WARNING

This is a case under the Child, Youth and Family Services Act, 2017 and subject to subsections 87(8) and 87(9) of this legislation. These subsections and subsections 142(3) of the Child, Youth and Family Services Act, 2017, which deals with the consequences of failure to comply, read as follows:

87(8) Prohibition re identifying child — No person shall publish or make public information that has the effect of identifying a child who is a witness at or a participant in a hearing or the subject of a proceeding, or the child’s parent or foster parent or a member of the child’s family.

(9) Prohibition re identifying person charged — The court may make an order prohibiting the publication of information that has the effect of identifying a person charged with an offence under this Part.

142(3) Offences re publication — A person who contravenes subsection 87(8) or 134(11) (publication of identifying information) or an order prohibiting publication made under clause 87(7)(c) or subsection 87(9), and a director, officer or employee of a corporation who authorizes, permits or concurs in such a contravention by the corporation, is guilty of an offence and on conviction is liable to a fine of not more than $10,000 or to imprisonment for a term of not more than three years, or to both.

CITATION: CAS of SD&G v. T.M. and M.C., 2026 ONSC 3376

COURT FILE NO.: 25-311

DATE: 2026/06/08

ONTARIO

SUPERIOR COURT OF JUSTICE

BETWEEN:

CAS of SD&G

Applicant

– and –

T.M.

Respondent

M.C.

Emily Gallagher, for the Applicant

Connor James Steele, for the Respondent T.M.

Nobody, for M.C.

HEARD: May 27, 2026

Ruling on motion REGARDING MEDICAL DECISION MAKING

Justice H. Desormeau

Relief sought

1This is the Respondent mother’s motion seeking medical decision-making authority for her child, V, who is in the temporary care of the Society. The specific order sought is the following:

1. An order varying or clarifying paragraph 2 of the temporary care and custody order of Justice Naik dated December 17, 2025, to provide that the Respondent mother shall have decision-making authority respecting the child’s medical, psychiatric, medication, therapeutic, developmental, and related treatment decisions, subject to any applicable statutory right of the child to consent to or refuse treatment and subject to any true emergency requiring immediate treatment.

2. An order that the Respondent mother’s medical decision-making authority shall include, without limitation, authority to:

a. consent to, refuse, or seek review of proposed psychiatric medication changes;

b. consent to, refuse, or seek review of proposed changes to antipsychotic, ADHD, mood-stabilizing, antiseizure, or other psychotropic medication;

c. request urgent medical, psychiatric, developmental, behavioural, or therapeutic follow-up for the child;

d. communicate directly with the child’s treating medical, psychiatric, developmental, behavioural, school-based, and therapeutic professionals; and

e. participate directly in care-planning meetings concerning the child’s medical, psychiatric, medication, communication, developmental, behavioural, and therapeutic needs.

3. An order that, except in a true emergency requiring immediate treatment, the Applicant Society shall not authorize, consent to, direct, or implement any non-routine change to the child’s psychiatric, psychotropic, antipsychotic, ADHD, mood-stabilizing, anti-seizure, or related medication without the Respondent mother’s prior knowledge and written consent or further order of the Court.

4. An order that, where the Applicant Society believes that a true emergency requires immediate treatment before the Respondent mother can be consulted, the Applicant Society shall notify the Respondent mother and her counsel as soon as practicable, and in any event within 24 hours, of:

a. the nature of the emergency;

b. the treatment or medication change authorized or implemented;

c. the name and contact information of the professional who recommended or provided the treatment; and

d. any follow-up plan, appointment, recommendation, or monitoring requirement.

Alternative Order Sought

5. In the alternative, an order varying or clarifying paragraph 2 of the temporary care and custody order dated December 17, 2025, to provide that the Respondent mother and the Applicant Society shall have joint decision-making authority respecting the child’s medical, psychiatric, medication, therapeutic, developmental, and related treatment decisions, with final decision-making authority resting with the Respondent mother if there is a disagreement, subject to any applicable statutory right of the child to consent to or refuse treatment and subject to any true emergency requiring immediate treatment.

6. If the Court grants joint decision-making authority rather than sole medical decision-making authority to the Respondent mother, an order that the Applicant Society shall not treat a proposed medical or medication decision as authorized merely because a physician, psychiatrist, or other professional has recommended it, unless the Respondent mother has been given a meaningful opportunity to review the recommendation, provide relevant information, and state her position, except in a true emergency requiring immediate treatment.

Disclosure and Communication Orders

7. An order that, on a go-forward basis, the Applicant Society shall provide the Respondent mother and her counsel with notice of all medical, psychiatric, developmental, behavioural, school-based, and therapeutic appointments involving the child as soon as they are scheduled or known to the Applicant Society.

8. An order that, on a go-forward basis, the Applicant Society shall provide the Respondent mother and her counsel with copies of all medical, psychiatric, developmental, behavioural, school-based, and therapeutic records, recommendations, medication lists, prescriptions, reports, appointment summaries, and treatment plans concerning the child within 48 hours of receipt by the Applicant Society.

9. An order that the Respondent mother shall be permitted to communicate directly with the child’s treating and consulting professionals, including but not limited to the child’s family physician, psychiatrist, CHEO providers, school-based providers, speech-language professionals, occupational therapists, behavioural consultants, and any other treating or consulting clinician, with the Applicant Society copied or included where appropriate.

