Complaints and Concerns about a Midwife

If you have questions with respect to the care you received and want to speak to a Professional Practice Advisor before filing a complaint, we can help you. Our advisor can’t help you decide whether to submit a complaint about a specific clinical situation. However, they can help you understand how the standards, legislation, and regulations relate to your situation. This may inform your decision on whether to file a complaint.

To contact our Professional Practice Advisor, please email practiceadvice@cmo.on.ca or telephone 416.640.2252.

To initiate a complaint against a midwife, please provide the following information in a written or recorded form, such as a letter, audio file or video recording:

• Your full name, mailing address and/or email, and phone number
  A clear statement indicating that you are filing a formal complaint including the name of the midwife you are complaining about
• Description of events, and the details of the complaint in your own words. Include the date(s) of the incident(s) and the specific issues you would like to complain about (this can be point-form)
• Name of the midwifery practice, hospital(s) or other health clinics related to your complaint, if applicable
• Any supporting documentation you wish to include
• Optional: Your expectation of outcome(s)

There are three ways to submit your complaint:

• Recommended: Submit your complaint through our secure deposit box. Please include the information listed above, as well as any additional supporting evidence relevant to your complaint. Submit your complaint through our secure deposit box.
• Alternatively, you may submit your complaint by email: conduct@cmo.on.ca. If you are sharing personal health information, note that regular email is not a secure method of transmission.
• Or, submit your complaint by mail to the attention of the 
Professional Conduct Department
  College of Midwives of Ontario
  21 St. Clair Ave E, Suite 303,
  Toronto, ON M4T 1L9

Professional Conduct staff at the College can assist in the administration of your complaint but they are not involved in the decision-making. You can contact the Professional Conduct Department if you have questions about the complaints process or are unsure if you would like to file a formal complaint. If you are unsure of the name of the midwife you want to complain about, the Professional Conduct staff can help you.

Contact the Professional Conduct department by email at conduct@cmo.on.ca, or by telephone at 416.640.2252.

After your complaint is received, a College staff member will contact you, usually within two business days, to explain the complaints process and confirm the main issues of your complaint. The College will confirm receipt of your complaint in writing within 14 days. The midwife will also be given notice of your complaint, along with a copy of your complaint, within 14 days.

The College has two complaint process streams: an alternative dispute resolution process and the Inquires, Complaints, and Reports Committee (ICRC) investigative process.

Information about the Complaints processes at the College are also described in College’s Guide to Filing a Complaint.

The College has set Professional Conduct Benchmarks based on historical data and regularly review them to ensure they are based on up-to-date data, current case volumes, and streamlined procedures. The College aims to process complaints efficiently and expediently. Our goal is to meet our benchmarks at least 80% of the time.

Alternative Dispute Resolution (ADR) is an alternative to the College’s investigative complaints process. It allows for the complainant, the midwife, and a third-party mediator to work together to create a resolution that satisfies all parties.

With ADR, there is no formal investigation of the complaint. The ADR process will only take place if both the complainant and the midwife agree to resolve the complaint through this process.

Many complaints are eligible for ADR, but complaints involving alleged sexual abuse or matters that have already been referred to the Discipline Committee cannot be referred to ADR. The College’s ADR Policy describes the ADR process and the criteria that must be met to process a complaint in this matter.

Resolutions are unique to each complaint so it’s difficult to predict what a resolution may look like. Some resolutions may include one or more of the following:

• Acknowledgment regarding the incident and the impact it had on the complainant, and/or an apology by the midwife
• Changes or initiatives set forth by the midwife that will improve future care
• An agreement by the midwife to take a remedial course or obtain additional educational relating to an issue(s) identified in the complaint
• An understanding or acknowledgment by the complainant that the midwife acted appropriately

Complaints that go through ADR must be resolved within 60 days, with a possibility of an extension to 120 days, which means that they are usually completed faster than those that go through the formal complaints process.

Learn more about the ADR process in the College’s Guide to Filing a Complaint. You can also read the College’s Alternative Dispute Resolution Policy.

The Inquiries, Complaints, and Reports Committee (ICRC) is responsible for investigating complaints and determining if a concern should be referred to the Discipline Committee for a hearing, or if other action should be taken in the public interest.

The ICRC deliberates on complaints in panels comprised of both midwives and members of the public who are appointed by the provincial government to represent the views of the public.

