DDO Legislative Update #2

A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest. 

by Pam Seto

Bills

  • No new bills of interest

 

Regulations

  • No new regulations of interest

 

Articles of Interest

 

Opioids Crisis

Bill to make it easier to create safe injection sites becomes law

Ontarians filled 9.2 million opioid prescriptions in 2015-2016, new data shows

Health Minister orders review of opioid guidelines after conflict-of-interest revelations

 

Ontario Doctors

Doctors, province reach tentative deal to send contract disputes to arbitration

 

Health Care Practitioners and Workplace Safety

Keeping Health Care Professionals Safe on the Job

 

Medical Malpractice

Woman who felt surgeons ‘rip her apart’ wins Canada’s first malpractice ruling over waking during operation

 

Health Care Funding

Ontario autism program will soon include direct funding as option

Feds vow to lower ‘unacceptably high drug costs’

 

Birth Certificates

Gender-neutral birth certificates could be issued in Ontario by 2018

 

Interesting Reads

Mohammed Shamji and Elana Fric Shamji: the inside story of a marriage gone horribly wrong

 

Self-care

Here are several easy ways to relieve digital eye strain

Lyme disease is on the rise in Ontario – here’s how to protect yourself

The 20 best doughnuts in Toronto right now

DDO Legislative Update

A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest. 

by Pam Seto

 

Bill 84 – Medical Assistance in Dying Statute Law Amendment Act, 2017

This Bill received Royal Assent on May 10, 2017.

The Bill amends various acts with respect to medical assistance in dying (MAID).

 The following acts are amended:

  • Coroners Act – A physician or nurse practitioner who provided MAID must notify the coroner and provide the necessary information to determine if the death should be investigated.
  • Excellent Care for All Act, 2005 – Physicians and nurse practitioners, and the people assisting is protected from litigation. The fact that people who receive MAID cannot be used as a reason to deny a right or refuse a benefit that would otherwise be provided under contract or statute.
  • Freedom of Information and Protection of Privacy Act and the Municipal Freedom of Information and Protection of Privacy Act–  Both acts do not apply to identifying information relating to MAID.
  • Vital Statistics Act – Coroner documentation requirements do not apply for MAID if there is no investigation.
  • Workplace Safety and Insurance Act, 1997 – A worker who receives MAID is deemed to have died as a result of the injury or disease for which the worker was determined eligible to receive MAID.

Introduced by Hon. Eric Hoskins, Minister of Health and Long-Term Care.

For more information: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=4460

 

Bill 87 – Protecting Patients Act, 2017

This Bill received Royal Asset on May 10, 2017.

The Bill implements health measures and measures relating to seniors by enacting, amending or repealing various statutes.  The following acts are amended:

  • Immunization of School Pupils Act
    • The Act is amended to require parents to complete immunization education sessions before filing a statement of conscience or religious belief; expand the categories of people who provide statements re immunizing agents; and requiring agents who administer immunizations to provide information.
  • Laboratory and Specimen Collection Centre Licensing Act
    • Some of the amendments to the Act include: new definitions (i.e. Laboratory facility); emergency suspension of licenses; powers of inspectors are changed; revisions to prosecutions of offences under the Act.
    • Some other acts are also amended as a result of the changes in this Act
      • Animals for Research Act
      • Health Insurance Act
      • Public Hospitals Act
  • Ontario Drug Benefit Act
    • The Act is amended to add a new definition for a “registered nurse in extended class”, and the regulations can incorporate documents by reference as amended.
  • Regulated Health Professions Act
    • The Act and its Health Professions Procedural Code (“Code”) has been amended. Some of the amendments to the Act include:
      • Providing the Minister the power to require the Council of a College to include in its reports to the Minister PHI or PI about any member of the College to allow the Minister to determine if the College is fulfilling its duties
      • S. 36.1 is expanded to include health human resources research
      • Minister given power to make regulations respecting committees and panels
      • Information in the register that is required by the College to take note is expanded
      • Definition of “Parent” has been expanded for the purposes of the sexual abuse provisions of the Code
      • Inquiries, Complaints and Reports Committee may make an order for interim suspension of the member’s certificate of registration
      • Imposition of gender-based terms, conditions or limitations on certificate of registration is prohibited
      • Grounds for mandatory revocation of a certificate of a member who has sexually abused a patient is expanded
      • Members are required to report to the Registrar if they belong to professional bodies outside of Ontario
      • Members are required to report to the Registrar if they have been charged with an offence
      • Mandatory programs for Colleges to provide funding for therapy and counselling for patients who were sexually abused by members is expanded
      • Penalties for failing to report sexual abuse of patients is increased

