Alberta Chiropractors: What to Do when Facing CCOA Complaints

If you are an Alberta Chiropractor, a complaint filed with the College of Chiropractors of Alberta (the “CCOA” or the “College”) can put your practice and reputation at risk.

When facing a CCOA regulatory action, you should act promptly and build an understanding of the potential consequences and the procedures involved. It is also important that you are prepared to safeguard your rights and defend against the allegations in a legally informed way.

This article provides some essential information about CCOA disciplinary action. However, it is not a substitute for legal advice, which is highly recommended if you are facing regulatory scrutiny.

Taylor Janis Workplace Law offers tailored legal services to all professionals facing regulatory actions across Alberta. Contact us today at our Edmonton or Calgary office if you need legal support.

The Disciplinary Powers of the CCOA

The Regulatory Role of CCOA

Under the Alberta Health Professions Act (the “Act”) and its accompanying Chiropractors Profession Regulation, the College of Chiropractors of Alberta, formerly known as Alberta College and Association of Chiropractors, is the regulatory college for the practice and profession of chiropractic in the province. Its regulated members have the exclusive right to use the restricted title “Chiropractor”.

Under the Act, the CCOA has a mandate to serve and protect the public interest. It is responsible for establishing, maintaining, and enforcing the standards of registration, practice, competence, and ethics for chiropractors. One of the key ways the College upholds these standards is through its complaints and discipline process.

The CCOA Has Broad Disciplinary Powers

The Act confers on Alberta Chiropractors the privilege to self-regulate. Along with this privilege, the CCOA is also conferred with broad powers and discretion to make legally binding disciplinary decisions against its regulated members. Upon determining that a Chiropractor has committed unprofessional conduct, the CCOA Hearing Tribunal may order one or more of the following against the disciplined chiropractor:

• A caution or reprimand;
• Imposition of conditions on their practice permit;
• Suspension of their practice permit temporarily or until certain conditions are satisfied;
• Requiring them to satisfy competence requirements;
  • A disciplined Chiropractor may be required to receive counselling or treatment programs, complete specific courses of study, or obtain supervised practical experience within a fixed period, during which the practice permit may be suspended.
• Cancellation of their registration and practice permit;
• Repayment of improper fees received from the complainant;
• Recovery of certain expenses incurred during the disciplinary process from the disciplined chiropractor;
• A fine not exceeding $10,000 for each finding of unprofessional conduct and not exceeding $50,000 for the aggregation of all unprofessional conduct found at one hearing; and                          
• Any other order deemed appropriate for the protection of the public.

Being disciplined can lead to further legal complications other than just the disciplinary measures listed above:

• Under the Act, CCOA can order disciplinary measures deemed appropriate for protecting the public. This means the College has certain discretion in ordering somewhat novel sanctions.
• The College can also enforce its disciplinary measures through further legal actions, meaning it may impose additional disciplinary measures, commence debt actions or apply for injunctive court orders if an initial order was not complied with.
• Where a matter raises a reasonable belief that a criminal offence has been committed, the Hearing Tribunal must forward its written decision to the Minister of Justice, thus creating a potential for further legal liabilities.

The Consequences of Being Disciplined

A disciplinary order by the CCOA can severely damage a chiropractor’s finances, career and reputation.

A severe disciplinary measure can be career-threatening, putting your practice and professional standing at risk. Even a seemingly “lesser” disciplinary measure, such as a requirement to complete a course of study within a fixed period, can be highly disruptive to your practice and personal life.

A disciplinary record can also put your professional reputation in serious jeopardy. Under the Act and the CCOA Bylaws, the College can publish information related to disciplinary decisions, and such publication will normally remain on its website for 10 years. Disciplinary decisions respecting sexual misconduct must be published on the College’s website and normally remain indefinitely accessible. Moreover, information related to a disciplinary suspension, cancellation or condition imposed on a practice permit must be forwarded to out-of-province regulators for chiropractors. Thus, the being disciplined can result in widespread and irrecoverable reputational damage, severely affecting the disciplined chiropractor’s practice, personal life and long-term career prospects.

