The Ministry of Health and Long-Term Care is constantly evaluating the ways in which our laws (legislation) affect public health and the delivery of care. The rationales for change may come from many sources and proposed amendments to legislation go through rigorous research and consultation processes. In the case of Bill 87 – also known as the Protecting Patients Act – the Ministry amended sixi different pieces of legislation all intended to keep patients healthy and safe.
Bill 87 evolved, in part, from the report of the Ministry’s Sexual Abuse Prevention Task Force, transparency initiatives undertaken by health regulatory Colleges over the past few years, and public/media scrutiny that appeared to suggest that Colleges were not aligned with changing social values.
The amendments to the Regulated Health Professions Act (or RHPA) resulting from Bill 87 directly affect the Colleges for all 26 self-regulated healthcare professions, including the CRTO. The Colleges are working together to ensure consistency across the professions. This helps to ensure that a patient/client or a Member of a regulated health profession would have a similar experience regardless of which College is contacted.
The revisions to the RHPA set out by Bill 87 focus on four key issues:
With the introduction of Bill 87 the Ministry of Health and Long-Term Care reiterated its stance of zero-tolerance for the sexual abuse of patients/clients by regulated healthcare professionals. Supports available to patients/clients have been enhanced to encourage reporting when abuse occurs. In contrast, penalties for abusing patients/clients have been stiffened.
- The RHPA contains a listii of sexual acts between patient and regulated healthcare professional that will result in the mandatory revocation of a Member’s certificate of registration. Bill 87 expands the list to include touching a patient’s genitals, anus, breasts or buttocks in a sexual nature.
- Bill 87 also now requires that, at a minimum, a Member’s certificate of registration is suspended for findings of sexual abuse where revocation is not mandatory (e.g., comments/remarks of a sexual nature). The previous penalty was a verbal reprimand.
- Bill 87 prohibits sexual interaction between a Member and a former patient for a minimum period of one year after the end of the patient-provider relationship.
- The RHPA already requires the CRTO to pay for up to 200-hours of therapy for a patient/client who has been sexually abused by a Respiratory Therapist after a Member has been found guilty. The changes under Bill 87 will make funding available at the time the complaint (or report from an employer) is made, and may be allotted for expenses other than just therapy (e.g., transportation to get to therapy).
- Fines for failing to report sexual abuse by a Member have increased to $50,000 for individuals (including other regulated healthcare professionals), and to $200,000 for corporations/employers under Bill 87.
- The Discipline Committee can no longer allow a Member to practice on only one gender (e.g., permitting a male practitioner to continue to practise on only male patients/clients) as a method of sexual abuse prevention.
In 2014 the Ontario Government introduced their “Open By Default” approach making transparency a key focus. The Minister of Health and Long-Term Care wrote to Colleges encouraging them to make transparency a priority in carrying out their mandates. In response, more information about regulated healthcare professionals has been made available on the public Registers of Members in varying degrees by all 26 regulatory bodies. With Bill 87, all Colleges are now required to collect or disclose similar information, including:
- On the public Register of Members:
- The date that a Member dies,
- Where a Member has been required to be verbally cautioned by a panel of the Inquiries, Complaints and Reports Committee,
- Where a Member has been required to complete a specified continuing education or remediation program (SCERP),
- The allegations against a Member for every case referred to the Discipline Committee until the hearing has concluded,
- Where a Member has been determined to be incapacitated and the requirements/restrictions in place.
- Council meeting dates, agendas and materials on the CRTO website.
- To the regulators of Long-Term Care and Retirement Homes the CRTO is now able to share information if it is in the public interest (e.g., investigation related matters).
- Members are required to report to the CRTO their registration with all other regulatory bodies, and any findings of professional misconduct or incompetence.
- Members are required to report to the CRTO all charges related to offences, and any resulting bail conditions or other similar restrictions.
Authority for Colleges
The revised authorities for Colleges under Bill 87 are intended to enable more timely responses to complaints/reports issues dealt with regularly.
- Bill 87’s implementation now permits the Inquiries, Complaints and Reports Committee to order the interim suspension of a Member’s certificate of registration when it feels that the Member’s conduct or behaviour is likely to put patients at imminent risk. Previously the ICRC could only suspend a Member after specified allegations had been referred to the Discipline Committee which could take several weeks/months from the time the concern is raised.
- Under Bill 87 the Registrar may now approve Alternative Dispute Resolution (ADR) agreements. ADR must be acceptable to both the Member and the Complainant as a way to address the concerns raised. ADR may not be applied to sexual abuse complaints.
- Similarly, Bill 87 provides authority for the Registrar to accept the withdrawal of a complaint (when requested by the person who submitted the complaint). Currently the Inquiries, Complaints & Reports Committee must consent to the withdrawal which can lead to unnecessary delays.
Powers of the Minister of Health
The Minister of Health and Long-Term Care is responsible for overseeing the 26 health regulatory colleges. The additional authorities given to the Minister under Bill 87 will allow him to further ensure that all Colleges are acting in the public interest.
- Under Bill 87 the Minister can require the CRTO to provide personal information regarding Members for the purpose of the Minister evaluating whether the CRTO is carrying out its duties.
- Bill 87 permits the Minister to make regulationsiii specifying how the CRTO is to investigate and prosecute sexual misconduct cases.
- Bill 87 gives the Minister the authority to make regulationsiii specifying:
- Committee composition (i.e., who and how many sit on the Committees),
- Panel quorum (i.e., minimum number of sub-Committee members who must be present),
- Eligibility requirements for Committee membership (e.g., relevant experience or attended training),
- Grounds for a Committee member’s disqualification (e.g., perceived conflict of interest).
i Drug and Pharmacies Regulation Act, Immunization of School Pupils Act, Laboratory and Specimen Collection Centre Licensing Act, Ontario Drug Benefit Act, Seniors Active Living Centres Act (2017) and Regulated Health Professions Act (1991).
ii Health Professions Procedural Code, S.51(5).
iii Although the ability for the Minister to make these regulations is already in effect, there have been no regulations developed to date. It is expected that Colleges would be consulted before any proposed regulations are finalized.