10. An order that the Applicant Society shall take all reasonable steps necessary to authorize the child’s treating and consulting professionals to communicate directly with the Respondent mother and her counsel about the child’s medical, psychiatric, medication, developmental, behavioural, communication, nutritional, and therapeutic needs, including by signing or facilitating any releases or authorizations reasonably required by those professionals.

Urgent Care-Planning Orders

12. An order that the Applicant Society shall cooperate in arranging an urgent medical and psychiatric care-planning meeting within 7 days of the order, or such other time as this Honourable Court considers appropriate, to address:

a. the child’s current medication regimen;

b. the child’s antipsychotic medication plan;

c. the child’s recent dysregulation, aggression, self-harm, fixation, and school deterioration;

d. any medication side effects or adverse reactions, including concerns previously raised about Epival and discolouration in the child’s hands or feet;

e. the plan for psychiatric follow-up while Dr. A is unavailable or on leave;

f. the role of Dr. P or any other family physician or substitute physician in coordinating care;

g. any nutritional, endocrine, neurological, EEG, bloodwork, or other medical investigations being considered or undertaken;

h. the child’s communication needs, including his history of American Sign Language and total communication supports; and

i. the plan for ensuring that medical, psychiatric, school, foster-placement, and parental information is shared in a timely and coordinated way.

13. An order that the Respondent mother shall be entitled to attend and participate in the urgent medical and psychiatric care-planning meeting, together with counsel if appropriate, and that the meeting shall include, where reasonably available, the Applicant Society, the foster caregiver, the child’s family physician, the child’s psychiatrist or substitute psychiatrist, and any other treating or consulting professional whose participation is reasonably necessary.

14. An order that the Applicant Society shall provide the Respondent mother and her counsel with a written summary of the urgent care-planning meeting, including any decisions, recommendations, follow-up appointments, medication changes, referrals, or outstanding issues, within 48 hours of the meeting.

Preservation of Clinical Judgment and Emergency Care

15. An order that nothing in this order requires any physician, psychiatrist, clinician, or other regulated health professional to provide treatment that is contrary to that professional’s clinical judgment, professional obligations, or applicable law.

16. An order that nothing in this order prevents the child from receiving emergency medical treatment where immediate treatment is required and consultation with the Respondent mother is not reasonably possible before treatment is provided.

Further Relief

17. An order abridging or extending any time for service or filing, if necessary.

18. An order granting the Respondent mother such further and other relief as this Honourable Court considers just.

19. An order that the costs of this motion be waived, or such other order as this Honourable Court considers appropriate.

2The Society opposes the relief sought by the mother in its entirety. The Society is not seeking to change the communication protocol as set out in the temporary order of Justice Naik, dated December 17, 2025, apart from the additional terminology consented to on May 21, 2026, which confirms that the mother can communicate directly with, and receive information from professionals involved with V.

3M.C. has never been served, thus has no position at this motion.

Prior determination

4On December 3, 2026, Justice Bramwell granted a temporary without prejudice order placing the child in the care and custody of the Society. She also ordered at paragraph 1(a) that the Society will make every effort to include the mother in planning for the child’s treatments and medical needs. However, the Society shall be permitted to act in the place of a parent in providing consent to treatment on behalf of the child pursuant to s.110(3) of the CYFSA and the Health Care Consent Act, 1996. At paragraph 1(b), she ordered that the Society shall also be permitted to obtain and share information regarding the child with his service providers and community partners pursuant to the Society’s functions as outlined at s.35(1)(d) of the Act.

5Paragraph 2 of Justice Bramwell’s order addresses the mother’s other two (2) children. The Society’s involvement with the other two children has been withdrawn on consent as of May 21, 2026.

6Justice Naik heard a temporary care and custody hearing on December 17, 2025. Justice Naik made determinations regarding medical decisions about V at the motion, having reviewed the mother’s “two very lengthy affidavits” dated December 12 (52 pages) and December 16, 2025 (35 pages).

7As part of her review of the evidence, Justice Naik found:

• V is a child with significant special needs.
• He is largely non-verbal and communicates through sign language and the use of some words.
• V has been diagnosed with Autism Spectrum Disorder (Level 3), Intellectual Disability, ADHD (combined presentation), and Tourette’s Syndrome.
• He has had many treatment plans and several community services in place through the years including but not limited to the following: a. Family physician b. Neurodiverse Health Department at the Children’s Hospital of Eastern Ontario (CHEO) c. Inspire Community Services d. Bartimaeus for one-on-one respite and behavioural services
• V has also been prescribed a variety of medications including psychotropic medications. His prescriptions have required careful follow-up and changes from time to time.

8Justice Naik reviewed the legislation and stated in paragraphs 31 onward:

Given that the mother consents to the interim order placing V in temporary care of the Society, my analysis is limited to the issue of how decisions will be made for V while he remains in care.

Pursuant to section 94(7), where the court makes an order under clause 94(2)(d), section 110 (child in Interim Society Care) applies with necessary modifications.

Section 110 reads as follows:

110(1) Where a child is in interim society care under an order made under paragraph 2 of subsection 101(1), the society has the rights and responsibilities of a parent for the purpose of the child’s care, custody and control.

