Executive summary: Key legal and evidentiary issues

• CPSA sought a contempt citation against Mr. Makis for defying an Interim Injunction Order granted on August 15, 2025, by Justice Yamauchi.

• Authentication of electronic evidence (social media screenshots, videos, podcasts, and emails) was challenged by Mr. Makis but upheld by the Court under the low threshold of “some evidence” that the documents are what they purport to be.

• Defences based on CPSA jurisdiction, extra-territoriality, freedom of expression, and third-party use of titles were rejected by Justice Mah.

• Mr. Makis’ credibility was found lacking, with his evidence described as self-serving, evasive, and inconsistent with his own social media statements and questioning transcript.

• All three elements of the Carey v Laiken contempt test were found to be established beyond a reasonable doubt, resulting in a finding of contempt and the granting of a Permanent Injunction.

• Costs were awarded to the CPSA on a 3X Column 1 basis, and Mr. Makis was given 72 hours to purge his contempt, failing which the CPSA may seek a warrant for his arrest and detention.

The background and the parties

The case of College of Physicians and Surgeons of Alberta v Makis, 2026 ABKB 159, involves the College of Physicians and Surgeons of Alberta (CPSA), a statutory regulator mandated to regulate the practice of medicine in Alberta in a manner that protects and serves the public interest under the Health Professions Act (HPA), and Viliam (William) Makis. The HPA requires registration and a valid practice permit to provide regulated professional services, and it restricts the use of titles such as “physician,” “diagnostic radiologist,” “nuclear medicine specialist,” “medical doctor,” “MD,” and “radiologist” to regulated members, with limited exceptions for certain uses of “doctor,” “surgeon,” “pathologist,” “oncologist,” or “Dr.” in teaching, research or administration.

Mr. Makis obtained an MD degree from McGill University in 2005. His CV, attached to an August 12, 2025 affidavit, shows continuous work and training in the medical field after graduation, and that he secured a position with Alberta Health Services as a nuclear medicine physician at the Cross Cancer Institute in Edmonton in 2013. He deposed to having over 15 years of experience in cancer diagnosis and treatment and more than 100 peer-reviewed articles. He was properly licensed by CPSA from 2013 to 2019. Because of workplace issues, he stopped working at the Cross Cancer Institute in 2016. On February 12, 2019, CPSA cancelled his practice permit due to failure to renew the permit, pay the annual registration fee and late payment fee, and pay hearing costs awarded against him from a 2018 disciplinary proceeding. He was expressly told that without valid registration and a practice permit, he was not permitted to practice medicine in Alberta.

The unauthorized activities and the initial injunction

CPSA contended that after cancellation of his practice permit, Mr. Makis continued to offer medical services to the public in the form of consultations to cancer sufferers regarding diagnosis and treatment and continued referring to himself using titles and terms such as physician, radiologist, oncologist, MD and Dr. CPSA’s initial evidence came from his social media postings between February 2023 and November 2024 and public inquiries about apparent unauthorized practice. Then-Registrar Dr. Scott McLeod issued a “Cease and Desist” letter on February 10, 2025.

In the initial application before Justice Yamauchi, CPSA sought a Permanent Injunction. Justice Yamauchi instead granted an Interim Interlocutory Injunction on August 15, 2025, pending a special application for a permanent order, because the record was not fully developed. He refused an adjournment request from Mr. Makis, citing the need to protect the public from unauthorized practice.

The August 15, 2025 Order prohibited Mr. Makis from: representing or implying that he is a regulated CPSA member or otherwise licensed to practice medicine in Alberta; using the protected titles, abbreviations or initials in Schedule 21, s 2 of the HPA; using “doctor,” “oncologist” or “Dr.” in connection with providing a health service; and offering or providing any health services to the public, including advice or consultations regarding cancer treatment. He was given until September 22, 2025 to make his social media profiles compliant.

Later, on February 14, 2026, Mr. Makis applied to the Court of Appeal for permission to appeal the August 15, 2025 decision. Permission to appeal was required because he had been declared a vexatious litigant in prior proceedings. The Court of Appeal held that the Injunction Order was temporary and that any application to set it aside belonged in the Court of King’s Bench in the context of the contemplated Permanent Injunction application. A stay was refused due to public interest concerns, and the Court of Appeal noted that the permanent injunction and contempt application could be heard together as a special application. Justice Mah heard that combined application on February 18, 2026, on a more developed record.

