New Bill 8 resurrects ECFAA changes affecting CCACs and LTC homes

On July 8, 2014, the former Minister of Health and Long-Term Care, Deb Matthews (now the President of the Treasury Board), introduced Bill 8, the Public Sector and MPP Accountability and Transparency Act, 2014, which proposes changes to several statutes including the Excellent Care for All Act, 2010 (ECFAA). The ECFAA provisions of Bill 8 are a restatement of those found in Bill 179. Clients may remember that Bill 179 had been introduced and carried at first reading during the former session of the Legislature but died on the Order Paper with the call for the provincial election.

Proposed amendments to ECFAA (Schedule 5)

Bill 8 outlines to following key amendments to ECFAA:

  • Expands the definition of “health sector organization” to include community care access centres (CCACs) and long-term care (LTC) homes.
  • Expands the functions of Health Quality Ontario (HQO) under the Act to include the area of patient relations. This appears to a formalization of initiatives already being undertaken by HQO. See here, for example.
  • Creates the position of patient ombudsman.  The patient ombudsman shall be appointed by the Lieutenant Governor in Council and employed by HQO.
  • Enumerates the functions of the patient ombudsman as:

o   receiving and responding to complaints from patients and former patients of a health sector organization, and other persons if prescribed;

o   facilitating the resolution of complaints made by patients and former patients of a health sector organization, and other persons if prescribed;

o   undertaking investigations of complaints made by patients and former patients of a health sector organization, and other persons if prescribed, and to undertake investigations of health sector organizations on the patient ombudsman’s own initiative;

o   making recommendations to health sector organizations following the conclusion of investigations; and

o   doing anything else provided for in the regulations.

  • Introduces provisions concerning complaint facilitation, investigations, reports and other matters are included.


Should the Bill be passed into law, CCACs and LTC homes will be most impacted, at least initially. In addition to the Bill’s increased oversight mechanisms (applicable to all health care organizations), an amended ECFAA will statutorily require CCACs and LTC home clients to adopt and implement (to the extent they have not done so already) additional and more formal quality improvement obligations – including the establishment of a Board quality committee, regular patient/provider surveying and public reporting. Quality Improvement Plan (QIP) development may be less of an issue since many in the LTC sector adopted it on a voluntary basis through the HQO Residents First initiative; and CCACs began submitting QIPs as of April 1 this year.

The Bill passed first reading on July 8, 2014. A full text of the Bill can be found here.

CASL Update #1: CRTC issues clarification for registered charities

Canada’s Anti-Spam Legislation (CASL) came into force on July 1. With many organizations still working on complying with the new legislation, the CRTC has begun to issue interpretative guidance. Most recently, the CRTC released updated FAQs that clarified the fundraising exemption and its application to commercial electronic messages (CEMs) “whose primary purpose is that of fundraising”.

What is fundraising?

The fundraising exemption under CASL enables registered charities to freely send CEMs where the primary purpose of the message is fundraising. Until recently and in the absence of additional information from either the CRTC or Industry Canada, clients struggled to understand:

1)      what activities constituted fundraising; and

2)      what “primary purpose” meant to qualify an email for the fundraising exemption.

Just prior to the coming into force of CASL, Imagine Canada released an issue alert based on advice received from Industry Canada (see Imagine Canada, Issue Alert: Update and clarifications on Canada’s Anti-Spam Law; as well as their Frequently Asked Questions (FAQs) specific for registered charities at that clarified the scope of fundraising covered by CASL. According to the alert, fundraising included all activities under the Canada Revenue Agency’s definition of fundraising as well as a number of other activities such as offering and/or promoting services to individuals on a cost-recovery basis and sending newsletters that promoted upcoming fundraising events.

More recently, the CRTC has provided additional updated FAQs outlining when a CEM has fundraising as its primary purpose and therefore falls under the exemption.

When is fundraising the primary purpose of a CEM?

The CRTC did not provide any hard and fast rules about when fundraising would be found to be the primary purpose of a message. Rather, the CRTC illustrated its understanding by way of example. To summarize, according to the CRTC:

  • A CEM that promotes a fundraising event where the proceeds from ticket sales flow to the registered charity has as its primary purpose the raising of funds.
  • An e-mailed charitable newsletter that does not contain any material that could be construed as encouraging the recipient to participate in commercial activity has as its primary purpose the raising of funds.
  • An e-mailed charitable newsletter that mentions corporate sponsors who support the charity (but does not encourage the recipient to participate in a commercial activity with that sponsor) has as its primary purpose the raising of funds. According to the CRTC, while this message may be considered a CEM under CASL, the primary purpose of the message may be viewed as raising funds; therefore, the fundraising exemption would apply.

In contrast, the CRTC explained that an e-mailed charitable newsletter providing information about the charity’s activities may not have fundraising as its primary purpose when the newsletter contains advertising from corporate sponsors and also encourages the recipient to participate in commercial activity with that sponsor.

The CRTC enforcement approach and registered charities

Our advice to clients has been and continues to be to interpret the fundraising exemption as broadly as possible within reason. Registered charities acting in good faith while attempting to comply with CASL are not the main focus of this legislation. Our position is validated by the CRTC, which has said that that its goals is “… to promote compliance with the CASL in the most efficient way possible while preventing recidivism.” While the CRTC acknowledges that it has the authority to impose administrative monetary penalties, it also outlined a number of key factors that will be taken into account when assessing a measure or penalty for non-compliance including:

  • demonstrations of due diligence (such as an organization’s tracking of how email addresses and consents have been obtained and the inclusion of an unsubscribe option);
  • the number of complaints and/or severity of the non-compliance related to a particular organization; and
  • whether or not an organization is willing to provide of an undertaking to comply with the CRTC (eliminates the possibility of private lawsuits).

Getting additional help with/information about CASL compliance

DDO Health Law’s Toolkit on CASL compliance is now available. For more information or to obtain a copy, please contact Kathy O’Brien at or 416.967.7100 ext 227. Additionally, the CRTC FAQs can be found here.

DDO’s CASL (Anti-Spam) Toolkit is now available

Even though July 1 has come and gone, it is a safe bet that many of you will still not be 100% CASL compliant. Just because your organization is in the non-profit sector does not mean that you are not required to comply with CASL.  Likely some of your electronic messages have a commercial element – and therefore must comply with CASL. Read More