Consent to treatment — society or parent may act

(2) Where a child is in interim society care under an order made under paragraph 2 of subsection 101(1), and the child is found incapable of consenting to treatment under the Health Care Consent Act, 1996, the society may act in the place of a parent in providing consent to treatment on behalf of the child, unless the court orders that the parent shall retain the authority under that Act to give or refuse consent to treatment on behalf of the incapable child.

Exception

(3) The court shall not make an order under subsection (2) where failure to consent to necessary treatment was a ground for finding that the child was in need of protection.

A plain reading of the legislation, in my view, allows the Society to step into the role of a parent and assume the rights and responsibilities of a parent for purposes of a child’s care once the child is, in fact, placed in a Society’s care.

That said, the legislation also contemplates the Court’s jurisdiction to make an order for a parent to retain authority to give or refuse consent to treatment on behalf of an incapable child. The only exception to the Court’s jurisdiction to make such an order is if the said parent’s refusal to consent to necessary treatment for the child was itself a ground for finding that a child was in need of protection.

On the evidence before me, I cannot reach the conclusion that the mother has refused to give consent for V’s treatment, thereby triggering the exception. At best, I can find that the mother has not been easily forthcoming in her cooperation with the Society in this regard. It is, therefore, open to me to consider making an order permitting the mother to retain authority to give or refuse consent to treatment for V.

However, I am also not persuaded that it is V’s best interest for the mother to retain complete authority to give or refuse to give consent for V’s treatment plan(s).

9Justice Naik was concerned with the nebulous situation between the mother and the Society which places V at significant risk of gaps in his services and medical care. She attempted to balance the mother’s desire to be involved in making important decisions and providing input with the Society’s ability to manage V’s day-to-day care while also being able to process and implement recommendations made by education and health care professionals in a timely manner.

10Justice Naik noted that the Society was prepared to make “every effort to include” the mother in the treatment plan and medical needs. She noted the communication difficulties between the Society and the mother. Justice Naik found that the logistics of how communication should occur were lacking and developed the following “Communication Protocol”:

2. The Society may make all minor day to day decisions as relating to V’s health, education, activities etc.

3. Prior to making any major non-emergency decisions affecting V’s education (for e.g. change of school) or health (for e.g. change in medication, doctor, treatment plan(s), hospitalization) the Society and the mother shall follow the communication protocol outlined below:

a. The Society shall inform the mother in writing via email [redacted] of the decision that they wish make for V, with a short description of the recommendations based on which they are going to make the said decision. They shall also confirm that they have sought input from V’s foster parent/primary caregiver before proposing their decision.

b. The mother shall have 24 hours from the time that the e-mail is sent by the Society to provide her input on the Society’s intended decision. The mother shall provide her input in writing, via email to her ongoing Society worker. If she disagrees with the Society’s intended decision for V, she shall provide her reasons outlined in no more than 2 pages.

c. The Society shall then share the mother’s written input with the relevant service provider(s) and seek their recommendation once the service provider has considered the mother’s input.

d. After considering the mother’s written input, should the service provider(s) wish to speak with the mother before providing a recommendation, the Society shall facilitate a call or a meeting between the mother and the said service provider.

e. Upon completion of the above steps a. through d. the Society shall have the authority to make a final decision in V’s best interest, in keeping with the recommendation made by the relevant service provider(s).

f. If an emergency medical decision is required to be made for V during his access with the mother and siblings, after the mother has dealt with the immediate emergency, she shall contact the Society Worker forthwith and inform them of the emergency decision she has made. Once that is done, the decision making and communication protocol described above shall once again become effective.

g. If the Society is required to make an emergency decision for V, they shall inform the mother immediately after the emergency has passed and obtain her input as contemplated above, thereafter.

Legislation and Case Law

11The primary purpose of the Child, Youth and Family Services Act (“CYFSA”) is to promote the best interests, protection, and well-being of children and recognize the need to support the autonomy and integrity of the family unit. It further recognizes that the least disruptive and most appropriate course of action available should be considered. It outlines that services provided to children should respect the child’s need for continuity of care, and for stable relationships within a family.

12Pursuant to section 94(7) of the Act, where the court makes an order under clause 94(2)(d) placing a child in the care of the Society, section 110 (child in interim society care) applies with necessary modifications.

13Section 110 CYFSA is properly articulated in Justice Naik’s order, reproduced above.

14Therefore, when a child is in the temporary care of the Society, the Society can make medical decisions on behalf of an incapable child.¹

15In Children’s Aid Society of Toronto v. L.P., Justice Katarynch states:

“The legislation does not intend a judge to dictate the manner in which the society exercises its discretion in medical decisions for a child entrusted to its care by the court. Once the temporary custody order is granted, the court withdraws. It is the society’s discretion that dictates what will and will not be authorized for the child — and like all decision-making for the child under the Child and Family Services Act, it must be done in a manner that promotes the primary objective of the Act to serve the child’s best interests, protection and wellbeing.”²

16The mother submits that the Society properly raises the issue of whether a parent alleged to have exercised poor medical judgment may nevertheless be found capable of making medical decisions for a child, notwithstanding the mandatory exception prohibiting persons whose child is in need of protection from acting as medical decision-makers. The mother argues that, although the relevant provision applies with necessary modification, that phrase does not import into the temporary care and custody stage the same restrictions that apply where a child is found to be in need of protection. To do so, she argues, would collapse the Legislature’s intended two-stage scheme. Relying on ordinary and contextual statutory interpretation, she submits that had the Legislature intended to impose those restrictions expressly at the temporary stage, it would have said so. On that basis, she submits the statutory barriers identified by the Society are not absolute bars to the order sought.