Mr. Makis' continued activities and the contempt application

For the contempt and Permanent Injunction applications before Justice Mah, CPSA relied on affidavits and exhibits from current Registrar Colleen Forestier and legal assistant Stephanie Lanz, among others. CPSA alleged that despite the Interim Injunction, Mr. Makis continued to practice medicine in Alberta without a licence by providing advice and consultations regarding cancer treatment and by continuing to hold himself out online as an MD, radiologist, oncologist, and nuclear medicine specialist.

Examples cited included:

• Appearances on podcasts and online shows (such as “TalkTruth,” “The Broken Truth.tv,” “The Matt Gaetz Show,” and “The Shannon Joy Podcast”), where he was described or described himself as a Canadian physician, MD, radiologist, oncologist, nuclear medicine specialist, or triple board-certified oncologist, diagnostic radiologist and nuclear medicine specialist, and where he spoke about his “cancer clinic,” his patients, and his dosing protocols for ivermectin and other anti-parasitic drugs used in cancer treatment.

• Posts and reposts on X where he stated that he has the world’s largest ivermectin cancer clientele, that he is at the cutting edge of cancer treatment, that he is cleaning up “mainstream Oncology’s disasters,” that he treats children, and that he is excited to be shaping the future of cancer care.

• An email to former Registrar Dr. McLeod dated December 7, 2025, with the subject line “BREAKING NEWS: Our Ivermectin Cancer Clientele has just reached 7500 Cancer patients,” in which he wrote that “We have been helping cancer patients from around the world for 500 days now!...7500 Cancer patients including 100 CHILDREN. We have the world’s largest cutting edge Cancer Program, utilizing the most promising repurposed drugs: ivermectin. Mebendazole. Fenbendazole & more. There is nothing like it anywhere in the world!”

• YouTube videos hosted on his “official” channel, including a December 9, 2025 video in which he gave an update on the “largest Ivermectin Cancer Group in the world” and said that in 500 days he had helped 7,500 patients, and a Christmas 2025 update where he claimed to have 7,800 cancer patients and that it had been the busiest year of his life.

• A video where he introduced himself as “Dr. Makis,” described himself as “a Canadian physician living in Edmonton, Alberta,” and said he is a radiologist, oncologist and cancer researcher who has devoted the last 18 years of his life to helping thousands of cancer patients in Alberta and worldwide.

• An X exchange dated November 21, 2025, where he discussed a person’s dosages of ivermectin and mebendazole and wrote, “You’re doing heavy doses of both Ivermectin and Mebendazole but if you’re tolerating them well, keep going!!”

The record also contained ten short testimonial affidavits from individuals in Canada, the United States, the United Kingdom and Spain (and one relating to a dog) who stated that they had learned of his research and protocols and, under the guidance of licensed physicians, incorporated elements of his protocol into treatment, reporting improvements. They stated that they did not receive direct advice from him, and that treatment was based on his publicly shared research.

In his November 3, 2025 questioning in a related Court of Appeal proceeding, Mr. Makis testified that he started providing health coaching services in July 2024, worked from home, interacted with clients by email or Zoom, and had three non-health-professional assistants. At that time, he had 7,000 health coaching clients, some of whom had cancer. He said clients paid for these services, though he declined to say how much. He stated that, as part of health coaching, he reviewed test results, treatment records and patient records of cancer clients. He also said that he did not provide advice but shared information and research, relying on his medical knowledge and expertise.

Mr. Makis' defences

In his August 12, 2025 response affidavit in the original application, and later affidavits dated January 16, 2026 and February 12, 2026, Mr. Makis advanced several defences:

• He said he was not practicing medicine, but engaging in independent research, writing Substack articles, and sharing information on alternative cancer treatments. He said he had no direct patient relationships and did not provide medical consultations. He pointed to disclaimers in his Substack articles and to a “Health Coaching Informed Consent and Waiver” advising clients that he does not dispense medical advice or prescribe treatment.

• He argued that, since he was not a CPSA member, the College had no jurisdiction over him.

• He asserted that many of his media appearances and activities occurred outside Alberta or Canada and that many of his clients were outside Alberta and Canada, suggesting this was beyond the territorial jurisdiction of the Court and CPSA.

• He stated that he could not control how media hosts or third parties applied titles or descriptors to him, and that he did not personally use or endorse titles in breach of the Injunction.

• He asserted that Facebook posts relied on by CPSA were fake and the result of impersonation, and produced examples of impersonator or fraudulent websites that he had asked to be taken down.

• He argued that CPSA could not show harm to anyone and that many had benefited from his work.

• He asserted that his internet activities were protected expression under section 2(b) of the Charter. He also invoked First Amendment free speech rights regarding his American activities.