Risk Assessment and Mitigation with Legal Advice

CCOA disciplinary measures have legally binding effects and can put your finances, practice and reputation at severe risk. The regulatory framework governing chiropractors is intricate, and both factual and legal issues are often intensely contentious in regulatory actions. Even seemingly minor or unfounded allegations may result in severe consequences.

Therefore, you should promptly obtain legal advice in assessing and mitigating the risks if you have received a complaint filed with the CCOA.

Taylor Janis Workplace Law is committed to providing tailored legal services. We can provide thorough legal representation when the risk is substantial. We can also give you transparent and practical legal advice if the risk is minimal. If you are under the CCOA’s regulatory scrutiny, please do not hesitate to contact us at our Edmonton or Calgary office today to schedule an initial consultation.

The Discplinary Procedures Explained

The procedures involved in a CCOA disciplinary process can be highly complex, consequential and disruptive to a chiropractor’s practice and personal life.

When expecting or undergoing a CCOA disciplinary process, you should promptly engage legal representation, as legal support can be crucial for navigating the procedural complexities and minimizing disruptions.

Complaints

Any person can file a complaint with the CCOA against a chiropractor. The College can also initiate a disciplinary process on its own motion, as if a complaint has been received, if it has reasonable grounds to believe that a chiropractor has committed unprofessional conduct.

Moreover, under certain circumstances, a fellow chiropractor or the employer of a chiropractor has a positive duty to report to the College regarding their concerns about a regulated member’s unprofessional conduct.

Therefore, a complaint does not necessarily come from a patient, and it is not the only way to trigger a disciplinary process.

the CCOA Complaints Director may only dismiss a complaint if it is vexatious, frivolous or lacks factual merit. Otherwise, they must initiate an investigation or facilitate an investigation.

Investigations

An unresolved complaint or a complaint deemed unresolvable will result in an investigation. The investigated chiropractors will normally be notified of the particulars of the allegation. During an investigation, you have an obligation to cooperate, but also a need to avoid inadvertently jeopardizing your case.

The investigatory measures available to the CCOA are broad, and an investigator can do one or more of the following:

• Require the investigated chiropractor to answer questions under oath;
• Require the investigated chiropractor to disclose documents, information and/or evidence relevant to the investigation; and
• Enter the investigated chiropractor’s premises for practice.

Under certain circumstances, the CCOA may also:

• Apply for a court order to enforce its investigatory measures.
• Temporarily suspend or place conditions on the investigated chiropractor’s practice permit.

Hence, an investigation can be highly intrusive and disruptive to the investigated chiropractor‘s practice and even personal life.

Upon the conclusion of an investigation, unless the complaint is dismissed for being trivial, vexatious or factually meritless, the investigated matter will be referred to the CCOA Hearing Tribunal.

When under investigation, legal representation can be crucial for avoiding potential legal pitfalls while remaining cooperative. It can also be integral to preparing a robust response to the allegations, which may discourage a frivolous, vexatious or meritless matter from being processed further, thus achieving a favourable and expedited resolution.

Hearings by the Hearing Tribunal

A hearing by the CCOA Hearing Tribunal determines the factual veracity of allegations, whether the conduct constitutes unprofessional conduct, and/or the appropriate disciplinary sanctions.

Navigating a hearing by the CCOA Hearing Tribunal can be highly challenging without legal representation, because:

• A hearing is a quasi-judicial and adversarial proceeding:
  • Both parties (the Complaints Director vs. the investigated persons) have a statutory right to counsel.
  • Decisions are based on the relative strength of the parties’ factual and legal submissions.
• An investigated chiropractor may be ordered to testify under oath:
  • If you testify, you may be examined (intensely scrutinized with questions) under oath.
  • Failure to cooperate may result in severe legal consequences.
• The time for preparation is limited:
  • A hearing would normally be scheduled within 90 days after a complaint has been referred to the Hearings Director.
  • The notice to attend and particulars of the matter can be given as late as 30 days before the hearing.
• A hearing may have profound reputational implications:
  • A hearing is presumed to be open to the public unless one of the limited legal exceptions requires it to be held in private in part or entirely.
  • Reputational harm may occur before a final verdict is reached, especially if the investigated chiropractor is under-prepared or acts in ways prejudicial to themselves.