17The mother contends that the central issue is whether there is a jurisprudential or statutory basis for judicial oversight of the Society’s exercise of medical decision-making authority. She relies on Children’s Aid Society of Toronto v. A.V.G. ³ While acknowledging that case concerned a medically inviable child and a proposed withdrawal of treatment without the mother’s consent under a temporary care and custody order, she argues it nevertheless stands for the proposition that the Society’s discretion, though broad, must be exercised in accordance with the child’s best interests.

18The mother further contends that A.V.G. supports limited judicial intervention where credible evidence suggests the Society may not have been alive to, or may not have adequately investigated, such as situations that could cause bodily harm to the child, the court may, in that limited case, permit intervention, as the primary source of discretion according to the paramount principle of the Act is the best interest of the child. Where the Society does not act in accordance with that principle and a risk of harm is said to arise, then judicial intervention is justified.

Overview of the Evidence

19In support of the relief sought, the mother relies on her affidavit commissioned May 20, “2023” [2026] which totals 146 pages, including attachments, as well as her factum.

20The Society’s materials consist of two affidavits, a factum, and a letter from Dr. P of Seaway Valley Community Health Centre dated May 26, 2026.

21I have considered all the evidence, which is summarized below.

22V, born in March 2015, has multiple neurodevelopmental diagnoses. He has long-standing complex behavioural, emotional, developmental, and medical needs. His treatment plan includes psychotropic medications, such as aripiprazole, atomoxetine, and clonidine, as well as behavioural supports from the Extended Needs Service through the Children’s Hospital of Eastern Ontario (“CHEO”).

23The mother wishes to exercise decision-making authority respecting V’s medical decisions. Alternatively, she seeks joint medical decision-making authority, with final decision-making authority resting with her in the event of a disagreement. In the further alternative, she seeks any order that the court deems appropriate, limiting the Society’s medical decision-making authority in order to give her a more meaningful role in V’s medical care and/or requiring Dr. A's medical treatment of V to be discontinued or reviewed.

24The mother understood that Justice Naik’s order of December 17, 2025, preserved her role in V’s medical decision-making, except in a true emergency. However, she argues that since the order was made, important medical and medication-related decisions have been made, delayed, or communicated in a way that has prevented her from carrying out that role effectively.

25There are several services and/or service professionals involved in supporting V which include the following: Dr. P, V’s family physician; Dr. A, his psychiatrist from CHEO; and Janet N., behaviour analyst with the neurodevelopmental health department at CHEO.

26The mother argues that she is a person who knows V’s medical and behavioural history the best, yet since the order, there has been fragmented medical care, delayed treatment planning, and inadequate consultation with her. She advances that V’s diagnoses are central to understanding his behavioural presentation, communication needs, medication history, and need for coordinated care. Given the child’s significant issues, she ought to be the primary, or equal, decision maker as to V’s medical needs.

27The mother articulates that prior to the Society’s more intrusive steps and the December 3, 2025, interim without prejudice order, the mother repeatedly sought or participated in services and advocated strongly for V.

28From the Society’s perspective, the mother’s advocacy skills for V are not contested. However, the child has been in their care since the Temporary Care Agreement from approximately November 22, 2024. The Society has also advocated for V and put in place services to assist and support his complex needs.

29The mother points to the CPIN notes or other evidence attached to her affidavit to support the proposition that V has regressed in care. She notes that V’s medications have always required close monitoring; she believes he can metabolize psychotropic medication quickly and some medications become less effective over time, thus requiring frequent adjustments. She has, since the December 3, 2025, order, repeatedly raised concerns about medication changes, side effects, and the need for a clear treatment plan. She believes her concerns have often been minimized, delayed, or treated as adversarial rather than as relevant information from V’s mother. The concerns raised by her include malnutrition or overnutrition; significant meltdowns and dysregulation linked with medication changes; an insufficient review of possible side effects; behavioural difficulties at school; aggressive behaviours; fixation patterns; self-harming behaviours; delayed follow-up care; regressive behaviour; and inadequate consultation with her.

30While the mother alleges that the Society instructed the child’s treating physicians not to speak to her, the evidence in my view shows otherwise.

31In essence, the mother feels unheard. She feels that her concerns are dismissed, and the Society acts without the requisite diligence. She also suggests that when she has raised valid concerns, such as the effects of Epival, as well as discolouration of V’s hands and feet, which she felt was urgent, the Society refused to grant an urgent appointment with the doctor. Dr. A discounted her concerns, but later Dr. P agreed with them, thus supporting her position.

