of capacity for compliance going forward.
The Health Professions Procedural Code framework. The Code (Schedule 2 to the RHPA) is the foundational procedural framework for physician discipline and reinstatement. The framework provides the structure for hearings, evidence, decisions, and appeals.
Why this case matters
For patients and former patients. The case provides a useful illustration of how the regulatory framework operates with respect to reinstatement following revocation.
Some practical observations:
Revocation is not necessarily permanent, but reinstatement is not automatic. The framework permits applications for reinstatement after a minimum waiting period, but it operates conservatively. The applicant bears the burden of demonstrating that reinstatement is consistent with the public interest. The framework treats reinstatement as the exception rather than the rule.
Patient safety is paramount. The framework treats patient safety as the central consideration in the reinstatement analysis. The framework does not require the elimination of all risk, but it does require that any residual risk be manageable through appropriate conditions.
Reinstatement does not mean the original misconduct was acceptable. The framework explicitly distinguishes between the seriousness of the original misconduct (which is not retroactively reassessed in the reinstatement application) and the framework for protecting current and future patients (which is the operative question in the reinstatement analysis). A reinstatement decision is not a comment on the underlying harm.
Affected patients may have legitimate ongoing concerns. The framework operates on a prospective protective basis. Patients who were harmed by the original misconduct may understandably view the reinstatement decision differently than the regulatory framework that produces it. The framework does not require former patients to accept the reinstatement outcome; it requires the regulator to make the protective and public interest assessment that the framework demands.
Conditions can be substantial. Where reinstatement is granted with conditions, the conditions framework can substantially constrain the scope and circumstances of practice. The framework includes ongoing oversight, scope limitations, and other safeguards designed to manage residual risk. Patients seeking care from a physician who has been reinstated with conditions may want to inquire about the specific conditions that apply.
For more on the framework for regulatory complaints and discipline in Ontario more generally, see A Patient’s Guide to Making Complaints About Health Care in Ontario.
For physicians and the broader profession. A few practical observations:
The framework recognizes the possibility of rehabilitation. The Section 72 framework permits applications for reinstatement after revocation. The framework recognizes that some forms of misconduct, while serious, can be addressed through rehabilitation, and that the protective function of the regulatory regime is not undermined by accommodating that possibility in appropriate cases.
Meaningful rehabilitation requires sustained engagement. The evidence base that supports a successful reinstatement application is substantial. Years of treatment, specialized rehabilitation programs, independent expert assessments, and demonstrated insight are typical features of successful applications.
The framework for conditions is robust. Where reinstatement is granted with conditions, the conditions framework operates as the ongoing mechanism for managing residual risk. Compliance with conditions is itself a continuing professional obligation.
Pattern misconduct and continued problem behaviors weigh heavily. The framework gives particular weight to evidence that the underlying issues were not addressed by previous less restrictive interventions (supervision, mandatory therapy, and so on) and to evidence that conduct of concern continued during periods of suspension or revocation. The framework treats these as significant predictors of future conduct.
Decision Date: January 12, 2026
Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal
Citation: Doyle v College of Physicians and Surgeons of Ontario, 2026 ONPSDT 1 (CanLII)
Outcome: Application for reinstatement granted with conditions. The Tribunal found that the applicant, whose certificate of registration had been revoked in 2018 following findings of serious professional misconduct including professional boundary violations with vulnerable patients, poor judgment, inadequate record-keeping, and improper handling of patient care and termination of treatment, had made significant efforts to address the underlying issues during the more than seven years since revocation. The rehabilitation evidence included years of intensive psychotherapy, participation in a specialized physician rehabilitation program focused on boundaries, ethics, and judgment, independent expert assessments concluding that the applicant did not currently suffer from a mental illness affecting competence, ongoing work in health-care settings without direct patient contact, and evidence of greater insight, accountability, and stability. The College opposed the reinstatement application on the basis of the pattern of misconduct over decades, the failure of previous interventions to prevent further problems, evidence of continued advice to former patients during periods of suspension and revocation, and expert assessments rating the risk of future misconduct at low to moderate. The Tribunal concluded that while some residual risk remained, it could be managed through appropriate conditions, and that conditional reinstatement was consistent with the public interest and would not undermine trust in the medical regulatory regime. The conditions imposed include limits on the type of care that can be provided, ongoing oversight, and specific safeguards around patient boundaries.
Key authorities: Regulated Health Professions Act, 1991, SO 1991, c 18 (foundational regulatory framework); Health Professions Procedural Code (Schedule 2 to the RHPA), particularly s 51 (discipline framework) and s 72 (reinstatement framework); Medicine Act, 1991, SO 1991, c 30 (physician-specific provisions).
