(1 of 3)
Effective June 4, 2026, Dr. Richard Nahas must cease to practice Medicine until such time as he has a clinical supervisor approved by the College, as specified by Paragraph (2)(b)(vi) of his Undertaking with the College dated February 3, 2026.
(2 of 3)
As from February 4, 2026, by order of the Ontario Physicians & Surgeons Discipline Tribunal, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Richard Nahas:
Practice Restrictions
i. The registrant will not be a Medical Director at an Out-of-Hospital
Premise (“OHP”). A Medical Director of an OHP is defined in the
College of Physicians and Surgeons of Ontario (the “College”)’s
Out-of-Hospital Premise Inspection Program’s OHP Standards and
Companion Documents.
ii. The registrant shall not perform the following:
1. any injections along or near the spinal column, including but not limited to neuraxial, paravertebral and plexus injections and/or nerve blocks for adult chronic pain;
2. administer any injection therapy for patients on anticoagulant or antiplatelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (“ASA”), including that the registrant will not take any steps to facilitate providing injection therapy by reviewing or
recommending anticoagulation treatment modification or short-term discontinuation for patients who otherwise need anticoagulation therapy; and
3. prescribe systemic corticosteroids, renew existing prescriptions of systemic corticosteroids, and/or administer systemic corticosteroids, and the registrant shall not
perform extra-articular or neuraxial corticosteroid injections.
iii. The registrant will post a sign in all waiting rooms, examination rooms and consulting rooms, in all his Practice Location or Practice Locations (collectively defined as “each and every location at which he practices, delegates, or has privileges, including, but
not limited to, any hospitals, clinics, offices, and any Out-of Hospital Premises or Independent Health Facilities with which he is affiliated, in any jurisdiction”), in a clearly visible and secure location, at all times whether or not he is physically present at the
Practice Location, in the form set out at Schedule “A” to this Order. If providing care in a virtual setting, the registrant shall display the sign to the patient at the outset of the patient encounter. If the patient encounter is by telephone, the registrant shall read the sign to the patient at the outset of the patient encounter. For further clarity, this sign shall state as follows:
Dr. Nahas shall not:
1. perform any injections along or near the spinal column,
including but not limited to neuraxial, paravertebral and plexus injections and/or nerve blocks for adult chronic pain;
2. administer any injection therapy for patients on anticoagulant or antiplatelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (“ASA”), including that Dr. Nahas will not take any steps to facilitate providing injection therapy by reviewing or
recommending anticoagulation treatment modification or short-term discontinuation for patients who otherwise need anticoagulation therapy; and
3. prescribe systemic corticosteroids, renew existing prescriptions of systemic corticosteroids, and/or administer systemic corticosteroids, and Dr. Nahas shall
not perform extra-articular or neuraxial corticosteroid injections. Further information may be found on the College of Physicians and Surgeons of Ontario website at
www.cpso.on.ca
iv. The registrant shall post a certified translation in any language in which he provides services of the sign described above in all waiting rooms of all his Practice Locations, in a clearly visible and secure location, in the form set out at Schedule “A” to this Order. The registrant will provide the certified translation to the College within thirty (30) days of this Order. If the registrant elects, after this Order is made, to offer services in any other language, the registrant will notify the College prior to providing any such
services and will provide the College the certified translation of the signage prior to beginning to provide services in any other language.
v. The College may accept an alternative arrangement with respect to signage, as described above, in a hospital or other setting, in the College’s sole discretion.