32The mother initially raises conflicting information about Dr. P and Dr. A’s treatment. However, their respective roles were clarified with Dr. P’s letter of May 26, 2026. Specifically, Dr. P advises that for a child with significant psychiatric complexity such as V, a pediatric psychiatrist is generally the most qualified physician to diagnose and recommend treatment and direct psychiatric management. As the family physician, Dr. P’s role is to work collaboratively with the psychiatrist by implementing recommendations, renewing prescribed medications when appropriate, monitoring for side effects, coordinating follow-up care, and communicating concerns or changes in the patient's condition. It would generally be inappropriate for a family physician to independently make significant changes to a specialist-directed psychiatric treatment plan without consultation with the treating psychiatrist. Such changes may carry risks, including worsening symptoms, medication interactions, or unintended adverse effects, which are best assessed by the specialist overseeing psychiatric care. Dr. P concludes his letter by indicating, “[a]ccordingly, in the care of [V], my role is to support continuity of care, monitor overall health and well-being, implement specialist recommendations where appropriate, and maintain communication with the treating psychiatric team. Significant psychiatric medication decisions would generally be made in consultation with the pediatric psychiatrist responsible for the patient's specialized mental health care. I trust this information assists the Court in understanding the role of a family physician in the collaborative care of a child with complex psychiatric needs.”

33The mother alleges that the Society has acted as a barrier between V’s medical professionals and herself and the foster parent, the people who can provide timely, practical information about his symptoms, medication history, and daily functioning. She contends that the delay and fragmented communication prolong his dysregulation and increase the risk of harm to him, his siblings, the foster placement and others around him. The medication instability has affected contact in that visits at the CAS Supervised Access Center were, in her view, unacceptable.

Analysis

34On May 21, 2026, with the consent of both parties, I ordered that the Protection Application regarding the other two (2) children was withdrawn; I ordered production of the medical records, and that the mother can obtain and receive information from professionals.

35The Society advances that the issue is res judicata. I disagree. The December 17, 2025, order is temporary, thus this concept, in my view, does not apply.

36I agree with the mother’s submission that because the December 17, 2025, Order is the operative temporary order and has governed the parties’ conduct since that date, the moving party must establish a material change in circumstances sufficient to justify disturbing the temporary status quo. If that threshold is met, the court then considers whether the proposed variation is consistent with the child’s best interests, protection, and well-being; the least disruptive appropriate course; and the evidence the court considers credible and trustworthy in the circumstances.⁴

37The Society argues that there has not been a material change warranting a variation of Justice Naik’s order of December 17, 2025, nor would it be in V’s best interest to grant the mother sole or joint decision-making authority regarding medical decisions.

38I agree with the mother that the restrictions applicable where a child is in need of protection do not apply at the temporary care and custody stage. To hold otherwise would collapse the Legislature’s two-stage scheme. There is therefore not an absolute bar to the order sought. I also accept that the court may exercise limited oversight of the Society’s medical decision-making authority. As A.V.G. confirms, that discretion must be exercised in the child’s best interests. Where credible concerns are raised that the Society has not adequately addressed a risk of harm, the court may intervene.

39The mother contends that since the temporary order dated December 17, 2025, the evidence shows a material change in circumstances: disputed medication changes, disputed reliance on the emergency exception, delayed psychiatric follow-up, barriers to timely communication with treating professionals, deterioration at school, and escalating dysregulation affecting the child’s safety, placement stability, school functioning, sibling contact, and access.

40The mother submits that the Society adopted tunnel vision and thereby exercised its medical decision-making authority unreasonably and contrary to the child’s best interests, particularly given the child’s heightened vulnerability arising from disability. The mother conceded in submissions that she too may have developed some tunnel vision. Nevertheless, she argues that she has demonstrated there has been a material change in circumstances.

41The Society agrees that the court can make this kind of order but articulates that the real question is whether it should. It argues that this issue has already been decided before, when Justice Naik considered and rejected giving the mother authority to consent to or refuse treatment for V.

42The Society also submits there has not been enough change to justify revisiting that issue. It points out that when the mother previously had medical decision-making authority, there were conflicts with doctors, changing instructions about who could be consulted, which created delays in V receiving services. The Society says that even if the legal threshold for reconsideration is met, returning medical decision-making to the mother would still not be in V’s best interests.

43On a balance of probabilities, for the reasons outlined by the mother, I find that the constellation of factors satisfies the test that there has been a material change in circumstances.

44The issue, then, is whether intervention is warranted on this record and whether the order sought is in V’s best interests.

45The mother argues V would be better off if she got medical decision-making power back. She argues that she knows V’s needs and history better than anyone, and that since the Society took over medical decisions, V’s condition has deteriorated. She points to more emotional instability, more self-harm, communication problems, and fainting at school. She says the court has the legal power to return that authority to her if it would help V.

46Given the level of care and involvement in meeting V’s medical, school, behavioural and developmental needs, knowing his triggers, communication style, and medication history, the difference between ordinary dysregulation and medication plan failing, the mother argues that she is best placed to ensure his medical needs are met. Alternatively, she would make these decisions with the Society, with final decision-making authority to her. In the further alternative, she asks for any order limiting the Society’s authority over V’s medical treatment to give her a more meaningful role in decisions affecting his health, and that Dr. A’s role as his treating physician be discontinued or reviewed.

