Procuring through a distributor: Set expectations early!

When procuring goods our clients are sometimes faced with purchasing a good through a third party distributor rather than directly from the manufacturer of the good. An indirect purchase through a distributor can be problematic from a contractual perspective if the distributor is not willing to take full responsibility for all aspects of providing the relevant good (e.g., the delivery, performance, installation, and maintenance of the good, as applicable). Distributors sometimes attempt to avoid providing all of the product representations and warranties that would routinely be provided by a manufacturer of goods. A distributor may be hesitant to provide warranties on a good that it has neither manufactured nor tested itself.

In some such situations, a distributor may seek to share the risks related to the supply of a good by requesting that the purchaser enter into separate agreements with each of the distributor and manufacturer. The agreement with the distributor would identify such things as the products being purchased, pricing, and delivery terms, while the agreement with the manufacturer would address such things as product warranties, specifications, and service or maintenance terms. In our experience one of the primary difficulties of a two contract approach in this type of arrangement is that, unless the risk allocation terms of the two contracts are very carefully drafted and responsibilities are clearly delineated, the result could be that the purchaser is unclear as to which party is responsible for which obligations and risks. If something goes wrong, a purchaser could find itself in a situation in which all parties are pointing fingers at each other because the relevant contracts do not provide sufficient clarity as to which party bears responsibility for a particular type of damage.

The best case scenario from a purchaser’s perspective is for the purchaser to enter into only an agreement with the distributor, rather than agreements with both the distributor and manufacturer. This agreement with the distributor will require the distributor to take full responsibility for all risks related to the good and its supply to the purchaser. If the distributor wants the manufacturer to share responsibility for the good, then the distributor can enter into a separate agreement with the manufacturer to allocate risk between the distributor and manufacturer. This agreement would be separate and apart from the purchase agreement between the purchaser and distributor.

One solution that DDO has used to help avoid debate about what contractual arrangements will be utilized when purchasing through a distributor is to address this issue at the request stage of a procurement. If a purchaser requires, as a condition of participation in its RFP (or other requesting document, as applicable), the distributor to agree that it will be directly accountable to the purchaser for all risks and obligations related to the provision of the required good, then the purchaser can avoid having to negotiate this aspect of the contractual arrangements at a later stage in the procurement process. In this way we find that we can avoid some headaches related to a purchase through a distributor.

Drafting Research Funding Agreements

Innovations in health care are often the result of research and development initiatives. Such initiatives cannot be carried out without funding. Many broader public sector organizations that carry on health-related research in Ontario rely heavily on:

  • partnerships with private sector corporations; and
  • charitable donations from philanthropic individuals and organizations,

to fund their research activities.

If your broader public sector organization receives funds from corporate partners or charitable donors, then you should ensure that the agreements, through which your organization receives such funds, are properly drafted. If not drafted with some forethought, your organization could agree to contractual obligations that conflict with its legislative or regulatory requirements.

For example, a corporate partner that is providing funding to a public hospital for a research initiative may expect that the hospital will utilize the funder’s brand of equipment to carry out the research. However, the purchase of equipment by a public hospital in Ontario must be carried out in compliance with the Broader Public Sector Procurement Directive. A hospital cannot purchase a significant piece of equipment without abiding by fair and transparent procurement processes, unless the procurement falls within an exemption or circumstance of non-application under applicable procurement regulations.

If created with care, a funding agreement could be drafted in a manner that allows a purchasing organization to satisfy conditions imposed on the funds by a funder, while still allowing the purchasing organization to be in compliance with its procurement (and other regulatory) obligations. DDO would be happy to provide advice on options for drafting your organization’s funding agreements.

Bill 74 – What Does it Really Mean?

This blog delves into what Bill 74 will really mean for the Ontario health care system – what exactly is changing? What powers will the Minister have, what powers will the super agency (Ontario Health, or OH) have, and what if any powers will remain with the LHINs? What are integrated care delivery systems (ICDSs) and how do they fit into the scheme of things?

Specifically, this blog answers the following questions:

  • What is Ontario Health?
  • How are the rules for OH different than the rules for LHINs, CCO, TGLN, etc.?
  • What is happening to the LHINs under Bill 74?
  • What’s the impact on HSPs?
  • What’s the impact of Bill 74 on those HSPs like public hospitals and LTC homes that were exempted from some of the LHINs’ powers under LHSIA?
  • Are integration powers broader/different than under the LHIN legislation?
  • What’s the impact on the ability to issue binding directives to HSPs?
  • What’s the impact on the ability to appoint investigators and supervisors over HSPs?
  • What’s the impact on funding of HSPs?
  • What are these new ICDSs?
  • What exactly happens when the Bill passes, and what may happen later?