If a hearing determines that the investigated chiropractor has committed unprofessional conduct, this determination will result in binding disciplinary orders. Hence, hearings are also highly consequential.

Extensive preparation is often necessary for achieving a favourable outcome at a hearing, and awareness of common pitfalls is crucial for minimizing reputational damage. Our strongest recommendation is that you exercise your statutory right to counsel if you are facing a CCOA disciplinary hearing.

Appeals

If an investigated chiropractor believes a hearing decision is biased or unfair, they can appeal the decision to the CCOA Council, and they can further appeal the CCOA Council’s decision to the Alberta Court of Appeal.

However, an appeal should be seen as a last resort, and the preferred approach is to engage legal representation early and work towards a favourable outcome at the initial stages. This is because:

• It is highly challenging to have a decision overturned:
  • The appellate standards are high and subject to stringent legal and evidentiary thresholds. A later section of this article will discuss the appellate standards in depth.
  • Courts are required to pay deference to statutory regulators out of respect for legislative intent, following the Supreme Court of Canada decision Vavilov.
• During an Appeal, the detriments of a disciplinary order may persist:
  • An appeal does not automatically suspend the enforcement of a disciplinary order.
  • Even if an appeal is successful, the remedy might be that the matter is sent back to the CCOA to be redetermined.
• An Appeal is legally intricate and technical:
  • An appeal is not a rehearing of the allegations, nor an opportunity for an appellant to reargue their case.
  • Normally, the scope of an appeal is limited to highly technical issues concerning the fairness of the original decision.

The preferred approach to disciplinary proceedings is a proactive one: you should obtain legal representation and aim for a favourable outcome at the early stages. However, if an appeal becomes necessary, its challenging and intricate nature means legal representation can be indispensable.

Voluntary/ Alternative Resolutions

There are alternative ways to resolve a complaint without going through the entire hearing process.

• Before a complaint is referred to the Hearing Tribunal, the Complaints Director may refer the matter to an alternative complaint resolution process. This is a voluntary and mediation-like process, where the complainant and the investigated chiropractor can reach a voluntary settlement.
• Before the Hearing Tribunal makes a factual determination regarding the alleged unprofessional conduct, the investigated chiropractor may admit some or all of the allegations. If accepted, such an admission can substantially shorten the fact-finding phase of the hearing.

However, these are consequential strategic decisions, and should be approached with legal advice, because:

• A settlement agreement is normally legally enforceable.
  • You need to ensure that its terms and conditions are fair and reasonable to you, based on a comprehensive review of all relevant legal and factual factors.
• An admission of unprofessional conduct does not conclude the disciplinary process.
  • A hearing may be necessary to determine the appropriate disciplinary measures.
• There are reputational implications.
  • Disciplinary decisions based on an admission are subject to the same publication and notification requirements and policies applicable to any other disciplinary decisions.
  • Under the CCOA Bylaws, a settlement agreement ratified by the College may be put on public notice.
• An admission of unprofessional conduct largely forecloses an appeal on grounds of erroneous fact-finding.

A voluntary settlement or admission may be advantageous under the right circumstances, but it is a strategic and consequential decision not to be made hastily. Before making such a decision, you should have your lawyer comprehensively review your case first.

Navigate the Procedures with Legal Advice

Even the early stages of a CCOA disciplinary process can be highly complex, consequential, and disruptive. Moreover, the reputational effects often start to emerge when the process commences, even before a final verdict is reached.

Throughout all stages of a disciplinary process, you need to avoid inadvertently jeopardizing your case, and you should also avoid settling a defensible case on unreasonable terms.

When expecting or undergoing a disciplinary process, you should obtain legal representation promptly. A lawyer can provide you with valuable legal support to navigate the complex procedures, make legally informed decisions and streamline the process where possible and reasonable.

The skilled lawyers at Taylor Janis Workplace Law are not only tenacious advocates but also resourceful problem solvers. Do not hesitate to contact us if you have any concerns about an upcoming or ongoing CCOA disciplinary procedure.