47She wishes the Society to be obliged to promptly disclose all medication changes, medication recommendations, medical appointments, psychiatric appointments, side-effect concerns, school reports relating to medication or regulation, and any communications from treating professionals concerning V’s health or treatment. She asks for direct communication with V’s service providers, including his doctor, psychiatrist, CHEO providers, school-based providers, treating therapist or clinician, with the Society copied or included where appropriate.

48The mother seeks an order requiring an urgent medical and psychiatric care-planning meeting to address V’s antipsychotic medication, side effects, current dysregulation, communication needs, nutrition concerns, and the follow-up plan.

49She argues she is not seeking unilateral control, but requesting an order that enables timely, accountable medical decision-making, direct communication, and meaningful consultation rather than through delayed communication via the Society. She takes responsibility for her communication style and wants to return to a healthier relationship with the Society.

50She accepts that she is not a doctor and is not asking to replace doctors’ medical judgment. Her concern is that the Society should not simply accept doctors’ recommendations without question if there are signs something may be wrong. If the court will not return decision-making authority to her, she asks, at a minimum, be advised in advance about all medical appointments and for an urgent care-planning meeting to look into the recent concerns about V.

51The mother also suggests that the draft order was written to comply with the Health Care Consent Act and was not intended to force any doctor or health professional to act against their medical judgment.

52The Society states that since V has been in their care, they have put several services in place, including Inspire Community Services; Susan F from Ontario Disability Support Program; Applied Behaviour Analysis; a CARST referral was submitted and Autism Programming through CHEO.

53From the Society’s perspective, though the mother is not prepared to have V returned to her care, she seeks to be his decision-maker or act jointly with the Society. They are of the view that any changes to the decision-making protocol would not be in V’s best interest and could pose a risk of harm.

54The Society points to several reasons why returning medical decision-making to the mother would not be in V’s best interests. First, because V is in the Society’s care, the Society would face serious responsibility and liability issues if the mother could direct treatment while the Society and foster parent remained responsible for V’s daily care. Second, the Society argues that the mother has had ongoing difficulty cooperating with the Society. Third, it notes that the mother did not see V for a period of time by her own choice, so her recent concerns are not based on direct observation. The Society says the behaviours she describes are not new, but part of V’s usual baseline difficulties.

55The Society also says the mother has secretly recorded conversations, including with medical professionals, and that this has damaged relationships with service providers. They articulate that some professionals have reported feeling unsafe or unable to work effectively with her because of her conduct. The Society argues this is part of a broader pattern of conflict, including with more than one doctor.

56At the same time, the Society says it is not trying to cut the mother out completely. It says there may be cases where a parent should make medical decisions, but this is not one of them because of the history of conflict and the need for one final decision-maker. It adds that it is open to looking into whether V could see a different psychiatrist, and says it will explore that option if CHEO supports it.

Findings of fact

57The evidence as I find it is that the mother has frequently raised concerns about V’s medication effects and interactions, behavioural deterioration and safety. These concerns are persistent and specific. This demonstrates a high level of parental engagement.

58I recognize that V has specific and complex medical needs, which is central to the best interest analysis. The mother has been a very strong advocate for him, and she has a unique perspective and historical knowledge that ought not be marginalized.

59Upon knowledge of the mother’s concerns, the Society workers acknowledge her concerns, encourage the mother to contact the doctor herself regarding the medication concerns as well as relay the information between the parties and attempt to maintain visit schedules and routine decisions. This suggests collaborative discussions. The Society responds through deferring to medical providers and generally maintaining the process. They do not generally escalate independently. The mother’s urgent framing of issues is not consistently matched by rapid responses by the Society or the doctor(s). Thus, it is not always aligned with the urgency expressed.

60The Society is responsive in maintaining contact, documenting concerns, and communicating with the physician when needed. There is an escalation gap in that the Society does not consistently treat the mother’s concerns as urgent triggers and defers to the scheduled reviews rather than creating new urgent ones.

61The evidence shows that there is clear relational strain between the mother and the Society. There are frequent disagreements about medication interpretation and behavioural causes. The tension is primarily around decision-making roles, and, secondarily, around visit arrangements. The mother’s communications use emotional and urgent language, whereas the workers avoid engaging in deeply disputed medical interpretation. Where the conflict is high, the Society tends to avoid taking independent positions and defers to the physician rather than advocating for one interpretation. The repeated concerns and repeated challenges by the mother are often, in my view, seen by the Society as an ongoing dispute rather than new information. This breakdown in communication and level of conflict is not in V’s best interest.

62There is also evidence of strain in the mother’s relationship with V’s treating physicians. The evidence reflects frequent disagreement regarding the effects of V’s medication, his treatment plan, and what the mother perceives as delay or dismissal of her concerns. In my view, the mother felt vindicated when a physician later shared her concern about Epival. At the same time, the evidence suggests that the mother’s own conduct, including surreptitious recordings and a heightened tone of urgency that may have been perceived as aggressive, contributed to a narrowing of communication between her and the treating physicians. Although the mother believed that the Society was interfering with her relationship with V’s service providers, the evidence does not support that conclusion.

63The evidence suggests that, where disagreement arises, the Society tends to defer to the treating physician’s judgment. In my view, this makes the Society less likely to independently scrutinize medical decisions. The evidence also indicates that the reduction in direct communication between the mother and service providers can create delay. In addition, where information is disputed, the need for verification, consultation, and internal discussion may slow the response to concerns that are said to be urgent.

