The Controlled Act of Psychotherapy Now in Force

The controlled act of psychotherapy was proclaimed in force on December 30, 2017. It was drafted into the Regulated Health Professions Act in 2007. Controlled acts are acts that are considered inherently dangerous and are restricted to those authorized to perform them by law, or their delegates.  In order to perform a controlled act, you must be a member of a regulatory college authorized to perform that Act, or be a delegate of an authorized professional.

In 2007, the Psychotherapy Act was enacted and it created the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario.  Companion legislation was amended so that the controlled act of psychotherapy would be authorized to:

  • Nurses
  • Physicians
  • Psychologists
  • Occupational therapists
  • Registered psychotherapists
  • Social workers

However, these provisions were not proclaimed in force, nor was the definition of the controlled act of psychotherapy, until December 30, 2017.

During the intervening period, the College of Psychotherapists was directed to work with 5 other regulatory colleges whose members were to be authorized to provide psychotherapy, to define the meaning of the controlled act. These other colleges are the College of Nurses of Ontario, the College of Psychologists of Ontario, the College of Physicians and Surgeons of Ontario, the College of Occupational Therapists of Ontario and the Ontario College of Social Workers and Social Service Workers.  In June of 2016 the colleges[1] published a document entitled “Understanding the Controlled Act of Psychotherapy[2]”.

In the fall of 2017 the Minister of Health and Long-Term Care referred the matter to its advisory council. The Minister asked HPRAC to further clarify the meaning of the controlled act and to build on the clarification document published by the Colleges[3]. HPRAC submitted its report to the Ministry in November of 2017 but that report has not been released by the Ministry.

In December, the Ministry notified the sector (via Bulletin) that individuals who practise psychotherapy but are not registered with one of the authorized colleges have until December 31, 2019 to determine if they are practising psychotherapy. If so, they must apply for registration with one of the colleges whose members are authorized to perform the controlled act[4]. The Bulletin also notes that the College of Psychotherapists has been instructed by the Ministry to further define the controlled act of psychotherapy and to identify practices that may be exempt from the controlled act of psychotherapy.

Finally, the Bulletin notes that the proclamations align with the Ministry’s objectives to increase accessibility to structured psychotherapy services for individuals with anxiety and depression.  The proclamations are certainly consistent with Health Quality Ontario’s recent recommendation to increase the pool of providers of psychotherapy in order to address prevalent mental health issues such as anxiety and depression. The bulletin further indicates that the Ministry will work with Health Quality Ontario and other stakeholders to provide access to structured psychotherapy services.

 


[1] All colleges except the CPSO participated in the development of the guidance document.
[2] Available on line at https://www.crpo.ca/controlled-act-of-psychotherapy/.
[3] The Minister’s referral letter can be found on line at http://hprac.org/en/links/resources/Letter-to-HPRAC_Aug-4_17-1.pdf .
[4] See the MOHLTC Health Bulletin entitled “New Psychotherapy Requirements to Support Patient Care and Safety”  dated Dec 21, 2017, available on line at http://www.health.gov.on.ca/en/news/bulletin/2017/hb_20171221.aspx .

 

Ultrasound technicians – road to regulation

Ultrasound technicians are on the road to regulation. The Ministry of Health and Long-Term Care is consulting on proposed regulations until October 16 to bring ultrasound technicians under the jurisdiction of Ontario’s College of Medical  Radiation Technologists.

Contact us for more information or for help with a submission.  To see the proposed regulations click here http://www.ontariocanada.com/registry/view.do?postingId=24694&language=en

Proposed regulations under LHIN legislation

On June 21st the Ministry of Health and Long-Term Care completed the transition of all 14 Community Care Access Centres in Ontario.  The administration and coordination of home care and community services and long-term care home placements will now be performed by the 14 Local Health Integration Networks (LHINs).

On July 4th, the Ministry released for consultation draft regulations that facilitate this transition.  Regulations under the Local Health System Integration Act are proposed to preserve the provision of services in French and to reflect the LHINs’ expanded mandate to arrange and provide home and community care services. Issues of patient safety, and quality of services and programs provided by the LHIN, will be discussed in proposed quality committees to be created at each LHIN. The text of each regulation amendment is available here:

http://www.ontariocanada.com/registry/showAttachment.do?postingId=24427&attachmentId=34511

 

Submissions to the Ministry about these regulations are due by September 4, 2017.

Ontario’s new Patient Ombudsman

Recently here at DDO we were discussing the role and powers of the Patient Ombudsman. The Patient Ombudsman has jurisdiction to resolve complaints about health service organizations such as public hospitals, long-term care facilities, and certain services provided by the LHINs.

The Patient Ombudsman is an office of last resort – so people having complaints must first explore resolution directly with their health service organization. When a complaint is filed, the Patient Ombudsman will ensure that no other body has jurisdiction over the complaint and, with patient consent, will try to facilitate resolution by contacting the health sector organization.

