DDO Health Law Update

August 30, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

No new and approved regulations of interest.

 

DDO News and Training

 

DDO Health Law Privacy Officer Training – Early Bird Special!

 

Articles of Interest

Digital Health

Big Data and Health

Epic to Gather Records of 20 Million Patients for Medical Research

Most Patients Say They Would Share Records for Medical Research

Ontario Health Teams: Digital Health Playbook

 

Health Care

Calgary Clinic Using New Device for Neural Therapy

OxyContin Maker Purdue Pharma Seeking to Settle 2,000 Lawsuits for Up To $12B

P.E.I. Woman Spending Life Savings Waiting for Lung Transplant in Toronto

 

Public Health

New Analysis Finds Link Between Vaping and Cannabis Use in Teens, Young Adults

Is This the End of Ebola, ‘King’ of All Diseases?

CEO of Vape Company Juul Says Non-Smokers Shouldn’t Use Their Product

World Health Organization Applauds Pinterest’s ‘Leadership’ in Fighting Vaccine Misinformation

DDO Health Law Update

August 23, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

There are no new and approved regulations of interest.

 

DDO News and Training

DDO Health Law Privacy Officer Training – Early Bird Special!

 

Government Newsroom

Supporting Students – Respecting Parents

Ontario bringing key health services together under one roof in the Ottawa region

Appropriateness Working Group Recommendations

 

Articles of Interest

 

Cannabis

42 Ontario cannabis store licenses to be awarded in 2nd lottery

 

Health Care

Ontario government to scrap ineffective medical tests, duplicative services to cut costs

Critics call it ‘shortsighted’ and ‘wrong’ but Ontario government moving forward with municipal funding cuts

How to end hallway medicine, Part 2: Solving the long-term-care crunch

Ontario scrap certain infertility tests, pre-op assessment to cut costs

Province pledges up to $75M for Orleans Health Hub

HPRAC’s Final Report: Applied Behaviour Analysis: Risk of Harm and Oversight”.

Opinion: Health care cannot modernize unless health policy changes first

National shortage of blood pressure drug shows safeguards are needed, doctors say

 

Professionalism and Misconduct

One of Ontario’s top-billing doctors faces discipline for alleged ‘incompetent’ care and inappropriate billings

 

Interesting Reads

The Woman with 200 kids

DDO Health Law Update

August 16, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

There are no new and approved regulations of interest.

 

DDO Training

 

DDO Health Law Privacy Officer Training – Early Bird Special!

 

Articles of Interest

 

Ontario Health Teams

Durham hopeful of selection as an Ontario Health Team

 

Health Care

Bring in pharmacare now, health experts ask federal leaders

Ontario man walks across country raining awareness for mental health

Ontario government to regulate autism therapists

A doctor’s warning: Safety is at risk in Ontario’s ERs

‘He doesn’t want us to give up on him’, family fights to keep life support

Nursing home residents with advanced dementia often face ‘distressing’ transfer, MDs find

 

Professionalism and Misconduct

Guelph doctor under investigation by Ontario College of Physicians and Surgeons

Edmonton pediatrician charged with child pornography offences

Doctor guilty of sexual abuse but revoking license too harsh court says

The harm to hospitalized patients cost Ontarians more than $1B a year: study

 

AI

Ontario Tech students using AI to teach robots sympathy

CMPA supports appropriate use of AI in healthcare

Blood pressure monitoring could be as simple as a selfie, Canadian researchers says

 

DDO Health Law Update

August 12, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

  1. REG 329/04 – PHIPA

 

The proposed amendments:

  • Ontario Health will assume current responsibilities of Cancer Care Ontario (“CCO”) under PHIPA as a prescribed entity and prescribed registry, and will also assume responsibilities of eHealth Ontario (“eHO”) for creating and maintaining the provincial electronic health record (“EHR”).
  • Revocation date of the regulation provisions enabling the operation of the EHR from January 1 2020, to January 1, 2021 to ensure eHO or Ontario Health, as the case may be, may continue to create and maintain the EHR while the government continues the work necessary before Part V.1 of PHIPA could be proclaimed into force.