Clinical Supervision
vi. Prior to commencing practice following the expiry of the period of suspension, the registrant shall retain at his own expense a Clinical Supervisor acceptable to the College (the “Clinical Supervisor”) who has executed an undertaking in the form attached
at Schedule “B” to this Order.
vii. For a minimum of six (6) months after resuming practice, the registrant will practise only under the supervision of the Clinical Supervisor (“Clinical Supervision”). The period of Clinical Supervision will commence on the expiry of the period of suspension, or on the date that the Clinical Supervisor is approved, whichever is later.
viii. Clinical Supervision will cease only with College approval, and in the College’s sole discretion.
ix. The Clinical Supervisor will discuss any concerns arising from the direct observation of patient encounters and chart reviews with the registrant.
x. The Clinical Supervisor will make recommendations to the registrant for practice improvement and ongoing professional development and inquire into the registrant’s compliance with the recommendations.
xi. The educational goals for the Clinical Supervision will be as
follows:
1. Appropriate indications for nerve blocks in the management
of chronic pain; and
2. Ensuring individualized chronic pain management plans.
xii. The Clinical Supervisor will perform any other duties, such as reviewing other documents or conducting interviews with staff or colleagues that the Clinical Supervisor deems necessary for the registrant’s Clinical Supervision.
xiii. If, prior to completion of the Clinical Supervision, the Clinical Supervisor is unable or unwilling to continue in that role for any reason, the registrant shall retain a new College-approved Clinical Supervisor who will sign an undertaking in the form attached at t
Schedule “B” to this Order. The registrant shall cease practising medicine until such time as he has obtained a Clinical Supervisor acceptable to the College. If the registrant is required to cease practising as a result of this paragraph, this will constitute a term,
condition and limitation on his certificate of registration and such term, condition and limitation shall be included on the College’s public register.
Moderate Level Clinical Supervision
xiv. For a minimum of three (3) months after resuming practice, the Clinical Supervisor will meet with Dr. Nahas at his Practicelocation, once every two (2) weeks (“Moderate Level Clinical Supervision”).
xv. During Moderate Level Clinical Supervision, the Clinical Supervisor shall directly observe at least three (3) patient encounters at every meeting. The Clinical Supervisor will not recommend a reduction in the level of supervision, as contemplated by subparagraph 2b(xviii) below, until at least the Clinical Supervisor is satisfied that no further
direct observation is needed.
xvi. During Moderate Level Clinical Supervision, the Clinical Supervisor will review at least fifteen (15) patient charts at every meeting, to be selected in the sole discretion of the Clinical Supervisor.
xvii. During Moderate Level Clinical supervision, the Clinical Supervisor will provide a report to the College once every month, or more frequently if the Clinical Supervisor has concerns about the registrant’s standard of practice or conduct.
Low Level Clinical Supervision
xviii. After a minimum of three (3) months of Moderate Level Clinical Supervision, if the Clinical Supervisor recommends and the College approves a reduction in the level of supervision, the Clinical Supervisor will meet with the registrant at his Practice Location, or
another location approved by the College, once every month for at least a further three (3) months (“Low Level Clinical Supervision”).
xix. During Low Level Clinical Supervision, the Clinical Supervisor shall review at least fifteen (15) patient charts at every meeting, to be selected in the sole discretion of the Clinical Supervisor.
xx. During Low Level Clinical Supervision, the Clinical Supervisor will submit a written report to the College at least once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about the registrant’s standard of practice or conduct
Professional Education
xxi. The registrant will participate in the following professional education:
1. Review, reflection, and discussion with the Clinical Supervisor of the following policies and other self-study:
a. CPSO’s Policy - Medical Record Documentation,
https://www.cpso.on.ca/Physicians/Policies Guidance/Policies/Medical-Records-Documentation
b. CPSO’s Policy – Complementary and Alternative
Medicine,https://www.cpso.on.ca/en/Physicians/Policies Guidance/Policies/Complementary-Alternative-Medicine
c. CPSO’s Policy - Essentials of Medical Professionalism,
https://www.cpso.on.ca/en/physicians/policies guidance/essentials-medical-professionalism
d. 2017 Canadian Guidelines for Opioids for Chronic Non Cancer Pain, https://doi.org/10.1503/cmaj.170363
e. 2024 Opioid Prescribing Guidelines, quick reference
summary,
https://npc.healthsci.mcmaster.ca/guidelines/
2. any additional professional education recommended by the Clinical Supervisor.
xxii. The registrant will complete this requirement within three (3) months of the start of the Clinical Supervision. The College may, in its sole discretion, extend the time to complete any professional education recommended by the Clinical Supervisor.