64Thus, the current dynamic is that the mother raises an urgent concern. The concern is complex or disputed. The Society logs the concern and relays or suggests contacting the doctor. The doctor’s response is delayed, limited, or not aligned with the mother, which results in the mother escalating further. The Society in return becomes more procedural and less interventionist, deferring to the doctor’s expertise.

65The level of conflict has affected the relationship between the workers and the mother, particularly when the mother has been strongly advocating or repeating the urgency of her concerns and feeling unheard, thereby causing her to escalate.

66The fact that the Society did not always share the mother’s sense of urgency does not undermine its diligence. I reject the suggestion that the Society acted with tunnel vision. On the contrary, the evidence establishes that the Society remained engaged, responsive, and consistently focused on V’s best interests.

67On the evidence before me, I am not persuaded it is in V’s best interest to give the mother sole or joint decision-making responsibility. While she is a strong advocate for him, I am concerned about the level of conflict and escalation created by her.

68I find the least disruptive order, which is in V’s best interest, is to make minor changes to the communication protocol to address the timing gap; the escalation ambiguity; communication fragmentation, and the physician alienation risk. In doing so, I will modify the passive relay model to a structured escalation and managed communication model and create a tiered concern framework.

69This protocol is intended to replace informal and, at times, reactive communication patterns with a structured, predictable, and timely system. It seeks to improve responsiveness where concerns arise; reduce the impact of conflict on decision-making; and ensure that the child’s medical needs are addressed efficiently and in coordination with treating professionals.

70The protocol recognizes that, while V’s treating physicians possess the relevant clinical expertise, the Society must not relinquish its own responsibility for medical decision-making by treating their views as determinative. In my view, as V’s guardian and caregiver, the Society must advocate for his interests with the diligence expected of a parent, including by seeking a second opinion where appropriate.

Disposition

71The following order is granted, varying paragraphs 2 and 3, the Decision-Making Protocol, from the order of Justice Naik dated December 17, 2025.

72All other relief sought not addressed below is dismissed.

73No costs.

Order: Communication and Decision-Making Protocol

1. The Children’s Aid Society shall retain final decision-making authority with respect to V’s “medical care” (deemed to include: psychiatric, medication, therapeutic, developmental, and related treatment decisions) and education, in accordance with the Child, Youth and Family Services Act and subject to the terms of this order. For greater certainty, this protocol shall also govern communication and consultation respecting major non-emergency medical care decisions affecting V’s education and significant activities or services, unless otherwise ordered by the court. The medical-specific provisions of this protocol apply particularly to treatment and clinical care.

2. The purpose of this protocol is to ensure that medical, educational, behavioural, and related concerns are addressed in a timely and predictable manner; provide a structured and predictable method of communication; ensure that the mother’s input is meaningfully considered; and safeguard the professional relationships necessary to V’s care and service delivery are preserved.

3. Prior to making any major non-emergency decisions affecting V’s education, including any proposed change of school, or health, including any proposed change in medication, physician, treatment plan, or hospitalization, the Society and the mother shall follow the communication protocol set out below.

4. The Society shall inform the mother in writing by email at [same email as December 17, 2025, order] of the decision it proposes to make for V, together with a brief description of the recommendations, information, or professional advice on which the proposed decision is based. The Society shall also confirm that it has sought input from V’s foster parent or primary caregiver before proposing the decision.

5. The Society shall designate a single liaison worker for medical and related service communications (“liaison worker”). That worker shall act as the primary point of contact with treating professionals, coordinate communications, and seek to ensure that information is conveyed clearly, neutrally, and in a clinically relevant manner so as to minimize duplication and fragmentation of communication.

6. The mother shall have 24 hours from the time that the Society’s email is sent to provide her input respecting the Society’s intended decision. The mother shall provide her input in writing by email to the ongoing Society worker. If she disagrees with the Society’s proposed decision, she shall provide her reasons in no more than two pages, absent agreement otherwise, and shall distinguish as clearly as possible between factual observation and opinion.

7. The Society shall forward the mother’s written input to the relevant service provider or providers without altering its substance and shall seek the provider’s recommendation after the provider has considered the mother’s input. The Society may provide context necessary to ensure that the concern is understood in a clear, neutral, and clinically relevant manner.

8. After considering the mother’s written input, if the relevant service provider or providers wish to speak with the mother before making a recommendation, the Society shall facilitate a call or meeting between the mother and the provider or providers. For greater certainty, treating professionals and other service providers retain discretion respecting whether and how to communicate directly with the mother, the format of any such communication, and whether the Society is present.

9. Upon completion of the process set out in paragraphs 4 through 8, the Society shall have the authority to make the final decision in V’s best interests, ordinarily in keeping with the recommendation of the relevant service provider or providers. Where disagreement remains, the Society shall first seek clarification from the treating or relevant professional and may, where appropriate, obtain a second opinion or address the issue at a case conference before making its final decision.