Comments deadline: October 7, 2019

More Information: https://www.ontariocanada.com/registry/view_posting.jsp;jsessionid=afAHE_Jq5vrvgKY1PFsKy9t?language=en&postingId=30070

 

Ontario Newsroom

Ontario launching program to fund out-of-country dialysis services

Ontario improving access to timely care for patients in crisis

Ontario adding more mental health and addictions services for indigenous communities

More tools available for police to find missing seniors

 

Articles of Interest

 

Ontario Health Teams

Guelph health partnerships moves towards OHT

Cambridge area health group reaches next round in Ontario Health Team process

Local push for Ontario Health Team continues

 

Health Care

Ontario needs $5.2B in additional health cuts to reach savings targets: report

Ontario to party fund dialysis for travelers after cutting out-of-country health care

Health group says Ontario must do more to protect children from climate change

Health Sciences North welcomes 25 new doctors

Canada slow to act against shoddy stem cell therapies, new paper argues

 

Privacy

Metrolinx to consult Ontario privacy watchdog before sharing ridership data

Ontario woman files class action against Capital One following data breach

Capital One now contacting millions of Canadians affected by data breach

 

Physicians

‘Manipulating physicians’: How drug reps pitch your doc

 

Professionalism and Misconduct

College cautions outspoken Sudbury doctor

Kelly McParland: The Wettlaufer report is clear – no one is to blame for anything

 

AI

Canada’s chief information officer Alex Benay leaving to join AI startup Mindbridge

Skills evaluation, tailored feedback: McGill AI project could change the way brain surgeons are trained

 

DDO Health Law Update

August 6, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

No new and approved regulations of interest.

 

Ontario Newsroom

 

Ontario Taking Immediate Action to improve Long-Term Care System

 

DDO Blogs

 

Long-Term Care Home System Strained but Not Broken: Summary of the LTC Homes Inquiry Report

 

Articles of Interest

 

Ontario Health Teams

View the full list of teams: Ontario Health Teams web page.

 

Privacy

Capital One data breach hits about 6 million people in Canada, 100 million in US

Canada’s privacy commissioner opens investigation into Capital One data breach

 

Professionalism

Ontario doctor with history of fraud, misconduct resigns, will not practice in province again

Inside an Ontario fentanyl trafficking ring involving a doctor and a pharmacist

Toronto neurosurgeon who murdered wife to face disciplinary charges

Greed, betrayal and medical misconduct at North York General

 

AI

Will Artificial Intelligence improve health care for everyone?

Long-Term Care Home System Strained but Not Broken

Co-authored by Nareh Ghalustians

The Report on the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (the “Report”) was released on July 31, 2019, with 91 recommendations (the “Recommendations”) for improving the safety and security of residents in Ontario’s long-term care system, and for Ontarians receiving home care services. The Report was released following the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (the “Inquiry”). The commission to spearhead this Inquiry was established on August 1, 2017, after Elizabeth Wettlaufer pleaded guilty to and was convicted of eight counts of first-degree murder, four counts of attempted murder, and two counts of aggravated assault offences that she committed while working as a registered nurse in various long-term care homes in southwestern Ontario and as a nurse providing home care services in private homes. She has been sentenced to life imprisonment with no parole eligibility for 25 years.

This article reviews Volume 1 of the Report and identifies the mandate of the Inquiry and its key findings and summarizes the Recommendations affecting long-term care homes in Ontario. We anticipate that there will be broader implications across the entire health sector arising from these Recommendations.

Background

The Report was dedicated to the victims and their loved ones. It notes that the regulatory regime that governs the system is not broken and imposes clear standards for long-term care homes, and a rigorous inspection regime to enforce those standards that can be built upon and improved. In that vein, the Report requires the Ministry of Health and Long-Term Care (the “Ministry”)[1] to issue a report by July 31, 2020, describing the steps it has taken to implement the Recommendations coming out of the Report, and to table that report in the Ontario Legislature. In a recent news release, the Ministry stated its intention to meet this deadline.

Mandate

The Report notes that the mandate of the Inquiry was to inquire into the events that led to the offences, circumstances, and contributing factors, and to make recommendations on how to avoid similar tragedies in the long-term care system. The mandate was not to conduct a general review of the long-term care system.

Key Findings

The Report highlights three main findings:

  1. The offences would not have been discovered if Elizabeth Wettlaufer had not confessed.
  2. The offences resulted from systemic vulnerabilities.
  3. The long-term care system is strained, but not broken.

Recommendations

The Report was clear that change is required on a systemic level.

Training

The Report recommends that long-term care home licensees must provide training to administrators and directors of nursing on hiring and discipline of staff, conducting workplace investigations, and on reporting obligations to the Ministry and the College of Nurses of Ontario (the “College”). Recommendation #3 suggests that this training be provided by the Ministry, the College, and the Office of the Chief Coroner/Ontario Forensic Pathology Service.

The Report also recommended that medical directors, attending physicians, and nurse practitioners of long-term care homes receive comprehensive, ongoing training on preventing resident abuse and neglect, a requirement from which they are currently exempted, unlike other staff such as registered nurses.