Reassessment
xxiii. Approximately six (6) months after the completion of Clinical Supervision as set out above in subparagraphs 2b(vi) to (xx), the registrant will submit to a reassessment of his practice (“the Reassessment”) by an assessor or assessors selected by the
College (the “Assessor”). The Reassessment shall include a chart review of a minimum of fifteen (15) patient charts, and may include direct observation of the registrant’s care, interviews with the registrant, colleagues and co-workers, feedback from patients, and
any other tools deemed necessary by the College.
xxiv. The registrant will co-operate fully with the Reassessment, conducted under the terms of this Order.
xxv. The registrant acknowledges that the Clinical Supervisor may receive and review the findings of the Assessor and may discuss with the Assessor any issues or concerns arising from the Reassessment.
xxvi. The registrant acknowledges that the results of the Reassessment will be provided to him and reported to the College and the Reassessment may form the basis of further action by the College.
Monitoring
xxvii. The registrant must inform the College of each and every one of his Practice Locations within five (5) days of this Order. Going forward, the registrant will inform the College of any and all new Practice Locations within five (5) days of commencing practice at that
location.
xxviii. The registrant will submit to, and not interfere with, unannounced inspections of his Practice Locations and patient records by a College representative for the purposes of monitoring his compliance with the provisions of this Order.
xxix. The registrant shall give his irrevocable consent to the College to make appropriate enquiries of the Ontario Ministry of Health and Ministry of Long Term Care, the Ontario Health Insurance Plan(“OHIP”) or the Narcotics Monitoring System (“NMS”) and/or any
person who or institution that may have relevant information, in order for the College to monitor his compliance with the provisions of this Order and shall promptly sign such consents as may be necessary for the College to obtain information from these persons or
institutions.
xxx. The registrant shall consent to the sharing of information between the Clinical Supervisor, the Assessor and the College as any of them deem necessary or desirable in order to fulfil their respective obligations, for the purpose of monitoring the registrant’s
compliance with this Order and/or for sharing information that comes to any of their attention which they believe may indicate a potential risk of harm to patients.
xxxi. The registrant shall be responsible for any and all costs associated
with implementing the terms of this Order.
(3 of 3)
As from June 7, 2022, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Richard Nahas in accordance with an undertaking and consent given by Dr. Nahas to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)
of
DR. RICHARD NAHAS
(“Dr. Nahas”)
to
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the “College”)
A. PREAMBLE
(1) In this Undertaking:
“Code” means the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended;
“Discipline Tribunal” means the Ontario Physicians and Surgeons Discipline Tribunal of the College;
“OHIP” means the Ontario Health Insurance Plan;
“Ontario Physicians and Surgeons Discipline Tribunal” means the Discipline Committee established under the Code;
“Public Register” means the College’s register that is available to the public.
(2) I, Dr. Nahas, certificate of registration number 72330, am a member of the College.
(3) I, Dr. Nahas, acknowledge that following a public complaint that raised concerns about my standard of practice and conduct in my pain management practice, the College conducted an investigation bearing File Number CAS-135240-L4F5S3 (previously, File Number 1112268) (the “Investigation”).
(4) I, Dr. Nahas, acknowledge that, in addition to accepting this Undertaking, the College will also deliver a caution in person.
B. UNDERTAKING
(5) I, Dr. Nahas, undertake to abide by the provisions of this Undertaking, effective immediately.
(6) Clinical Supervision
(a) I, Dr. Nahas, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the “Clinical Supervisor” or “Clinical Supervisors”), for six (6) months (“Clinical Supervision”).