Note of Caution

As I write this, we’re only at second reading. Details in the Bill may change.

This analysis is not intended to be comprehensive.

Overview – The Evolution of Power Distribution

Bill 74 is essentially a redraft and revisioning of the LHIN legislation (the Local Health System Integration Act, 2006, or LHSIA). Of course, the current government isn’t a fan of the LHINs. So Bill 74 (the Connecting Care Act) is LHSIA on steroids.

As the LHINs evolved under the Liberal government, day-to-day integration decisions about health service providers (HSPs) were devolved from the Minister to the LHINs, along with the responsibility for funding of HSPs. The Minister gave over significant power, reserving for the Ministry powers over integration orders that create what I call “extinction level events” (ELEs). When I refer to ELEs in this blog, I’m referring to integration decisions that require a HSP to:

  • wind-up, dissolve or cease operating
  • amalgamate
  • transfers all or substantially all of its assets to another entity.

The 2016 Patients First Act amended LHSIA so that the LHIN had even greater powers unilateral powers:

  • To issue binding directives to HSPs
  • To appoint investigators and supervisors over HSPs (with notable exceptions for long-term care homes and hospitals).

The 2016 Patients First Act gave the Minister parallel new powers over LHINs – showing that the way the Minister would control the health care system would be by using the LHINs as its operational agencies. The Minister could issues directives to the LHINs, and the LHINs could then pass them down to the sector, in addition to the LHINs’ own unilateral powers. And if the LHINs got out of hand, the Minister had the ability to appoint investigators and supervisors to turn things right. Government also controlled LHINs through the appointment of their board members through Orders-in-Council.

Fundamentally, Bill 74 is repatriating powers back to the Minister. And the Minister may then delegate all of those powers (except for regulation-making) to the new health care “super agency”, OH.

Bill 74 will dissolve the LHINs – not immediately, but eventually and with certainty.

  1. What is Ontario Health?

OH is the new “super agency” that is going to assume the mandates of the 14 LHINs and the following other six government agencies:

  • Cancer Care Ontario (CCO)
  • Trillium Gift of Life Network (TGLN)
  • eHealth Ontario (eHO)
  • HealthForce Ontario (HFO)
  • Health Shared Service Ontario (HSSO)
  • Health Quality Ontario (HQO)

OH is going to be a hugely powerful agency. The Minister may delegate all of her powers (except for regulation-making) to OH. Depending on the extent of delegation by the Minister of her powers to OH, it could become all-powerful over Ontario HSPs. We will have to see how this evolves.

Current status: Even though OH only comes into existence as a Crown agency when Bill 74 is passed, the government has incorporated a non-profit called Health Program Initiatives and has already appointed its first 12-person board of directors:

As of Friday, March 8th, by Order-in-Council, the OH board members became the board for all the 20 agencies it will ultimately inherit. The Orders-in-Council of the then-existing directors of the 20 agencies were revoked, allowing them to be replaced. The OH board is now doing initial due diligence to determine what decisions need to be made for the 20 agencies over the immediate next months.

  1. How are the rules for OH different than the rules for LHINs, CCO, TGLN, etc?

Importantly, OH is not required to hold its board meetings in public or to give public notice of its board meetings. This is very different from the public mandate of the LHINs in particular.

Interestingly, the OH board can delegate to its employees any of its powers, except the power to appoint investigators and other powers that may be prescribed by regulation. This allows the OH board to delegate to staff the ability to exercise the following powers that were previously required to be performed by the LHIN boards:

  • Imposing a service accountability agreement (SAA) on a HSP after a negotiation period
  • Issuing directives to HSPs
  • Appointing supervisors over HSPs
  • Issuing a facilitated integration order to a HSP
  • Issuing a required integration order to a HSP
  • Vetoing a voluntary integration by HSPs.

This level of delegation means that the senior staff of OH could be hugely powerful themselves.

Unlike each LHIN currently, there is no requirement for OH to have an integrated health service plan that is publicly available and for its funding decisions to be consistent with that plan.

Unlike some of the existing agencies (such as TGLN), OH will not be able to give indemnities in contracts. This is status quo for CCO and the LHINs.

OH must be audited by the Auditor General. Previously some of the agencies (like LHINs, TGLN and HSSO) engaged their own auditor.