The Report also adds a specific Recommendation that Medical Directors complete the Ontario Long-Term Care Clinician’s Medical Director course within two years of assuming the role of Medical Director in a long-term care home.

Furthermore, the Report recommends additional training for staff, visitors, and residents about their obligations to report to the Ministry (not just to the long-term care home) regarding suspected abuse and neglect of residents that results in a risk of harm to the resident (see s. 24(1) of the Long-Term Care Homes Act, 2007 (the “Act”)).

Summary of Other Key Recommendations

  • Handling of Medication. Recommendations were made for improving the long-term care home’s medication administration and medication incident reporting systems, and how to use the recommended redesigned institutional Patient Death Record, once it is created.

 

    • Improved medication management in long-term care homes is recommended through a three-pronged approach directed at the Ministry creating new policies, improving the annual quality inspection process, and by long-term care homes modifying and improving the security of rooms in which medications are stored and using technology to support medication management.

 

    • Recommendations are made to the Ministry to permit long-term care homes to use the additional nursing and personal care funding to purchase or upgrade integrated automated medication dispensing cabinets and install cameras and/or glass doors in medication rooms.

 

    • It is recommended that long-term care homes improve their medication incident analyses (required by the Act) and treat the use of glucagon as a medication incident. Medication incidents, under the Act, would have to be reported and reviewed at least quarterly by the long-term care home’s medication management interdisciplinary team, composed of the Medical Director, administrator, director of nursing and personal care, and the pharmacy service provider. More details regarding medication management can be found in Recommendations #74-84 of the Report.

 

    • Recommendation #19 recommends that the Ministry expand the nursing and personal care funding envelope and permit long-term care homes to use these funds to pay for a broader spectrum of staff including porters, pharmacists, and pharmacy technicians.

 

    • Recommendation #76 goes further to recommend that long-term care homes use this funding to engage a staff pharmacist and/or pharmacy technician. The Report also recommends that the licensees use this new funding for training, education, and professional development of all staff, including the backfilling of positions for staff attending training. Further, the Report recommends that licensees be permitted to use the expanded or new funds for annual membership fees in AdvantageOntario and the Ontario Long-Term Care Association.

 

  • Agency Nurses, Service Providers, and the Role of the Ministry. Specific Recommendations are made regarding long-term care homes’ use of agency nurses (Recommendations #11-13); home care service provider obligations (Recommendations #14-18); and the role of the Ministry (Recommendations #19-31).

 

  • LHINS/Ontario Health, College, Coroner, and Ministry Recommendations. Recommendations #32-39 are directed toward Local Health Integration Networks (“LHINs”) and providers and coordinators of home care services, and thereby to Ontario Health, once it takes over this role. One of the Recommendations is for the LHINs to adopt a common electronic events reporting system and to train staff and service providers on its use. Recommendations #40-49 are directed to the College and Recommendations #50-61 to the Office of the Chief Coroner/Ontario Forensic Pathology Service. Recommendations #62-63 suggest an expanded leadership role for the Ministry and improved communication with the LHINs/Ontario Health.

 

  • Health Care Serial Killer Phenomenon. Building awareness of the “healthcare serial killer” phenomenon is addressed in Recommendations #64-73 (a phenomenon used to describe murders committed by individuals working as health care professionals). The Inquiry heard evidence that 90 healthcare serial killers have been convicted in the USA, Canada, and Western Europe since 1970, but the phenomenon has been documented since the 1800s.

 

  • Number of Registered Staff. It is recommended that the Ministry conduct a study to determine the adequate levels of registered staff in the long-term care homes on each of the day, evening, and night shifts, table the study in the legislature by July 31, 2020, and increase funding accordingly (Recommendation #85).

 

  • Detecting Deaths. Suggestions for improving the detection of intentionally caused resident deaths are covered in Recommendations #86-91.

Conclusion

The Report highlights the dedication and commitment of individuals working in the long-term care system under pressure and with limited resources. The Report highlights improvements that were implemented by stakeholders during the Inquiry and prior to the release of this Report, including the formation of a working group on medication management systems in long-term care homes, and the increase in the amount of information available from the College about nurses’ employment history, and stakeholder-led initiatives that predated the Inquiry, such as a medication safety pilot project and the clinical support tools program.

The Report expresses hope that the Inquiry and the Report can rebuild Ontarians’ shattered trust in the long-term care system.

[1] The Government of Ontario recently divided this Ministry into two, appointing a separate Minister of Long-Term Care in addition to what is now called the Ministry of Health. This blog post uses the language of the Report, which references both Ministries jointly.