In coming to a decision, the ICRC will consider the information gathered in an investigation, along with midwifery and College standards, and the legislation and regulations that govern midwifery practice in Ontario to determine if they have concerns with a midwife’s practice along with the level of risk that conduct may pose to the public.

Each step of the complaints process is designed to ensure fairness to both the person filing the complaint and the midwife who is named in the complaint.

The ICRC also has the power to make an interim order at any time following the receipt of a complaint. The ICRC can make an order if it believes a midwife’s conduct exposes or is likely to expose clients to harm or injury.

In this process, the Inquiries, Complaints and Reports Committee (ICRC) investigates and makes decisions on complaints. The investigation will usually include obtaining a copy of the relevant midwifery record. Other investigative steps could include obtaining hospital or EMS records, witness statements, etc. if they are deemed relevant to the complaint.

Occasionally, the ICRC may decide an expert opinion is required. Sometimes, the ICRC may engage a third-party investigator to conduct aspects of the investigation.

The midwife is asked to respond to the complaint within 30 days. Sometimes extensions are granted. Examples of extensions can include time to obtain relevant medical records, and requests for extensions to respond.

The midwife’s response to the complaint is generally shared with the complainant, particularly if it raises new information and the ICRC requires the complainant’s further comment.

The midwife is given an opportunity to provide a further written submission on all information gathered in the investigation before the ICRC meets to deliberate and decide on the complaint.

After thoroughly reviewing the materials gathered in the investigation, a panel of the ICRC will then meet to deliberate and decide on an appropriate outcome.

Risk Assessment Framework

The College’s Inquiries, Complaints, and Reports Committee (ICRC) forms panels to investigate public complaints and information the College receives through reports regarding concerns related to professional misconduct, incompetence, or incapacity.

As part of our commitment to fairness and transparency, we developed the ICRC Risk Assessment Framework. The framework is designed to guide committee panels in their assessment of complaints and reports, aiding them in making fair, consistent and transparent decisions.

The ICRC panel will use the College’s Risk Assessment Framework to make a fair, consistent, and transparent decision on the complaint. The panel could decide to do one or more of the following:

1. Take no further action on the complaint if the panel determines the midwife met the standards of the profession.
2. Provide advice and recommendations to the midwife.
3. Require the midwife to complete a Specified Continuing Education or Remediation Program (SCERP). This involves education to improve a midwife’s future practice, which can include taking courses, reviewing materials, writing a reflection paper or Practice Protocol, or requiring the midwife to participate in a chart review.
4. Require the midwife to appear before a panel of the ICRC to receive an oral caution.
5. Require the midwife to sign an acknowledgment and undertaking, which is a voluntary agreement between the midwife and the College to place certain restrictions on the midwife’s practise
6. Refer specified allegations of professional misconduct and/or incompetence in the complaint to the Discipline Committee for a hearing.
7. Refer the matter to the Fitness to Practise Committee, should the matter involve an allegation regarding the physical or mental capacity of the midwife.

Read more about the ICRC Risk Assessment Framework.

ICRC Panel Decisions

The ICRC panel has no authority to assess injury or award compensation to the complainant. That is the subject of civil court proceedings.

The ICRC will prepare written reasons for their decision. Both the complainant and the midwife will receive a copy of the panel’s written decision.

Appeal Process

The complainant and the midwife have the right to request a review of the decision to the Health Professions Appeal and Review Board (HPARB) within 30 days of the decision being issued. Information about this process will be provided to the complainant and midwife with the decision.

For more information about complaints, please review the Complaints Process Flowchart, the College’s Guide to Filing a Complaint, ADR Policy, and common questions.

Alternatively, you can contact a Professional Conduct staff member by email conduct@cmo.on.ca or by telephone 416.640.2252 ext. 224.

To submit a complaint, please use the College’s secure deposit box.

None at this time.

None at this time.

All Discipline hearings are open to the public. The College is currently conducting its hearings by videoconference. If you would like to attend a hearing, please contact our Professional Conduct department at conduct@cmo.on.ca.

Fitness to Practise hearings are closed to the public unless the midwife who is alleged to be incapacitated requests that it be open to the public. The hearing requires the Fitness to Practise panel to make a finding on whether a person is incapacitated and if so, what order would be most appropriate.