No OH annual report is required to the Minister – this was a requirement for some of the agencies, such as LHINs and TGLN.

Notably, Bill 74 does not include the powers given to the Minister under the Patients First Act in 2016 over LHINs – the Minister cannot appoint an investigator or supervisor over OH.

  1. What is happening to the LHINs under Bill 74?

LHINs are going to disappear, but not immediately. LHIN boards have already been taken over by the OH board as of March 8, and the LHIN mandates will be eventually assumed by OH, with their assets, employees, operations and liabilities being transferred to OH by Ministerial order, mirroring how the CCACs were transferred to the LHINs in 2017.

Bill 74 repeals LHSIA, but that repeal does not take effect on passage (Royal Assent) of the Bill. Instead, the Bill contemplates that LHSIA may be repealed in different provisions on different dates by proclamation. This is clearly intended to be an evolution – over what period of time, we can’t say.

There are a couple hints about how that evolution may play out, embedded in Bill 74:

  • The Bill contemplates amending one specific section of LHSIA (again, not at the time of Royal Assent, but later) that takes Health Quality Ontario out of the reporting loop for LHINs. This suggests the LHINs will be around for a bit.
  • There’s an existing exclusion in LHSIA – the community services (home care services) purchased by a LHIN from service providers under the Home Care and Community Services Act were not themselves HSPs. This exclusion remains, but the LHINs are no longer the ones purchasing the community services – it’s the HSPs or ICDSs directly purchasing community services, with no mention of LHINs. That suggests to me that the LHINs will not be operating the home care services for very long, if we’re plotting out how this is going to evolve.
  1. What’s the impact on HSPs?

If you are an HSP under the existing LHIN legislation, you are a HSP under Bill 74.

And congratulations to independent health facilities – you are joining the fold of HSPs.

It is important to note that physicians still are not HSPs, what I have always considered a fatal flaw. I get the political rationale behind this, but it’s hard to integrate a health care system without physicians.

  1. What’s the impact of Bill 74 on those HSPs like public hospitals and LTC homes that were exempted from some of the LHINs’ powers under LHSIA?

Exemption Table

ExemptionLHSIABill 74
LHIN DirectivesPublic hospitals
LTC homes
University of Ottawa Heart Institute

Note: Directives now issued by Minister unless power delegated to OH
LHIN Appointment of InvestigatorLTC homesLTC homes (even if they are part of an ICDS subject to an appointment)

Public hospitals – but the Minister can recommend to Cabinet the appointment of an investigator for a public hospital or the ICDS it is part of (recall that the Minister can recommend the appointment of an investigator to Cabinet under the Public Hospitals Act)
LHIN Appointment of SupervisorPublic hospital
Private hospital
LTC homes
Public hospitals – but the Minister can recommend to Cabinet the appointment of a supervisor for a public hospital or the ICDS it is part of (recall that the Minister can recommend the appointment of a supervisor to Cabinet under the Public Hospitals Act)

LTC homes (even if they are part of an ICDS subject to an appointment)

Note: Supervisors now appointed by Minister unless power delegated to OH
Voluntary Integration OrdersLTC homes, to the extent the Minister or director the Long-Term Care Homes Act had approval right in that legislationSame
ELE Integration OrdersThe Minister could not issue an ELE integration order to a Board of Management.

The Minister could not issue an ELE integration order to a stand-one LTC home (one that is not also a hospital or other type of HSP).

The Minister could not issue a ELE integration order for wind-up/dissolution only to a HSP such as a hospital that also operates a LTC home, where the ELE order is only in respect of the LTC home.

Plus ELE integration order includes an order to co-ordinate services with or partner with another person or entity that receives funding from the Agency
  1.  Are integration powers broader/different than under the LHIN legislation?

The definition of “integration” is exactly the same.

Integration orders are almost the same, with a few tweaks.

Recall that LHSIA divided integration orders into four categories:

  • Section 25, integrations negotiated/facilitated by the LHIN
  • Section 26, integrations required by the LHIN
  • Section 27, voluntary integrations proposed by HSPs that could be vetoed by the LHIN
  • Section 28, integrations required by the Minister.

These same orders exist but are now framed as:

Type of Integration OrderLHSIABill 74
FacilitatedSection 25(2) – LHINs issueSection 32 - Facilitation decision by OH
RequiredSection 26 – LHINs issueSection 33 - “Integration order” by Minister*
VoluntarySection 27 – LHINs issueSection 35(8) – Decision by the Minister* not to proceed with an integration
MinisterialSection 28 – Minister issues (ELE orders)Section 33 – grouped with Ministerial* orders under “required integrations”

LHSIA had defined “service” very broadly, so that the integration of services included front-line, supportive services for front-line services, and back-office services. Bill 74 does not define “service”, and this is a significant omission. Note that Cabinet can pass regulations defining terms in the Bill not otherwise defined, so it may be the intention to define what constitutes a “service” under the regulations.

