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

Formal complaints may be made against midwives at the College of Midwives of Ontario. These regulatory proceedings have the potential to result in professional consequences, and can be stressful. To assist midwives, we have prepared this basic guide for responding to complaints.

Midwives will typically receive the following at the outset of the formal complaint process: notification of the complaint against them, a copy of the complaint, and their prior complaint history, if applicable. The College of Midwives of Ontario generally must address and investigate all complaints, and may request interviews with midwives. Failing to comply with this or any other requirement may result in professional discipline. After the investigation concludes, a panel of the Inquiries, Complaints and Reports Committee (“ICRC”) will make a disposition. The ICRC is comprised of both midwives and government appointed public members.

Regardless of how they feel about a complaint, midwives typically should prepare a response. The formal complaint process operates through documentary exchange and review rather than oral hearing, meaning that responses must be made in writing. Midwives will likely not have another opportunity to explain their conduct to the ICRC.

The College of Midwives of Ontario typically requires a response from midwives within 30 days. Preparing a response may be time consuming and challenging. Midwives should consider seeking assistance from lawyers who are experienced in the area of professional regulation. Once retained, legal counsel will typically become the main point of contact with the College of Midwives of Ontario, and will assist with the response and any other issues.

Midwives should consider any unique aspects of their case when drafting their response, including when they provided care, the complexity of care, and the possibility of a civil lawsuit. In our experience, it is often useful to format the response as a chronological account of the event.

When submitting their response, midwives should enclose any relevant patient records and materials. As a general practice, midwives should always keep their records in compliance with the guidelines of the Midwifery Act, 1991. The ICRC can evaluate a midwife’s records at any time, and can make a negative disposition on the basis of inadequate recordkeeping. 

Upon the conclusion of the investigation, the ICRC will receive and review the complaint file, and may make any of the following dispositions: 

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

Midwives will typically receive written reasons explaining the ICRC’s decision. The ICRC will not provide written reasons if it has referred a midwife to discipline or for incapacity proceedings.

The College of Midwives of Ontario must post details of the following ICRC dispositions on the Public Register: Specified Continuing Education or Remediation Programs (“SCERP”); cautions; undertakings; and referrals to discipline. This information will be available to anyone accessing a midwife’s online profile. 

In serious cases where their alleged conduct exposes or is likely to expose patients to harm or injury, midwives may be subject to an interim order. Interim orders can take the form of terms, limitations, or conditions on a midwife’s certificate of registration, including licence suspension. Interim orders can last for the entirety of the formal complaint process. The Registrar may also appoint a special investigator to investigate serious complaints against midwives. Under section 75 of the Health Professions Procedural Code, this investigator has much broader powers than in the standard complaint process.

Midwives 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 College of Midwives of Ontario’s investigation was adequate and whether the ICRC’s decision was reasonable. A review at HPARB will be based on the documents and materials that were available to the ICRC. HPARB will typically provide these materials to midwives and complainants in advance of the review.

Dealing with a complaint at the College of Midwives of Ontario can be a difficult experience. Legal counsel can help midwives address the situation. The formal complaint process has potentially negative consequences, so midwives should respond accordingly.