*The procedures cited above may vary if the alleged unprofessional conduct is related to the incapacity of the regulated member, sexual misconduct, or the procurement or performance of female genital mutilation.

Defending Against Discipline Actions: Rules, Facts and Advocacy

A robust and effective defence often requires more than telling your perspective of the alleged facts. It is often necessary to correctly reference a wealth of legal rules, substantiate the facts with strong evidence, and enhance the overall persuasiveness through skillful advocacy. This can be especially true when there are contentious factual or legal issues.

Interpreting and Applying Legal Authorities

Under the Act, unprofessional conduct is disciplinable and includes a broad range of conduct:

• Displaying a lack of knowledge, skill or judgment when practicing chiropractic;
• Contravention of applicable legislation, code of ethics or standards of practice;
• Practicing chiropractic without an appropriate practice permit or registration, or in ways contravening the conditions imposed on a practice permit;
• Non-compliance with an investigatory request or disciplinary decision of the CCOA; and
• Conduct that harms the integrity of the profession of chiropractic.

However, the list above does not provide a comprehensive understanding of what may attract discipline, nor how CCOA disciplinary decisions are made. When formulating a legal defence, it is important to know:

• There are multiple sources of legal rules specifically applicable to chiropractors in Alberta:
  • Any contravention of the Act, its accompanying regulations, the CCOA Bylaws, the CCOA Code of Ethics, or the CCOA Standards of Practice can be unprofessional conduct under the Act.
  • Expertise in all these sources of legal rules can be crucial for formulating effective legal arguments.
• The CCOA can consider other legal authorities, such as common law cases:
  • A chiropractor must follow all laws at all times, like everyone else. Correspondingly, the CCOA may consider other sources of legal rules and principles when adjudicating a matter, especially when the issue is complicated or nuanced.
  • For example, in this published Findings Decision, the CCOA Hearing Tribunal relied on a great number of common law cases for its reasoning regarding highly complex and technical legal issues, such as adequate disclosure of particulars, the concept of ungovernability and whether religious belief can be an exemption to following the College’s directives. In this Penalties Decision regarding the same matter, Jaswal factors were comprehensively considered for determining the appropriate penalties.

Resourcefully citing a wide range of legal authorities is often integral to an effective legal defence. Legal rules and principles are often highly nuanced, particularly when applied to the facts or when interacting with each other. Therefore, preparing a sound legal argument may require considerable legal acumen and extensive research.

Supporting Factual Defence with Robust Evidence

In CCOA regulatory proceedings, the perspectives of the parties often diverge, and the facts are often intensely disputed. Decisions are ultimately based on factual inferences drawn on the relative strength of competing evidence from both parties.

Legal representation can be integral to building a robust evidentiary basis and effective factual defence. This is because:

• Pieces of evidence are not equal in their probative value, factual relevance and legal materiality.
  • Proper organization and presentation are often crucial for showcasing the strength and relevance of your evidence.
  • Your legal counsel can flag problematic opposing evidence for being unreliable or irrelevant, thus enhancing the chance of a favourable outcome.
• The CCOA Hearing Tribunal has discretion to admit or exclude pieces of evidence and weigh them differently.
  • The Hearing Tribunal is not bound by the courts’ rules of evidence. It has a degree of discretion in admitting, excluding and weighing evidence, and this discretion should be exercised fairly.
  • A lawyer can not only highlight evidence that might otherwise be underconsidered, but also object to opposing evidence that is unduly prejudicial to you, thus reducing the chance of unfair fact-finding.

Skillful Advocacy

A lawyer, as your advocate, will tenaciously examine the strengths and flaws of each argument. This can be vital to the persuasiveness of your defence.

