Can a health professional require patients, as a condition of treatment, to promise they will never complain to their regulatory college? In College of Physicians and Surgeons of Ontario v. Hart, 2026 ONPSDT 29 [CPSO v. Hart], the Ontario Physicians and Surgeons Discipline Tribunal (the “Tribunal”)[1] found that doing so amounted to disgraceful, dishonorable and unprofessional conduct. In its August 5, 2026, decision, the Tribunal accepted a joint submission on penalty suspending the physician’s certificate of registration for six months and prohibiting him from prescribing ketamine and testosterone replacement therapy upon his return to practise.

What did the Tribunal decide in CPSO v. Hart?

This decision originated from complaints by two patients, as well as reports from the Ontario Health Insurance Plan and assessors’ analysis of 34 other patients’ charts.[2] Of particular concern was the physician’s prescribing of ketamine, as he failed to properly assess and educate patients, obtain informed consent, prescribe appropriate dosages, or maintain adequate records.  The physician also prescribed testosterone replacement therapy where it was not indicated and failed to perform required tests.[3]

Prior to administering ketamine treatment, the physician required patients to sign a document promising not to take any legal action against him or make a complaint to the College of Physicians and Surgeons of Ontario (the “College”).[4] One of his patients, “Patient A,” received a document entitled “Ketamine Treatment Release & Acknowledgement” before her first appointment. The document contained the following statement and required Patient A’s signature: “I agree not to take any legal action against the assessing physician, the Readytogo Clinic, or to make a complaint of any kind to the College of Physicians and Surgeons in Ontario. [sic]”[5]

Patient A received a prescription for ketamine during an initial phone consultation with the physician, who failed to adequately explain ketamine’s risks and side effects. He also failed to provide instructions for managing adverse reactions associated with ketamine and did not recommend or implement any safeguards. Patient A experienced severe adverse effects after taking the dose of oral ketamine, including loss of balance, slurred speech, weakness, increased heart rate, and dissociation.[6] During a follow-up phone call two weeks later, the physician pressured Patient A not to complain to the College. He repeatedly asked her not to report him or take any action against him, which made Patient A feel intimidated and uncomfortable.[7]

Another one of the physician’s patients, “Patient B,” was also asked to sign a document with the same language as set out above.[8]

Why was the physician disciplined?

With respect to the physician requiring patients to sign a document promising not to take legal action or make a complaint to the College, the Tribunal found that doing so constituted conduct that would reasonably be regarded as disgraceful, dishonourable and unprofessional:

What is more, it was disgraceful, dishonourable and unprofessional to ask clients to sign a document promising not to take legal action against him or make a complaint to the College and to discourage Patient A from complaining to the College. Physicians may not attempt to hinder the College’s regulation of the profession in the public interest by encouraging the withdrawal of complaints. It is equally improper to attempt to discourage patients from making a complaint to the College and exercising their legal rights. The privilege of practising medicine brings with it the requirement of being governed by the College.[9]

Can an Ontario physician ask patients not to complain to the College?

The short answer is no. Put another way, members of regulated health professions are accountable to their governing colleges, and requiring patients as a condition of treatment to sign away their right to sue or make a complaint to a health college is itself a ground of professional misconduct. 

How Miller Thomson can help

Miller Thomson’s Health Industry lawyers are available to assist with any questions or issues, including regulatory investigations matters and matters pertaining to privileging/credentialing of physicians and other regulated health professionals.

[1] The Tribunal is part of a group of tribunals called the Health Professions Discipline Tribunal, which holds discipline hearings for several health colleges in Ontario.

[2] College of Physicians and Surgeons of Ontario v. Hart, at para. 1.

[3] College of Physicians and Surgeons of Ontario v. Hart, at para. 2.

[4] College of Physicians and Surgeons of Ontario v. Hart, at para. 4.

[5] College of Physicians and Surgeons of Ontario v. Hart, at para. 9.

[6] College of Physicians and Surgeons of Ontario v. Hart, at para. 11.

[7] College of Physicians and Surgeons of Ontario v. Hart, at para. 12.

[8] College of Physicians and Surgeons of Ontario v. Hart, at para. 19.

[9] College of Physicians and Surgeons of Ontario v. Hart, at para. 39 [citations omitted].