(b) I, Dr. Nahas, acknowledge that I have reviewed the Clinical Supervisor’s undertaking, attached hereto as Appendix “A”, and understand what is required of the Clinical Supervisor. The Clinical Supervisor will, at minimum:
(i) Facilitate the education program set out in the Individualized Education Plan (“IEP”), attached hereto as Appendix “B”;
(ii) Review the materials provided by the College and have an orientation session with me, including to discuss the objectives for the Clinical Supervision;
(iii) Meet with me at my Practice Location, or another location approved by the College, once every two (2) weeks for a minimum of three (3) months;
(iv) During the first three (3) months of clinical supervision, perform direct observation of three (3) patient encounters at each meeting;
(v) After a minimum of three (3) months of Clinical Supervision, if my Clinical Supervisor recommends and the College approves a reduction in the level of supervision, my Clinical Supervisor will meet with me at my Practice Location, or another location approved by the College, once every month for a further three (3) months;
(vi) Review at least fifteen (15) of my patient charts at every meeting;
(vii) Discuss any concerns arising from the chart reviews;
(viii) Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations;
(ix) Perform any other duties, such as reviewing other documents or conducting interviews with staff or colleagues, that the Clinical Supervisor deems necessary to my Clinical Supervision; and
(x) Submit written reports to the College at least once every month for three (3) months or until the College approves a reduction in the level of supervision, and then once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice.
(c) I, Dr. Nahas, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP, attached hereto as Appendix “B”, as well as the areas of concern identified in the report of the assessor dated March 16, 2021 and May 22, 2021, and concerns that may arise during the period of Clinical Supervision.
(d) I, Dr. Nahas, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Appendix “A” to this Undertaking, and to abide by the recommendations of my Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development.
(e) I, Dr. Nahas, undertake to ensure that Appendix “A” to this Undertaking is signed and delivered to the College within thirty (30) days of the date I execute this Undertaking.
(f) I, Dr. Nahas, undertake that if a person who has given an undertaking in Appendix “A” to this Undertaking is unable or unwilling to continue to fulfill its provisions, I shall, within twenty (20) days of receiving notice of same, obtain an executed undertaking in the same form from a similarly qualified person who is acceptable to the College and ensure that it is delivered to the College within that time.
(g) I, Dr. Nahas, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (6)(e) and/or (f) above, I will cease practising medicine until such time as I have obtained a Clinical Supervisor acceptable to the College.
(h) I, Dr. Nahas, acknowledge that if I am required to cease practise as a result of section (6)(g) above this will constitute a term, condition or limitation on my certificate of registration and that term, condition or limitation will be included on the public register.
(7) Professional Education
(a) I, Dr. Nahas, undertake to participate in and successfully complete all aspects of the detailed IEP, attached hereto as Appendix “B”, including all of the following professional education (the “Professional Education”):
(i) Medical Record Keeping Program, University of Toronto;
(ii) Documentation: Principles of Medical Record Keeping eLearning Module, CMPA;
(iii) Review, reflection, written summary and discussion of the following with the Clinical Supervisor:
1. Complementary/Alterative Medicine, College Policy;
2. Medical Records Documentation, College Policy;
3. The Practice Guide;
4. Ending the Physician‐Patient Relationship, College Policy;
5. Consent to Treatment, College Policy.
(iv) individualized instruction in medical ethics and professionalism satisfactory to the College, with an instructor selected by the College;
(v) any additional professional education recommended by my Clinical Supervisor.
(b) I, Dr. Nahas, undertake to provide proof to the College of my successful completion of the Professional Education, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it. I acknowledge that the College will determine, in its sole discretion, whether I have successfully completed the Professional Education.
(c) I, Dr. Nahas, undertake to complete this requirement by September 1, 2022 or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.
(d) I, Dr. Nahas, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.
(e) I, Dr. Nahas, acknowledge that if any of the programs listed above become unavailable, substitution requests will be reviewed by the College and the College will determine in its sole discretion whether substitution is appropriate.