The Seniors Active Living Centres Act, 2016 is repealed and replaced with a new Act. The Act is amended to allow an operator that is NOT an individual to obtain funding from Minster Responsible for Seniors Affairs to establish a program if a director appointed by the Minister approves of the operator and the program (it must promote active and healthy living, social engagement and learning for seniors).

Introduced by Hon. Eric Hoskins, Minister of Health and Long-Term Care.

For more information: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=4477

 

Regulations

 

  • O. REG 114/17 – Excellent Care for All Act, 2010
    • This regulation amends O.REG 445/10 under the Excellent Care for All Act, 2010 by revoking certain provisions as it relates to the Ontario Health Quality Council (i.e. the Council acting as a Crown Agent is revoked).

Effective Date: April 19, 2017

Please see regulation: https://www.ontario.ca/laws/regulation/r17114

 

  •  O.REG 115/17 – Ontario Drug Benefit Act
    • This regulation amends O. REG 201/96 under the Ontario Drug Benefit Act to specify that recipients of professional services that are provided or arranged by a LHIN are eligible persons under the Ontario Drug Benefit program. Once the transfer of CCACS to LHINs is complete, reference to professional services provided by CCAS will be revoked.

Effective Date: April 19, 2017

Please see regulation: https://www.ontario.ca/laws/regulation/r17115

 

  • O.REG 116/17 – Health Insurance Act
    • The proposed amendment to REG 552 of RRO 1990 of the Health Insurance Act would add a reference to recipients of professional services that are provided or arranged by a LHIN.

Effective Date: April 19,2017

Please see regulation: https://www.ontario.ca/laws/regulation/r17116

 

  • O.REG 117/17 – PHIPA
    • The proposed amendment to O.REG 329/04 under PHIPA would designate the LHINs as HICs under PHIPA.
    • Under the Patients First Act, 2016, LHINs are responsible for home and community care, which is currently the function of the CCACs. All the CCAC functions, employees and assets will be eventually transferred to the LHINs. As a result of this change, the LHINs must comply with the privacy obligations set out in PHIPA. In particular, the LHINs would be a HIC for providing or assisting in providing health to an individual,  and for records transferred to it from CCAC.

Effective Date: April 19, 2017

Please see regulation: https://www.ontario.ca/laws/regulation/r17117

 

  • O.REG 118/17 – Home Care and Community Services Act, 1994
    • The regulation amends O. REG 179/95 (Conveyances of Assets) under the Home Care and Community Services Act, 1994 to exempt LHINS from this regulation.

Effective Date: April 19, 2017

Please see regulation: https://www.ontario.ca/laws/regulation/r17118

 

Articles of Interest

MAID

Strident opponent of assisted dying in Canada won’t chair advance request review

 

Health Care Coverage

It’s not just Americans who need to worry about health-care costs: Pape

Bankrupt by Cancer

Ontario parents want help for their developmentally delayed adult-age children

 

Class Actions

Class-action suit initiated over potentially defective defibrillators

 

Interesting Reads

A Suicide Therapist’s Secret Past

 

Self-care

So, you’d like to quit smoking: Why not collect points in the process?

Lifting weights now can help you ace your golden years

How to do a really good job of washing your hands

Are you an emotional eater? Blame your parents, study suggests

 

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.

Congratulations to Mary Jane Dykeman

Our founding partner Mary Jane Dykeman has been named by the Ontario Bar Association Health Law Section as the second recipient of the Susan Hilary Davidson Memorial Award for Excellence in Health Law.  The award honours lawyers with outstanding achievements in health law.

Mary Jane is a most worthy recipient, having written and lectured prolifically throughout her career on topics close to her heart, including privacy, mental health, and consent and capacity.

The award will be presented to Mary Jane at a dinner at the OBA in Toronto on June 13th.

The award was named for Mary Jane’s good friend Susan Davidson, who was herself an amazing health lawyer and devoted OBA Health Law Section volunteer.

We are all so proud of our colleague!

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.