Transparency & the By-Laws: FAQs

What is ‘transparency’?
Why does the CRTO need to be more transparent?

Transparency simply means clear and visible. Advancing technology has created borderless societies – think of our global economy. That, coupled with high profile examples of businesses and people acting in their own interest at the cost of others’, has helped to give rise to the general expectation that companies, organizations, government and individuals provide access to a greater amount of information that can be easily understood. These expectations are no different for health care and regulation – being as transparent as possible by providing relevant, timely and accessible information to the public and stakeholders is the new norm.

The CRTO has already made transparency an important factor over the last few years, and it continues to be a priority. Along with the values of accountability, fairness, openness and effectiveness, transparency is fundamental to regulating the Respiratory Therapy profession in the public interest. The Ministry of Health and Long-Term Care (MOHLTC) has also requested that Ontario health regulatory bodies make transparency a priority in carrying out their mandates.

It’s important to allow anyone access to information about the CRTO and the RT professionals we regulate, in an easy and timely manner. We believe that being more transparent offers a better understanding of self-regulation, leading to greater participation in the process and ultimately public confidence in the regulatory framework and the profession of Respiratory Therapy. Some recent initiatives to improve transparency include our re-designed website, changes to the By-Laws & Register, other social media platforms (e.g., Twitter™) and online complaints forms.

You said that the Minister of Health and Long-Term Care asked all colleges to be more transparent. Can I read the letter from the Minister?

Yes. Here is a link to our transparency page where you can find more information about our approach, as well as the letter from the Minister of Health and Long-Term Care.

What has the CRTO made public?

To be consistent with other health regulatory colleges, and comply with the Minister of Health and Long-Term Care’s request, the CRTO has put some additional information about complaints against RTs on the website. Specifically, the CRTO has added oral cautions, remediation, undertakings, and criminal/other charges or findings of guilt, and bail conditions to the Register. This will affect very few Respiratory Therapists; less than 0.5 per cent of, or approximately 16, Members are investigated annually and even fewer have requirements put in place that will be affected by these changes.

Health care, like many other industries, is making a great deal more information public. For example, Toronto restaurants must display their health inspection results on brightly-coloured reports in windows or on the DineSafe website. Similarly, Ontario’s patients have the right to know if an aspect of an RT’s practice has been identified as being so concerning that a panel of peers required the Member to get some remediation. To be more transparent, the CRTO has recently made changes to the By-Laws regarding the Register, some existing policy documents and creating a few additional resources. All of these changes are intended to provide relevant, timely and important information needed for patients to make informed decisions about their care.

What is an oral caution?

If a panel of the Inquiries, Complaints and Reports Committee is of the opinion that a Member’s conduct is serious and has the potential to put others a moderate risk (e.g., bullying or intimidating behaviour towards colleagues), it may order the RT to meet with them. At the meeting, the panel reads a letter of caution (or warning) to the Member that his/her alleged behaviour is of below the standards expected of an RT, of significant concern to them and will not be tolerated. An oral caution is considered by health regulatory colleges to be one-step below a discipline hearing.

What does remediation consist of?

The type of remediation that the CRTO is talking about making public is referred to as a SCERP – a specified (or specific) continuing education or remediation program. The word ‘program’ suggests that the task required by a panel of the Inquiries, Complaints and Reports Committee of the RT will require some effort and has an assessment component to indicate that the Member has met the expectations. For example, a Member may be required to take a full-day course on documentation, or attend 10-hours of anger management training, or a 12-week university/college-level course on interpersonal communication.

Is an undertaking like a contract?

Essentially, an undertaking is an agreement or a contract that a Member makes with the CRTO to do certain things. For example, an RT may sign an undertaking to have his/her documentation practices monitored for a 1-year period. The contents of an undertaking are proposed by a panel of the Inquiries, Complaints and Reports Committee in response to concerns raised about a Member. Often, an undertaking is requested in conjunction with some sort of remediation (i.e., SCERP) such as completing the course of documentation and through the undertaking, the RT’s documentation practices are then evaluated periodically over the year to ensure that s/he is applying what was learned. Sometimes, an undertaking will have a Member agree NOT to do certain things, like bullying or intimidating colleagues and students.

Like a contract, an undertaking is a serious commitment and a Member is always advised to seek legal counsel prior to signing it. If a Member breaches the undertaking, it is likely that allegations of professional misconduct will be referred for a discipline hearing.

What kind of charges will be on the Register?

As of January 1, 2016 if a Member is charged with a criminal, insurance, controlled drug, or other offence relating to his/her suitability to practice, this information will be posted on the Register. It is important to note that this information is already part of the public record – meaning that it is available to the public through the courts. However, in an effort to be more transparent to patients, and align with the policies of other colleges, the CRTO will now include this public information on the Register.

Who decides what charges are relevant to my suitability to practice?

When a Member informs the CRTO that s/he has been charged with an offence, the Registrar will consider the information using policies and guidelines to determine if the offence may affect the Member’s suitability to practice. In general, the CRTO will only take action if, after obtaining additional information from the RT or other sources (e.g., the courts) it appears that the conduct that resulted in a charge reflects on a Member’s ability to practise Respiratory Therapy ethically, safely and competently. View the Assessing Suitability to Practice policy here.

How do I get information removed from the Register?

Six (6) years after a Member completes the ICRC’s requirement(s), s/he can submit a written request to have the information removed from the Register. In general, the information will be removed if no other concerns of a similar nature have been reported to the CRTO within that time. This scenario does not apply to notations/information about disciplinary action regarding sexual abuse.

Although details regarding ICRC requirements, court charges or findings of guilt may be removed from the Register, they remain part of a Member’s official record with the CRTO and can be accessed by the public upon written request.

How will this affect my practice?

The changes to the Register will not affect your practice. The transparency-related changes are regarding the information available about RTs to the public and other stakeholders.

What are other health colleges doing about transparency?

The MOHLTC has asked all of the health regulatory colleges to make transparency a strategic priority. A sub-group of the Federation of Health Regulatory Colleges of Ontario (FHRCO) made up of the medicine, nursing, physiotherapy, pharmacy, optometry and dentistry colleges began work on becoming more transparent in 2013. The colleges in this group, called AGRE (Advisory Group for Regulatory Excellence) have already put some changes in place, and have others scheduled to occur in the coming months. Please note that each health regulatory college has its own process, values and views on the transparency initiative – their proposed or implemented changes do not necessarily reflect what is planned for the CRTO.

To see what other colleges are doing, click on the links below:

When did the By-Law changes take effect?

The development and consultation process was lengthy and involved. The CRTO worked within the following timeline to make changes:

September 25, 2015→ 
Council approved the consultation with CRTO Members on By-Law changes
September 28, 2015 – November 27, 2015→ 
Consultation & Feedback period
December 4, 2015→ 
Council reviewed feedback from the consultation; proposed amendments and updates as required
January 1, 2016→ 
By-Law revisions and Register changes  came into effect