Your legal advocate also assists the adjudicator in making a fair decision in a variety of ways:

• A zealous advocate can highlight hidden but important factors which may otherwise be overlooked.
  • This can be especially instrumental when complex or principled analysis is engaged.
  • For example, the beneficence and competence principles under the Code of Ethics require a chiropractor to exercise competent judgment. Whether a particular decision is competent is a question ideally answered with a comprehensive analysis of all underlying circumstances and variables affecting the patient’s condition. Such factors are not necessarily obvious without being highlighted by an advocate.
• A skilled advocate can assist the decision-makers with issues that are not within their expertise.
  • Members of the Hearing Tribunal may not necessarily possess the same level of judicial training as a judge. When a legal rule or principle is at issue, legal counsel can play a crucial role in supporting their efforts to make fair decisions.
• Moreover, tenacious advocacy may be necessary for protecting your administrative law rights when undergoing a regulatory action. Your administrative law rights are the focus of the next section of this article.

Taylor Janis Workplace Law Advocates for You

As a chiropractor, you are committed to helping your patients through health challenges, and it can be difficult to shift your focus from your practice to address legal matters. You should have a legal advocate when facing regulatory challenges.

Taylor Janis is committed to advocating for our clients’ best interests in regulatory actions. Please do not hesitate to contact us if you need a skilled and zealous advocate.

Safeguarding Your Rights with Legal Representation

When undergoing a disciplinary process, your administrative law and common law rights are constantly engaged, and some of these rights even have constitutional roots.

Protecting your rights is often integral to upholding fairness. Therefore, you should be informed of your rights and prepared to safeguard them, and it is highly recommended that you engage legal representation early and throughout the entire disciplinary process.

Your Rights Are Integral to Fairness

The rights a person has when undergoing regulatory actions are ultimately informed by the principles of natural justice and fairness, which can be a difficult and abstract legal concept to grasp. It is often equally difficult to identify potential infringements, especially without legal guidance.

However, to summarize it for informational purposes, you have three broad but distinct rights:

• The right to substantive fairness:
  • This means a decision and its factual and legal reasoning must meet certain standards.
  • The Act provides that a final disciplinary decision made by the CCOA Council can be appealed to the Alberta Court of Appeal. Hence, the standards here are “no palpable and overriding errors” in fact-finding and “correctness” in legal reasoning (Vavilov; Housen).
• The right to procedural fairness:
  • This right is about due process. At its core, this means everyone is entitled to know the particulars of the allegations against them and have appropriate opportunities to make a full answer and defence.
  • The due process can be found under the Act and the CCOA Bylaws.
  • A lack of due process or a due process conducted unfairly can both result in an infringement. Hence, spotting infringement of this right may require both legal knowledge and in-depth analysis of the circumstances of a decision-making process.
• The right to unbiased decision makers
  • The legal standard is that decision makers should not give a reasonable apprehension of bias to a reasonable bystander observing the entire decision-making process.
  • Reasonable apprehension of bias is a high legal and factual threshold: it is not any apprehension of bias.

The applicable standards to successfully appeal a final disciplinary decision made by the CCOA Council are the same as the appellate standards on appeal from lower courts. Moreover, courts are required to follow the common law principle of paying deference to regulatory decision makers out of respect for legislative intent.

Hence, it is highly challenging to address infringements through an appeal. The preferred approach to safeguarding your rights is to retain ongoing legal support during a disciplinary process. Having a legal counsel engaged with the entire process means they can spot, flag and object to potential infringement as they arise, which can be essential for protecting your rights and achieving a fair outcome.

Early and Ongoing Legal Representation

Your rights are engaged by every procedure when facing a disciplinary process. Once it is made, it is highly challenging to overturn a disciplinary decision through an appeal.

Hence, our strongest recommendation is that you engage legal representation early and throughout a CCOA disciplinary process, protecting your rights every step of the way.

Taylor Janis is dedicated to upholding our clients’ rights. Contact us today to schedule an initial consultation and secure skilled legal representation.

Seeking Professional Representation

When facing a CCOA regulatory challenge, skillful legal representation can be indispensable for protecting your practice, reputation and professional standing.

Taylor Janis Workplace Law is dedicated to providing thorough, practical, and transparent legal advice. Whether you are dealing with an investigation, hearing, or appeal, Taylor Janis has the legal and practical expertise to assist you in navigating the legal challenges. With a proven track record of success in regulatory actions and a commitment to always providing tailored legal services, Taylor Janis understands the intricacies of regulatory actions and appreciates that every case and each client’s needs are unique.

