CCO President’s Message and Newsletter – November 27, 2025

President’s Message – November 27, 2025

The first snowflakes have begun to fall, and so our thoughts naturally turn to the upcoming festive season. Warmest holiday greetings to each and every one of you! This season invites us to celebrate light, connection, and the quiet miracles that renew and sustain us all throughout the year. On behalf of CCO, I wish you all the best, whatever holiday traditions you may celebrate. May your days and nights be filled with genuine happiness, surrounded by the love of family, friends, and the community spirit that make our profession so rewarding.

I am mindful that while the holidays can sparkle brightly, they can also bring heightened expectations, busy schedules, and extra stresses. A gentle adjustment (of either posture or perspective), and just being present in the moment can keep the mounting seasonal pressures from crowding out our joy.

And let us remember that there are those for whom this time of year feels heavy. Some among us, whether patients, colleagues, neighbours or friends, may be facing illness, dealing with grief, are far from loved ones, or are enduing loneliness. If the opportunity arises to offer them a kind word, lend a hand, or extend an invitation please consider it. Small gestures can go a long way to lighten others’ burdens, and are an expression of the healing spirit that motivate our province’s chiropractors every day.

Here’s to a season filled with laughter, excellent company, and most importantly, your continued good health.

Sincerely,

Dr. Kyle Grice President

CCO Newsletter – November 27, 2025

Ministry of Health Conducts Consultations on Expansion of Diagnostic Testing

As one of the 27 regulated health professions in Ontario, chiropractors are governed by specific legislation which articulates their scope of practice, the types of activities authorized to the profession, and the protected titles that members of the profession may use. CCO members are required at all times to practice within the scope of practice, to understand thoroughly the permitted and proscribed activities for the profession, and to regularly review relevant legislation, standards of practice, policies and guidelines and to be aware of any changes or amendments such as those articulated below.

Recently, the Ministry of Health conducted consultations on scope of practice for several regulated health professions, including chiropractors, to consider enhanced access to diagnostic testing. The objectives of this consultation include reducing pressure on the health-care system by expanding access to diagnostic testing and allowing providers to work to the full extent of their training and expertise, within their scope of practice. The consultation comment period closed on November 3, 2025.

CCO submitted a comprehensive response to the Ministry of Health in support of allowing chiropractors to order diagnostic ultrasounds, MRIs and CT scans, noting that chiropractors already possess the necessary knowledge, skills and judgement to order these advanced diagnostics as part of their scope of practice.

The College believes the proposed changes would better integrate chiropractic care across all health care settings, resulting in improved patient care. It would also generate significant annual savings by eliminating avoidable visits to primary care providers from patients solely seeking a diagnostic test, and thereby reduce wait times for primary care overall.

Thank you to everyone who contributed to the consultation. CCO looks forward to working with the ministry and all health system partners as the consultation and potential enhancements proceed.

Authorized versus Restricted Titles

As noted, profession-specific legislation (e.g., the Chiropractic Act, the Medicine Act) sets restrictions for the use of specific titles, variations of titles, and representations of qualifications and specialties that are authorized only to members of a specific profession. It is essential for the public interest that the public knows what type of health professionals they are obtaining services from, and that there is no misrepresentation.

CCO Policy P-010: Use of Professional Titles, Designations and Credentials lists several of these titles and terms that are restricted for members of CCO, meaning they must not be used.

Specifically, the titles “chiropractic physician”, “medicine”, “orthopractic”, “functional neurologist”, functional medicine” and “osteopath” are restricted, and cannot be used by members of CCO. These restricted titles may be confused by the public as representing a specialty of medicine that is not chiropractic. It must always be clear to the public that the regulated health professional they are receiving chiropractic services from is a chiropractor, and members may only represent themselves accordingly.

Committee Corner: Updates from the Quality Assurance Committee

Amended Standards of Practice

On November 20, 2025, changes to two standards of practice approved by CCO Council at its September 12, 2025 meeting came into effect. The amendments are as follows.

Standard of Practice S-001: Chiropractic Scope of Practice

Standard of Practice S-001: Chiropractic Scope of Practice has been amended to add breast examinations to the list of prohibited procedures itemized on page 4 of the Standard. As a reminder, precedents set by the Inquiries, Complaints and Reports Committee and Discipline panels may result in the enumeration of prohibited procedures. The prohibition on breast examination arises from a recent Inquiries, Complaints and Reports Committee decision.

Standard of Practice S-005: Chiropractic Adjustment or Manipulation

The Continuing Education requirements referenced on page two of Standard of Practice S-005: Chiropractic Adjustment or Manipulation have been amended to include the requirement to complete “a minimum of 5 hours of structured CE activity, that primarily focuses on an in-person hands-on or hand-held instrument adjustment or manipulation activity, and includes training in the competency of manual or hand-held instrument spinal adjustment or manipulation skills, at least once every three CE cycles (or six years).” For further information about CE requirements, please see Continuing Education webpage.