As pointed out above, there is a new required integration order the Minister can make (or can delegate to OH to make): to co-ordinate services with or partner with another person or entity that receives funding from the Agency. This is classified with the ELE integration orders above, because the Ministry cannot issue such an order to LTC home licensees that are boards of management or to stand-alone LTC home licensees. I’m a bit puzzled why coordinating services is being grouped with the ELE orders – it’s not like the other ELEs that end a HSP’s existence. It’s not that burdensome to coordinate with another organization – in fact, this is the heart of integrations. I’m not sure what the rationale is here, unless the intent is that integration of services and partnering be done primarily through the ICDSs.

  1. What’s the impact on the ability to issue binding directives to HSPs?

The Minister now assumes the powers to issue directives to HSPs. OH does not have the power to issue binding directives to HSPs, unless this power is delegated by the Minister.

LTC homes, public hospitals and the University of Ottawa Heart Institute are not exempt from binding directives.

Note that the LHINs had to issue a binding directive in draft. This is no longer a requirement.

LHSIA referred to “operational” or “policy” directives. There is no longer this distinction. There is just a reference to “directives”. I don’t think this is material.

LHSIA gave the Minister the power to issue “provincial standards”. This is gone, but the ability to issue directives is so broad it would encompass this former authority to set provincial standards.

Interesting thought:  Given that OH also will include the mandate of eHO, directives could be issued relating to standardized use of EMR systems in Ontario in order to move forward a provincial EMR.

  1. What’s the impact on the ability to appoint investigators and supervisors over a HSP?

OH assumes the power to appoint investigators from the LHINs.

Public hospitals are now exempt from the appointment of an investigator, but the Minister can recommend to Cabinet the appointment of an investigator for the public hospital or the ICDS it is part of.

OH does not take over the power of appointing supervisors from the LHINs. This is now a Ministerial power, which can be delegated to OH.

Public hospitals remain exempt from the appointment of a supervisor, but the Minister can recommend to Cabinet the appointment of a supervisor for the public hospital or the ICDS it is part of.

Recall that the Minister can recommend the appointment of an investigator or supervisor to Cabinet under the Public Hospitals Act.

LTC homes remain exempt from the appointment of investigators and supervisors, even if they are part of an ICDS.

  1. What’s the impact on funding of HSPs?

OH takes over the role of the LHIN in funding HSPs or ICDSs directly. OH may fund both health services and non-health services that support provision of health care. There is no longer a geographic component to the funding as there was with the 14 geographically situated LHINs.

The Minister can assign to OH or any other person or entity an existing funding agreement. Under LHSIA, the Minister could assign funding agreements only to the LHINs – recall the fuss this created in the negotiation of the FHT funding agreement and the concerns about the LHINs taking over funding for the FHTs.

Unlike each LHIN currently, there is no requirement for OH to have an integrated health service plan that is publicly available and for its funding decisions to be consistent with that plan.

Negotiation of the SAA is more expedited than under LHSIA. Recall the 2016 Patients First Act gave HSPs extensive and escalating negotiating rights over the SAA. That negotiation period is now 90 days from first notice. After the 90 days, OH can issue a notice of offer (take it or leave it), and there’s a further 60-day period to finalize. At the end of the 60 days, OH can impose the SAA on the HSP, copying the Ministry. The process no longer includes a written issues statement from the HSP, escalating involvement of CEOs and Chairs, and the funder’s need to consider the HSP’s issues before imposing the SAA.

I’ve tried to summarize how powers are distributed under the Connecting Care Act in this table:

Power Chart

PowerLHSIABill 74
FundingMinister – power over LHIN
LHIN – power over HSPs
Minister – power over OH
OH – power over HSPs and ICDSs
DirectivesMinister – power over LHIN
LHIN – power over HSPs

Minister* only – power over Agency, HSPs and ICDSs
InvestigatorMinister – power over LHIN
LHIN – power over HSPs (with exceptions)
OH – power over HSPs and ICDSs (with exceptions)
SupervisorMinister – power over LHIN
LHIN – power over HSPs (with exceptions)
Minister* - power over HSPs (with exceptions) and ICDSs
Designate an ICDSn/aMinister*
Facilitated/negotiated integration decisionLHIN – power over HSPsOH – power over HSPs
Required integration decisions (including ELE integration decisions)LHIN – power over HSPsMinister* - power over HSPs and ICDSs
Voluntary integration decisionsLHIN – power over HSPs to veto voluntary integrationsMinister* - power over HSPs and ICDSs to veto voluntary integrations


*Recall that the Minister can delegate all powers under Bill 74 (except regulation-making) to OH.