As the first step of securing a tailored legal plan, contact our Edmonton or Calgary office for an initial consultation. We offer legal services to all professionals facing regulatory actions in all areas of Alberta.

Frequently Asked Questions

How Long Does a CCOA Complaint and Disciplinary Process Typically Take?

This could vary greatly depending on many factors, including the factual and legal merit and complexity of the complained matter. A vexatious or frivolous complaint is likely going to be dismissed fairly quickly, but a full investigation or hearing can lengthen the process to several months or well over a year. How you respond to the situation is also an important factor. A robust response from you may result in quicker resolutions, and strategic planning may prevent unnecessary procedural complexity and disruptive effects. If you have any questions or concerns about an ongoing disciplinary action, reach out to Taylor Janis for a comprehensive assessment of your case.

I Think the CCOA Has Made an Unfair Licensing Decision against Me. What Should I do?

If you have concerns about an unfair CCOA decision regarding registration, reinstatement, or a practice permit application, you can apply to the College’s Council for a review. A review by the Council comes with its own procedural complexities and time limits, and how you present your case to the Council can critically impact the outcome and your ability to practice. You have a statutory right to legal representation during the review. If you think you have been treated unfairly by CCOA, contact Taylor Janis Workplace Law to discuss your case.

Do I Need a Lawyer for Minor CCOA Complaints?

Even when a complaint is seemingly trivial or unfounded, it is still a good idea to at least talk to a lawyer first. A lawyer is equipped with the legal knowledge and research skills to assess the actual strength and gravity of a claim and can more accurately assess the potential risks. Having a lawyer on your side also shows that you are taking the situation seriously and are prepared, which may help resolve vexatious or meritless complaints early, thus minimizing the disruption and stress. If a complaint is truly unfounded, at least you get peace of mind knowing the risk is minimal after a consultation with a lawyer.

How much Does Legal Representation Cost? Will My Professional Liability Insurance Cover the Legal Fees?

Every case is different, so the total cost may vary. At Taylor Janis, we are committed to providing transparent fee structures. Depending on your case, we may be able to offer some flexibility in fee arrangements. Under the CCOA Bylaw, all chiropractors must maintain professional liability insurance. But your insurance may or may not cover legal fees for regulatory actions. If you are unsure about fees or the coverage, we recommend a quick initial consultation with us so we can review your case and provide an estimation.

Can I Continue Practicing Chiropractic During a Disciplinary Process?

This depends. If the CCOA did not suspend or place conditions on your practice permit, then you can continue working. However, if your permit is suspended or has conditions placed upon it, then you should strictly adhere to the College’s direction; otherwise, you are risking further legal liabilities. You can legally challenge an arbitrary or unfair decision to suspend or place conditions on your practice permit. If you are concerned about your ability to work when undergoing regulatory challenges, you should consult a lawyer.

Conclusion

When facing a complaint filed with the CCOA, it is highly recommended that you seek legal advice promptly. Experienced legal counsel can play a vital role in mitigating the potential risks. They do this by navigating you through the complex and consequential disciplinary procedures, preparing a robust response and defence, as well as safeguarding your rights throughout the entire process. The regulatory legal team at Taylor Janis Workplace Law is dedicated to advocating for the best interests of our clients, and we are looking forward to assisting Alberta chiropractors facing CCOA regulatory challenges.

References:

• Health Professions Act, RSA 2000, c H-7
• Chiropractors Profession Regulation, Alta Reg 277/2006
• Housen v. Nikolaisen, 2002 SCC 33 (CanLII), [2002] 2 SCR 235
• Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65 (CanLII), [2019] 4 SCR 653
• CCOA Standards of Practice
• CCOA Code of ethics
• Dr. Curtis Wall – Hearing Tribunal Written Findings Decision – January 27, 2023
• Dr. Curtis Wall – Hearing Tribunal Written Penalties Decision – August 10, 2023

Resources for Readers:

• Discipline decisions published by the CCOA
• CCOA complaints process
• CCOA complaints portal

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