During the hearing, the panel will listen to each party’s submissions and review evidence regarding physical or mental incapacity. They will then deliberate to decide whether the midwife is incapacitated.

If after the hearing, the panel decides that the midwife is incapacitated, then it may impose one or more of the following orders:

1. Order a revocation – the midwife’s certificate of registration will be revoked.
2. Order a suspension – the midwife’s certificate of registration will be suspended for a specified period of time.
3. Impose a term, condition or limitation on the midwife’s certificate of registration – the midwife’s practise will be restricted for a specified or indefinite period of time.

Applications for Variation

A midwife can bring an application to vary a term, condition or limitation imposed on their certificate of registration anytime unless the order stipulates a specific time period for which the term, condition, or limitation must remain on the midwife’s certificate. In that case, the midwife can only bring an application for variation once that time limit has passed.

A decision of the Fitness to Practise panel on an application for variation can be appealed to the Divisional Court for judicial review within 90 days of being issued. There must be a question of law, fact, or both in order for an appeal to be granted. The court may affirm, rescind, or rehear the matter in whole or in part.

A notation of the appeal and its outcome will appear on the College’s public register.

Applications for Reinstatement

A midwife can apply for reinstatement after one year from the original revocation or suspension of their certificate. A repeat reinstatement application can be brought six months after the prior application. A panel of the Fitness to Practise Committee will hold a hearing to make its decision regarding the application.

A decision of the Fitness to Practise panel on an application for reinstatement cannot be appealed to Divisional Court.

Anyone can make a complaint, including former clients, family members, and other health professionals.

The College cannot process anonymous complaints. If you wish to proceed with a formal complaint, we require your information to investigate the matter fully.

You can report your concerns to the College anonymously, and the College will look into the concerns. However, you will not be informed of what steps, if any, the College took to address the concerns raised.

No, you can only make a complaint about individually named midwives. This is because the College only has jurisdiction over individual midwives and does not regulate Midwifery Practices or their employees. In some cases, and depending on the nature of the concern, your complaint can be made against the individual midwives who are practice owners. The College can assist you with this.

There are no time limitations on filing a complaint with the College, but it is recommended that you make your complaint as soon as possible so the College can investigate your concerns as soon as possible. Sometimes the time passage may impact the College’s ability to conduct its investigation.

Health regulatory college investigation procedures are designed to keep information about the complaint confidential. However, it is important to note that your personal information will be released to the midwife that is the subject of the complaint.

You should also be aware that if your complaint is appealed to the Health Professions Appeal and Review Board, or if concerns raised in the complaint are referred to the Discipline Committee, the case will be heard in a hearing that is open to the public.

Yes. As a part of the process, the midwife is notified and provided with a copy of complaint within 14 days of the College receiving your complaint. They will also have an opportunity to provide a written response to the ICRC once all the investigation materials are received.

College staff will review the complaint. The College may contact the complainant to introduce themselves, confirm the issues in the complaint if needed, explain the complaints process, and answer any questions the complainant may have about the process.

The complainant will receive a formal acknowledgment of the complaint within 14 days of receipt of a complaint.

If the complaint is eligible for Alternative Dispute Resolution, this acknowledgment will include a request for the complainant to respond in writing as to whether they consent to participate in this process.

As part of the investigation process a client’s personal health information may be obtained by the College Usually, the College will request that the midwife to submit the midwifery record to the College.

The College may request that the complainant provide written consent to authorize the release of other medical records as part of the investigation.

The midwife will receive a formal notice of complaint within 14 days of receipt of the complaint along with a copy of the complaint.

Note: The Regulated Health Professions Act, 1991 and the Personal Health Information Protection Act, 2004 allow midwives to disclose personal health information about a client to the College for the purpose of the administration of the complaint.

Before the ICRC makes a decision on a complaint, it must complete an adequate investigation. The first step in any investigation is obtaining the midwifery record of the client (if the complaint is related to a client). Other investigation steps may include obtaining other health records including hospital records, or other documents relevant to the investigation and interviewing people or witnesses.

Some documents include obtaining the client’s consent to release the medical records. Consenting to release records is voluntary, however, if a complainant chooses not to release records, it may impact the ICRC’s ability to make an informed decision.

Sometimes, the ICRC may appoint a formal investigator to conduct aspects of the investigation such as obtaining documents or interviewing witnesses.