(8) Reassessment of Practice
(a) I, Dr. Nahas, undertake that, approximately six (6) months after the completion of the Clinical Supervision set out in section (6) above and Appendix “A” to this Undertaking, and the completion of the Professional Education set out in section (7) above, I will submit to a reassessment of my practice (“the Reassessment”) by an assessor or assessors selected by the College (the “Assessor” or “Assessors”). I acknowledge that the Reassessment may include a chart review of a minimum of fifteen (15) charts, direct observation of my care, interviews with me, colleagues and co-workers, feedback from patients, and any other tools deemed necessary by the College.
(b) I, Dr. Nahas, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Nahas, acknowledge that my Clinical Supervisor may receive and review the findings of the Assessor, and may discuss with the Assessor any issues or concerns arising from the Reassessment.
(d) I, Dr. Nahas, acknowledge that the results of the Reassessment will be provided to me and reported to the College and the Reassessment may form the basis of further action by the College.
(9) Monitoring
(a) I, Dr. Nahas, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises or Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my “Practice Location” or “Practice Locations”), within five (5) days of executing this Undertaking. Going forward, I further undertake to inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location.
(b) I, Dr. Nahas, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient records by a College representative for the purposes of monitoring my compliance with the provisions of this Undertaking.
(c) I, Dr. Nahas, give my irrevocable consent to the College to make appropriate enquiries of OHIP and/or any person who or institution that may have relevant information, in order for the College to monitor my compliance with the provisions of this Undertaking.
(d) I, Dr. Nahas, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix “C”.
C. ACKNOWLEDGEMENT
(10) I, Dr. Nahas, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(11) I, Dr. Nahas, acknowledge and undertake that I shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Undertaking.
(12) I, Dr. Nahas, acknowledge that I have read and understand the provisions of this Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.
(13) I, Dr. Nahas, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location (“Chief of Staff” or “Chiefs of Staff”).
(14) I, Dr. Nahas, acknowledge that a breach by me of any provision of this Undertaking may constitute an act of professional misconduct and/or incompetence, and may result in a referral of specified allegations to the Discipline Tribunal of the College.
(15) I, Dr. Nahas, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(16) Public Register
(a) I, Dr. Nahas, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Nahas, acknowledge that, in addition to this Undertaking being posted in accordance with section (16)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Following a public complaint, a College investigation was conducted into Dr. Nahas’s standard of practice and conduct in his pain management practice. As a result of the investigation:
Dr. Nahas will practise under the guidance of a Clinical Supervisor acceptable to the College for 6 months.
Dr. Nahas will engage in professional education in medical record-keeping, complementary/alterative medicine, ending the physician-patient relationship, consent to treatment, and medical ethics/professionalism.
Dr. Nahas’s practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision.
(c) I, Dr. Nahas, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.
D. CONSENT
(17) I, Dr. Nahas, give my irrevocable consent to the College to provide the following information to any person who requires this information for the purposes of facilitating my completion of the Professional Education and to all Clinical Supervisors, and/or Assessors:
(a) any information the College has that led to the circumstances of my entering into this Undertaking;
(b) any information arising from any investigation into, or assessment of, my practice; and
(c) any information arising from the monitoring of my compliance with this Undertaking.
(18) I, Dr. Nahas, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and/or any information arising from the monitoring of my compliance with this Undertaking.
(19) I, Dr. Nahas, give my irrevocable consent to any persons who facilitate my completion of the Professional Education, and to all Clinical Supervisors, Chiefs of Staff and Assessors, to disclose to the College, and to one another, any of the following:
(a) any information relevant to this Undertaking;
(b) any information relevant to the provisions of the Clinical Supervisor’s undertaking set out at Appendix “A” to this Undertaking;
(c) any information relevant to the Reassessment;
(d) any information relevant for the purposes of monitoring my compliance with this Undertaking; and/or
(e) any information which comes to their attention in the course of providing the Professional Education and which they reasonably believe indicates a potential risk of harm to my patients.
Terms and conditions imposed on certificate by: Member