Reminder: Use of Diagnostic and Therapeutic Procedures Must Comply with Standard of Practice S-001: Chiropractic Scope of Practice

Members are reminded they must ensure that all current diagnostic and therapeutic procedures, including chiropractic techniques, are within the chiropractic scope of practice and compliant with Standard of Practice S-001: Chiropractic of Scope of Practice. Members are encouraged to review S-001 and note specifically that:

For a diagnostic or therapeutic procedure to be acceptable for clinical purposes it must be taught in the core curriculum, post-graduate curriculum or continuing education division of an accredited educational institution.

In order to perform a diagnostic or therapeutic procedure, members must: achieve, maintain and be able to demonstrate clinical competency (e.g., examination, certification, or other proof of training) in the diagnostic or therapeutic procedure.

Imagine that you come across a video of a novel chiropractic technique on social media, or read a description of a potentially exciting new diagnostic or therapeutic procedure. You must first determine whether it satisfies the explicit requirements of S-001 above in order to be in accordance with the standards for chiropractic in Ontario, before being able to use it. As always, members must obtain the patient’s consent to the use of any diagnostic or therapeutic procedure, consistent with Standard of Practice S-013: Consent.

Committee Corner: Updates from the Inquiries, Complaints and Reports Committee

The work of CCO’s committees is essential to meeting our statutory obligation to regulate chiropractic in the public interest. Here we highlight a case brought before the Inquiries, Complaints and Reports Committee (ICRC) in the hope that it will be instructive for patients, stakeholders and members.

Deficient Record Keeping Results in Specified Continuing Education or Remediation Program (SCERP)

An insurance company (IC) filed a complaint with the College of Chiropractors of Ontario alleging systematic inappropriate billing practices at Dr. DC’s multidisciplinary clinics. The core concerns were:

Splitting single brace claims ($750–$800) into two submissions ($500 + remaining balance on separate days) to circumvent IC’s $500 “reasonable and customary” (R&C) limit for off-the-shelf braces, resulting in overpayments.
Submitting claims for compression stockings that were never dispensed or even discussed with patients, apparently to “top up” brace reimbursement shortfalls.
Billing errors including wrong patient names (family members mistakenly selected from drop-down menus), services not rendered, incorrect providers, inadequate or missing documentation, and occasional failure to collect co-payments.
Claims for chiropractic treatment when physiotherapy was actually provided, and vice versa, often after one benefit category was exhausted.

The subsequent CCO investigation confirmed multiple discrepancies but found the actual number of problematic claims was relatively small. Most appeared to stem from administrative errors, poor staff training, outdated processes, and lack of oversight rather than deliberate fraud. The brace-splitting practice, while clearly improper, had been mistakenly believed by clinic staff to be permissible based on earlier conversations with IC representatives. Dr. DC acknowledged deficient record-keeping and the inappropriate brace submission method, implemented clinic changes before and during the investigation, and cooperated fully.

The ICRC panel determined the conduct did not warrant referral to discipline (high threshold not met) but represented moderate risk requiring remediation. Dr. DC was ordered to complete a one-year SCERP with an assigned peer mentor focused on record keeping (S-002), assistive devices (S-021), business practices (G-008), code of ethics (G-009), and assessments (G-013), with practice monitoring every three months, submission of reflective essay, and an in-person oral caution. Both the SCERP and caution appear on the public register.

Observations

Among other key learnings, this case demonstrates that ultimate responsibility for billing accuracy and documentation lies with the registrant, even when delegated to staff. Splitting claims to bypass insurer limits, even if thought permitted by insurers or “helpful” to patients, is improper. Patients are reminded to always review their explanation of benefits statements. If a service or product is itemized that you never received (e.g., compression stockings), report it to your insurer immediately.

CCO Continues to Meet with System Partners

CCO Council members and staff continue to meet with stakeholders and system partners in health regulation. In November 2025, this included attending the Federation of Canadian Chiropractic (FCC) meetings in Toronto and the Canadian Chiropractic Examining Board (CCEB) meetings (held virtually), as well as participating in training sessions offered by the Health Profession Regulators of Ontario.

November 3, 2025: Mr. Joel Friedman, Deputy Registrar and Dr. Katherine Tibor, Director of Professional Practice, participated in a presentation to 1^st year students at CMCC.

Happy Holidays from CCO Council and Staff!

CCO Council as of February 2025. Dr. Salima Ismail and Dr. Annette Langlois joined CCO Council in April 2025. New public member, Ms Janet Lemieux, joined CCO Council in November 2025.

Contents:

President’s Message – November 27, 2025

CCO Newsletter – November 27, 2025

Committee Corner: Updates from the Quality Assurance Committee

Committee Corner: Updates from the Inquiries, Complaints and Reports Committee

Happy Holidays from CCO Council and Staff!