The Patient Ombudsman may investigate complaints where a facilitated resolution is unsuccessful. Health sector organizations such as hospitals and long-term care homes will be well placed to respond to inquiries from the Patient Ombudsman if their internal processes for addressing complaints are robust, thorough, and comprehensive.

For more information about the Patient Ombudsman, for help in crafting a robust complaint process, or for help in responding to an inquiry from the PO, please contact me at spalter@ddohealthlaw.com.

Nurse practitioner’s role now includes prescribing controlled substances

Nurse practitioners (NPs) fill an important gap in our health care system. In 2007, the first Ontario NP-led clinic opened its doors in Sudbury, and dozens more are now in operation in Ontario.

On April 19, 2017, the role of NPs was expanded. Provided the NP successfully completes the required education, NPs have the authority to prescribe medical cannabis and substances that may be used for medical assistance in dying (MAID).  The education must be approved by the governing council of the College of Nurses of Ontario and must be specifically designed to educate NPs to safely, effectively and ethically prescribe controlled substances.

Before prescribing can occur:

  1. there must be a nurse-patient relationship between the NP and the patient;
  2. the intended use of the substance can only be therapeutic; and
  3. certain information must be contained in the prescription, a copy of which must be retained as part of the patient’s health records.

To see more information, click here http://www.cno.org/en/news/2017/april-2017/nps-can-now-prescribe-controlled-substances/ or access the Nursing Act general regulation: https://www.ontario.ca/laws/regulation/940275#BK39.

Bill 84, the Medical Assistance in Dying Amendment Act, includes limited immunity for NPs who assist with MAID.  NP-led clinics are also given limited immunity in relation to the delivery of MAID. Bill 84 received Royal Assent and became law on May 10th.

For advice concerning NPs in your health care organization, contact Simmie: spalter@ddohealthlaw.com.

The Genetic Non-Discrimination Act: Bill S-201

Genetic information can reveal very sensitive and personal information about an individual and his/her family. The federal Genetic Non-Discrimination Act (Bill S-201) received Royal Assent in the Senate on May 4, 2017.

The Bill gives control to Canadians over the use of their genetic test results by banning anyone from requiring an individual to undergo genetic testing, or from disclosing the results of a genetic test, as a condition of entering into or continuing a contract; or as a condition of providing goods or services to that individual.  The Bill makes amendments to the Canadian Human Rights Act to prohibit discrimination on the ground of genetic characteristics and amends the Canada Labour Code to protect employees from being required (by their employers) to either undergo genetic testing or disclose the results of such testing. Violation of the prohibition is an offence that can result in substantial fines, imprisonment or both.

The prohibition against requiring disclosure of genetic test results does not apply to a physician, pharmacist or other health care practitioner (in respect of individuals to whom they are providing health services) or to researchers conducting medical, scientific or pharmaceutical research (in respect of research participants).

Bill S-201 would prevent insurance companies from requesting disclosure of genetic test results, received either in a therapeutic or research context, in order to assess actuarial risk. The first-reading version of the Bill exempted high value insurance contracts from the prohibition if the province enacted a provision expressly permitting an insurer to require a person to disclose any existing genetic test results as a condition of entering into or continuing a contract of insurance. That clause did not appear in the final version of the Bill.

The Canadian Life and Health Insurance Association (CLHIA) announced, on November 11, 2016, a commitment from insurers to refrain from collecting or using any genetic test results for new applications for life insurance policies up to $250,000, effective January 1, 2018. As a result, according to the CLHIA, more than 85% of applications for life insurance would not require any disclosure of genetic test results[1]. This is a higher policy amount than was included in the exemption for insurance contracts ($1,000,000) that appeared in the first version of Bill S-201. Even with this commitment, insurers would not be permitted to require disclosure of genetic test results for higher value policies under Bill S-201.

However, there is concern that the Bill intrudes upon the provinces’ jurisdiction over insurance.  In the Senate debates of April 4, 2017, Senator Frum noted that the Prime Minister and the Minister of Justice will be referring the Bill to the Supreme Court of Canada, on the matter of constitutionality, after it receives Royal Assent[2].

The meaning of “personal information” under Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA) was also at issue in the first version of the Bill. When the Bill was introduced, it included amendments to PIPEDA to define personal information to include “personal health information, such as information derived from genetic testing”.  However, David Therrien, the Privacy Commissioner of Canada, noted that the current definition of personal information in PIPEDA is broad enough to include information derived from genetic testing, and that including such information as an example of personal health information could narrow the definition of personal health information and also limit information derived from genetic tests to the health care context, thereby excluding information from genetic testing conducted for other purposes, such as paternity, ancestry and others. Subsequently, the Bill was amended at third reading in the Senate to remove the amendments to both PIPEDA and the Privacy Act.

[1] See https://www.clhia.ca/domino/html/clhia/clhia_lp4w_lnd_webstation.nsf/page/07AC1F9D1616B528852580A4006D544E

 

[2] See https://sencanada.ca/en/Content/Sen/chamber/421/debates/108db_2017-04-04-e#31.

 

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