• He stated that he had obtained a medical license in the State of Florida as of February 6, 2026, and that his YouTube, X, email and LinkedIn content related to Florida-based research and practice. He deposed that he was in the process of establishing a practice and moving his family to Florida, and he later adduced a “Notice of Intent to Approve Licensure With Conditions” from the Florida Board of Medicine. He suggested any breaches of the Injunction were technical or inadvertent and not worthy of serious sanction.

In addition, his counsel submitted that the rationale for the injunction should be reconsidered in light of the Florida licensure developments and his planned relocation.

The Court's analysis of authentication and evidence

Justice Mah addressed the authentication of CPSA’s electronic evidence. Counsel for Mr. Makis argued that the screenshots, videos and emails were not properly authenticated, and pointed to the absence of metadata, hash values, timestamps, expert forensic analysis, continuity evidence, proof of account control, and email header information.

Justice Mah relied on the electronic documents provisions of the Canada Evidence Act and the Alberta Evidence Act, and cited appellate decisions (including R v Martin) confirming that the authentication threshold is low: there must be some evidence that the tendered document is what it purports to be, which can be shown through direct or circumstantial evidence such as a witness going to the source (website, email platform, etc.), viewing the item and printing or copying it. The Court found that the affidavits of Dr. McLeod, Dr. Forestier and Ms. Lanz met this standard, including the emails attached on information and belief in Ms. Lanz’s affidavit.

On weight, the Court noted that Mr. Makis had identified three specific instances of impersonation websites and denied having any Facebook accounts, but he did not deny the authenticity of the X, LinkedIn and YouTube material or the emails to Dr. McLeod. He also acknowledged operating X, LinkedIn and YouTube accounts. The Court observed that the messaging and content across CPSA’s exhibits were consistent with each other and with his questioning evidence describing his health coaching business, and that the material was branded with his name and image. It concluded, on the totality of the evidence, that CPSA had circumstantially proven that he was the originator of all the online and email material it tendered, except for the three instances in Exhibit “A” to his February 12, 2026 affidavit, and made no finding on the Facebook posts. The Court held that it would be illogical and unreasonable to infer that all the CPSA evidence was fake.

Jurisdiction, extra-territoriality, and freedom of expression

On jurisdiction, the Court accepted that CPSA has no jurisdiction to regulate him as a member because he is not a regulated member, but it held that CPSA was not purporting to do so. Rather, CPSA, acting in the public interest, had asked the Court to restrain unlawful conduct, and the Interim Injunction was the Court’s order. The contempt and Permanent Injunction applications were a continuation of the Court’s regulation of that conduct. The Court cited Law Society of Alberta v Beaver for the proposition that the foundation for such an injunction — protection of the public from unauthorized practice — remains regardless of a change in the person’s regulatory status.

On extra-territoriality, the Court accepted that it had in personam jurisdiction over Mr. Makis while he resides in Alberta. The fact that his clients are outside Alberta and Canada, that some interviews are recorded elsewhere, or that he interacts with people online does not displace the fact that he is physically in Alberta when these activities occur. The Court cited Google Inc v Equustek Solutions Inc to illustrate that injunctions can have extra-territorial effects where the internet is involved, but emphasized that CPSA was not seeking extra-territorial enforcement. CPSA sought only to restrain unauthorized practice of medicine and use of protected titles while he is an Alberta resident and not a regulated member. The Court noted that CPSA would not pursue these proceedings if he were not residing in Alberta.

On freedom of expression, the Court observed that no formal Charter remedy application under s. 24(1) had been brought, but it addressed the argument. It stated that if Mr. Makis had confined himself to talking about ivermectin and repurposed drugs, the s. 2(b) argument might have had force. However, CPSA’s complaint was that he was providing a service to the public that constituted unauthorized practice of medicine and using protected titles contrary to statute and the existing Court Order. Relying again in part on Google, Justice Mah concluded that freedom of expression cannot be used to justify unauthorized practice of medicine or unauthorized use of protected titles in Alberta, and stated he did not see how people in Florida would object to an Alberta order prohibiting unauthorized practice and use of such titles in Alberta.

Credibility findings and the contempt determination

Justice Mah addressed credibility. He noted that he was entitled to make adverse credibility findings where affidavit evidence is undermined by cross-examination or contrary evidence, particularly where the evidence is general, vague or self-serving. He found that Mr. Makis’ evidence had these defects. The Court held that his assertion of not providing treatment or advice was contrary to the language in his own posts and what his clients said, and directly contrary to Dr. McLeod’s evidence about what constitutes practicing medicine — applying medical knowledge and skills to address health concerns. The Court found that the evidence showed he made individualized recommendations based on his clinical judgment.

