Responding to Complaints at the College of Chiropractors of Ontario: What Chiropractors Need to Know

Chiropractors may become subject to formal complaints and regulatory proceedings at the College of Chiropractors of Ontario (“CCO”). This process has the potential to result in professional consequences, and can happen to any chiropractor. To assist, we have prepared this introductory guide for responding to complaints at the CCO.

Chiropractors who are subject to complaints will receive notification of the complaint from the CCO, a copy of the complaint, and any of their prior complaint history. After the CCO concludes its investigation into the complaint, a panel of the Inquiries, Complaints and Reports Committee (“ICRC”) will make a decision on the matter. The ICRC is comprised of both chiropractors and government appointed public members.

The CCO is generally required to address all formal complaints against chiropractors. The investigation may require chiropractors to submit to formal interviews. Failing to cooperate with this or any other requirement may result in professional discipline. Whether or not chiropractors consider complaints to be legitimate, they typically should prepare a response.

Formal complaints proceed by way of documentary exchange and review. This means that chiropractors are generally required to respond to complaints in writing, and will not be able to supply an in-person explanation of the care they provided. As hearings will not be held, it is important for chiropractors to craft comprehensive written responses.

Chiropractors will generally have 30 days to provide their response to the CCO. Preparing a response to allegations of professional misconduct may be time consuming and challenging. Chiropractors may benefit from the assistance of a lawyer who is experienced in the field of professional regulation. Once retained, legal counsel will typically become the primary point of contact with the CCO, submitting the response and addressing any other issues as they arise.

When drafting a response, chiropractors should consider any unique factors in their case, including when they provided care, the complexity of care, and the possibility of a civil lawsuit. In our experience, it is often helpful to provide a chronological account of the event in question.

Chiropractors should enclose any relevant patient records and materials when submitting their finalized response to the CCO. Regardless of the outcome of the CCO’s investigation into a specific complaint, the ICRC may evaluate a chiropractor’s records at any time. Inadequate recordkeeping is an independent act of professional misconduct, so chiropractors should always maintain their records in compliance with the guidelines of the Chiropractic Act, 1991. 

Upon concluding their complaint investigation, the investigator assigned to a chiropractor’s case will enclose their findings in a report to the ICRC. The ICRC will review the file, and may make any of the following dispositions: 

  • Take no further action; 
  • Caution a chiropractor in person before the ICRC; 
  • Inquire into a chiropractor’s professional capacity; 
  • Refer the matter to the Discipline Committee; or 
  • Make any other appropriate action, including ordering further investigation. 

The ICRC will typically provide chiropractors with written reasons for its decisions. Chiropractors will not receive written reasons if they are referred to discipline or to another panel of the ICRC for incapacity proceedings.

The CCO is required to post details of the following ICRC dispositions on the Public Register: Specified Continuing Education or Remediation Programs (“SCERP”); cautions; undertakings; and referrals to discipline. Members of the public will be able to find this information on a chiropractor’s online profile. 

In serious cases where a chiropractor’s alleged conduct exposes or is likely to expose patients to harm or injury, the ICRC may impose an interim order as a safeguard against any further alleged harm. Such an order will be imposed before the ICRC can make a final disposition, and can last for the entirety of the formal complaint process. Interim orders can take the form of terms, limitations, or conditions on a chiropractor’s certificate of registration, including licence suspension. The Registrar is also empowered to appoint a special investigator to investigate serious complaints against chiropractors. Under section 75 of the Health Professions Procedural Code, this investigator has much broader powers than in the standard complaint process.

Chiropractors and complainants are both entitled to request a review of the ICRC’s decision. Reviews take place before the Health Professions Appeal and Review Board (“HPARB”), which will consider whether the CCO’s investigation was adequate and whether the ICRC’s decision was reasonable. A review at HPARB will be based on the documents and material that were available to the ICRC. HPARB will provide these materials to chiropractors and complainants prior to the date of the review.

Addressing a formal complaint before the College of Chiropractors of Ontario can be stressful. It is prudent for chiropractors to consider retaining legal counsel who can assist with these regulatory proceedings. As the complaint process has the potential to end with professional consequences, chiropractors should take care to respond accordingly.