10. All concerns raised by the mother shall, where practicable, be categorized by the Society as Routine, Elevated, or Urgent:

(a) routine concerns are non-urgent matters or routine questions regarding care, schooling, activities, or services;

(b) elevated concerns are concerns involving ongoing behavioural escalation, possible medication side effects, educational or service issues reasonably requiring prompt review, or comparable concerns; and

(c) urgent concerns are concerns involving risk of harm to V or others, suspected serious adverse medical effects, marked behavioural deterioration, or risk to the stability of V’s placement, schooling, or functioning.

11. Where a concern is Routine, the Society shall record the concern, address it at the next scheduled clinical, educational, or service review as appropriate, and confirm to the mother that the concern has been noted.

12. Where a concern is Elevated, the Society shall communicate the concern to the relevant treating professional, educator, or service provider within 48 hours, request acknowledgment where reasonably possible, and advise the mother that the concern has been forwarded.

13. Where a concern is Urgent, the Society shall take steps to contact the appropriate professional within 24 hours, seek direction regarding any immediate measures required, and, where necessary, access alternate medical, educational, or service supports. The Society shall promptly advise the mother of the steps taken.

14. For greater certainty, where a concern is urgent and affects V’s immediate safety, health, placement stability, schooling, or functioning, the Society may act before the expiry of the mother’s 24-hour response period, provided that the mother is notified as soon as reasonably possible thereafter and her input is obtained promptly once the immediate urgency has passed.

15. If an emergency medical decision is required while V is in the mother’s care during access, the mother shall first deal with the immediate emergency and shall then contact the Society worker forthwith to inform the Society of the emergency and any decision made. Once the urgency has passed, the communication and decision-making protocol set out in this order shall again apply.

16. If the Society is required to make an emergency decision for V, it shall inform the mother immediately after the emergency has passed, or as soon thereafter as reasonably possible, and shall obtain her input in accordance with this protocol once the immediate emergency has been addressed.

17. The Society shall request that treating professionals and other relevant service providers acknowledge elevated or urgent concerns where reasonably possible and provide guidance within a timeframe appropriate to the nature of the concern. The court recognizes that treating professionals and service providers are not parties to this proceeding and are not bound by strict timelines; the obligation rests on the Society to follow up where appropriate.

18. The Society shall facilitate the mother’s participation in appointments, meetings, or reviews where appropriate, having regard to the views of the relevant service provider, the nature of the issue, and the need to maintain a safe and professional environment. Nothing in this order requires any treating professional or service provider to communicate directly with the mother or to act contrary to their professional judgment.

19. The Society shall convene a case coordination meeting within 14 days, and thereafter at least every 30 days, or more often if clinically or practically required, involving relevant Society personnel, appropriate service providers, and the mother where appropriate. Such meetings shall be structured and time-limited and shall focus on treatment planning, educational planning where relevant, service coordination, and any outstanding concerns. These meetings shall be used to address: (a) the child’s current medication regimen; (b) the child’s antipsychotic medication plan; (c) the child’s recent dysregulation, aggression, self-harm, fixation, and school deterioration; (d) any medication side effects or adverse reactions, including concerns previously raised about Epival and discolouration in the child’s hands or feet; (e) the plan for psychiatric follow-up while Dr. A is unavailable or on leave; and (f) the role of Dr. P or any other family physician or substitute physician in coordinating care.

20. The Society shall maintain records of: (a) concerns raised; (b) communications with professionals or service providers; (c) responses received; and (d) action taken. The Society shall provide the mother with notice of significant medical decisions, updates regarding treatment or material service changes, and advance notice of “medical care” appointments within 12 hours of making such an appointment.

21. All parties shall communicate in a measured, focused, and respectful manner that supports V’s best interests and preserves the professional relationships necessary to deliver care, education, and services. The Society shall ensure that concerns are addressed in a timely and substantive manner.

22. For greater certainty, nothing in this Order requires any physician, clinician, educator, or other professional to act contrary to their professional judgment, statutory obligations, or governing professional standards.

23. The mother may communicate directly with, and receive information from all of V’s service providers, subject to their protocols. Ideally, the service providers would communicate in writing to both the Society and the mother regarding their involvement in V’s care to avoid miscommunication.

24. The Society shall take all reasonable steps necessary to authorize the child’s treating and consulting professionals to communicate directly with the mother and her counsel about the child’s medical, psychiatric, medication, developmental, behavioural, communication, nutritional, and therapeutic needs, including by signing or facilitating any releases or authorizations reasonably required by those professionals.

25. Pursuant to the Order of May 21, 2026, the mother may communicate directly with, and receive information from, the Seaway Valley Clinic, and any professional at CHEO, subject to their protocols. Ideally, the Service Providers would communicate in writing to both the Society and the mother regarding their involvement in V’s care to avoid miscommunication.

Footnotes

1. 1Huron-Perth Children’s Aid Society v M.L., 2025 ONCJ 228 at para 32
2. 2Children’s Aid Society of Toronto v L.P., 2010 ONCJ 320, at para 69
3. 3Children’s Aid Society of Toronto v. A.V.G., 2024 ONCJ 157 at para. 90.
4. 4Child, Youth and Family Services Act, 2017, SO 2017, c 14, Sched 1, ss 1(1), 1(2), 94(9)– (10); Children’s Aid Society of Toronto v A.S., 2022 ONCJ 553 at paras 51–55 [A.S.]