Justice Mah also pointed to personal insults made by Mr. Makis against Dr. McLeod and others, including accusations of pedophilia, conspiracy with the Premier of Alberta to criminalize ivermectin and “murder” cancer patients, and calling Justice Yamauchi “corrupt” and the earlier hearing “rigged” or fraudulent. Some of these were published on the internet, which the Court viewed as indicating reckless indifference to truth. The Court also noted inconsistencies in his description of his practice history and status, including his Florida licensure documentation referencing “practice of medicine in Canada of more than twenty years” and his description of his licensure status in Alberta and Florida.

On the contempt test, the Court applied Carey v Laiken and held that all three elements had been proven beyond a reasonable doubt. The August 15, 2025 Order was clear and unequivocal. There was no dispute that he had actual knowledge of the Order, and he was represented by counsel at the time. The Court found that he had deliberately breached the Order by continuing to offer and provide health services to the public, including advice and consultations regarding cancer treatment, and by using protected titles. It rejected his attempts to re-label his activities as “health coaching,” to call patients “clients,” or to characterize his conduct as merely sharing information and research. It held that the substantive nature of his activities placed them within the statutory definition of the practice of medicine in the HPA, including assessing individuals to establish a diagnosis, assisting them to make informed choices about medical treatments, and treating physical and psychosocial conditions. The Court noted that he himself described operating a “clinic” online, despite denying operating a clinic in questioning.

The Court concluded that he was in contempt of the August 15, 2025 Order. It emphasized that the risk to the public lay in the unauthorized practice of medicine — providing medical services without a licence and representing himself as a licensed physician — rather than in disseminating research or information about ivermectin or any other drug. It stated that proof of actual harm to specific individuals was not required where the prohibited act itself constituted the harm for contempt purposes.

The ruling and the outcome

On sanction, CPSA asked for immediate imprisonment under Rule 10.53(1), arguing that nothing short of imprisonment would be effective. Justice Mah accepted that fines or costs were inadequate, given that Mr. Makis had already disregarded a substantial costs award against him. However, the Court described imprisonment as drastic without giving an opportunity to purge contempt. Applying Carey and Lymer, it chose a bifurcated approach.

The Court ordered that, with respect to his health coaching business, Mr. Makis must immediately cease providing medical advice and treatment and otherwise practicing medicine without a license. Regarding his online presence, he was given 72 hours, starting at 12:01 a.m. on the day after the decision, to remove all offending titles, initials and abbreviations, whether the content was originally posted by him or reposted. The Court stated that this gave him a reasonable opportunity to purge his contempt. It held that, if he did not do so or reoffended, CPSA could, upon affidavit proof of non-compliance, obtain a warrant from a Justice of the Court for his arrest and detention, after which he would be brought before the Court. Justice Mah noted he had used the same warrant approach in another case and concluded that the risk of arbitrary detention was mitigated by the requirement that a Justice first be satisfied there was a breach.

On the Permanent Injunction, the Court held that CPSA clearly had a legal right, in discharge of its public interest mandate, to insist that anyone practicing medicine or using protected titles in Alberta be properly licensed as a regulated member. It cited authority confirming that a regulator has standing and the Court has jurisdiction to grant a permanent injunction to restrain unauthorized practice. The Court referred to a video where Mr. Makis rhetorically asked why the government, courts and regulator could not stop him from helping cancer patients and then stated that “they’re the evil people” and “the people breaking the law,” which the Court characterized as a declaration of his contempt and evidence of his intent to continue breaching the Order.

Considering irreparable harm and balance of convenience, the Court found that CPSA and the public interest could not be adequately compensated by damages, that the balance of convenience favoured CPSA, and that Mr. Makis had persisted in practicing medicine without a license despite the injunction. The Court granted a Permanent Injunction on the same terms as the Interim Injunction, enforceable through the same warrant process. It clarified that the Permanent Injunction is a final order, not necessarily an order that lasts forever, and stated that it would remain in effect until he is reinstated as a regulated CPSA member or so long as he is a resident of Alberta.

The Court added that it was not directing him to leave Alberta or Canada and acknowledged his passion and belief in his cancer work. However, it emphasized that the case was about regulation of the medical profession in Alberta and who is entitled to practice medicine and dispense medical advice and treatment while in Alberta.

On costs, the Court held that CPSA, as the successful party on both the contempt and injunction aspects, was presumptively entitled to costs. It placed the matter in Column 1 of Schedule C, noted the public interest nature of the matter, the volume of evidence, and the work required of CPSA’s counsel, and ordered that Mr. Makis pay CPSA’s costs for all steps in the matter at 3X Column 1.