The ICRC may obtain an expert or legal opinion for some complaints.
The ICRC attempts to complete its investigation and render decisions on complaints within 150 days of receipt of a complaint. However, this is not always possible. Any additional investigation steps taken may cause delays in the process and impact the ICRC’s ability to complete a timely investigation.

The Regulated Health Professions Act ,1991 (RHPA) mandates that complaints be disposed of within 150 days after the complaint is received. The legislation requires the College to send notices to the midwife and complainant when this is not possible and provide a reason for the delay.

Reasons for delays can include:

• Delays in receiving medical records from hospitals or other healthcare providers
• Delays in receiving coroner reports or other documentation
• Delays experienced in scheduling and conducting interviews
• Providing extensions to provide written responses
• Providing the midwife with an opportunity to comment on any new information gathered in the investigation before the ICRC meets
• Obtaining an expert opinion
• Obtaining legal advice on a complaint matter
• Time required for the ICRC to draft their reasons

Letters explaining the delay are sent to the complainant and midwife when the complaint has exceeded 150 days, 210 days, and every thirty days after that until the complaint is disposed of by the ICRC.

Both the complainant and the midwife will receive a copy of the final decision made by the panel of the Inquiries, Complaints and Reports Committee.

If the Inquiries, Complaints, and Reports Committee is concerned that the midwife’s conduct, or physical or mental state, exposes or is likely to expose the midwife’s patients to harm or injury, they may make an interim order. The interim order would direct the Registrar to suspend or impose terms, conditions, or limitations on the midwife’s certificate of registration until finally disposed of by the Inquiries, Complaints, and Reports; Discipline; or Fitness to Practise Committee.

The ICRC makes decisions based on whether it has concerns about the midwife’s conduct and the level of risk those concerns pose to clients and the public interest. The outcomes of the complaint process are intended to be remedial in nature, rather than punitive.

The ICRC has no authority to assess injury or award compensation to the complainant. That is the subject of civil court proceedings.

The ICRC has a number of options available to them and can include:

Taking no action.

When the ICRC considers a complaint and is of the view that the midwife’s conduct presents no/minimal risk to the public, they can decide to take no further action. The ICRC takes no action when the information in the record does not support taking any regulatory action and there was no impact on client care, safety, or the public interest or the midwife appears to be meeting the standards of the profession.

Offer advice and recommendations

This disposition occurs when the ICRC is of the view that the midwife’s conduct is low risk to the public and is unlikely to have an impact on client care, safety, or the public interest and believes that the midwife could benefit from advice or recommendations to improve their future practice.

Require the midwife to complete a Specified Continuing Education or Remediation Program (SCERP)

This disposition can occur when the ICRC is of the view that the midwife’s conduct poses a moderate to high risk to the public and may have a direct impact on client care, safety, or the public interest. The ICRC requires the midwife to undergo specific education activities to improve their future practice. These requirements can include that the midwife must complete educational courses, mentoring, reflective papers and/or undergo chart reviews.

Issue an oral caution

An oral caution is issued for moderate to high-risk matters and when the ICRC has a significant concern that the midwife’s conduct may have a direct impact on client care, safety, or the public interest if not addressed. This disposition requires the midwife to appear before a panel of the ICRC and the ICRC will communicate a clear message to the midwife that the conduct is unacceptable and must be changed to avoid similar incidents from happening in the future.

Require the midwife to sign an acknowledgment and undertaking

The ICRC may decide to engage in a voluntary agreement between the midwife and the College to place certain restrictions on the registrant’s practise to address moderate risk issues that are likely to have an impact on client care, safety, or the public interest.

Refer specified allegations of professional misconduct and/or incompetence to the Discipline Committee

This outcome is reflective of high-risk conduct or practise that is likely to have an impact on client care, safety, or the public interest. The ICRC refers matters to the Discipline Committee when the issue is serious enough, there is enough evidence to refer and is of the view that the concerns cannot be adequately addressed through other remedial dispositions, or previous dispositions have been unsuccessful in remediating concerns.

Refer the matter to the Fitness to Practise Committee, for allegations regarding incapacity

After a health inquiry is completed, the ICRC may refer high-risk matters the matter to the Fitness to Practice Committee if it is concerned that the midwife’s illness or capacity will adversely affect their practice and there is a risk posed to both the registrant and the public.