  1. What are these new ICDSs?

These are referred to in some media reports as “Ontario Health Teams”, which will, according to government media, provide:

  • one integrated team of health care providers working together to meet your needs
  • a medical record that both you and your providers can access easily
  • help in navigating the public health care system 24/7

The Minister has new powers to designate one or more persons as an ICDS to deliver at least three of the following types of services:

  • hospital
  • primary care
  • mental health or addictions
  • home care or community
  • long-term care
  • palliative
  • services prescribed by regulation.

There may be further regulations established by Cabinet that prescribe conditions and requirements that must be met before a designation of an ICDS by the Minister. Again, a reminder that the Minister can delegate this designation power to OH.

ICDSs will be directly funded by the Agency, which may reduce the number of SAAs across Ontario. OH may provide overarching funding to an ICDS with a constituent board (or all constituent boards?) of the constituent HSPs being required to determine how to allocate funding amongst themselves. We will see how this plays out.

Any power in the Bill relating to a HSP can be extended to an ICDS and each constituent HSP in that ICDS.

Do ICDs have any powers over other HSPs? No, not on the face of the Bill. But note that Cabinet can pass regulations respecting “any other matter that the Lieutenant Governor in Council consider necessary or desirable for carrying out the purposes and provisions of this Act” – which is very broad and would allow Cabinet to devolve/delegate Agency powers to ICDSs.

  1. What exactly happens when the Bill passes, and what may happen later?

Very little actually happens when the Bill receives Royal Assent.

Under the Connecting Ontario Act, nothing happens on Royal Assent (not even creating OH as a crown agency). Everything happens by proclamation.

Schedule 3 of the Bill sets out the impacts on other pieces of legislation. On Royal Assent:

  • The composition of CCO’s board changes under the Cancer Act to align with OH
  • The Cancer Act can be repealed in different parts on different dates
  • The composition of HQO’s board changes under the Excellent Care for All Act to align with OH
  • ECFAA can be repealed in different parts on different dates
  • LHSIA can be repealed in different parts on different dates
  • The Lung Health Act can be repealed in different parts on different dates
  • The composition of TGLN’s board changes under the TGLN Act to align with OH
  • Mysteriously, the non-existent section 246 of ONCA is repealed. Anyone who figures this out gets a gold star. Why would anything in ONCA be repealed immediately when ONCA itself isn’t in force yet?

This will be an evolution. The question is, how fast or how slow?


Questions? Please contact Kathy O’Brien @



Conducting Supplier Debriefings

The Broader Public Sector Procurement Directive entitles unsuccessful proponents participating in a procurement valued at $100,000 or more to a supplier debriefing. A debriefing is an opportunity for a proponent to:

  • discuss with the purchaser the strengths and weaknesses of the proponent’s submission in relation to the evaluation criteria of the procurement;
  • ask questions related to the procurement process; and
  • provide feedback on how the procurement process and the purchaser’s practices could be changed or improved.

A purchaser must include in the documents that initiate a procurement details about supplier debriefings, including the process by which a proponent can request a debriefing. A purchaser must provide proponents with at least 60 days following contract award notification to request a debriefing.

A debriefing should be a process that allows both the purchaser and a proponent to gain valuable input from the other. However, if not conducted properly, a debriefing could lead to additional questions or process-related challenges from a proponent, which would likely mean greater costs being incurred by the purchaser for staff time and legal fees.

To ensure that your organization carries out debriefings efficiently, effectively, and in keeping with applicable regulatory and contractual obligations, your debriefing processes should be formalized to ensure consistency and your staff should be educated on restrictions imposed by applicable procurement requirements and contractual obligations.

DDO is experienced in helping our clients to:

  • establish straight-forward and effective processes for addressing debriefing requests;
  • ensure that their staff are up-to-date on current legislative and regulatory requirements related to debriefings;
  • create an agenda for debriefings that will allow for consistency across debriefings and contribute to the (a) equitable treatment of proponents and (b) transparency of the process;
  • formalize document management and record-keeping procedures for debriefings;
  • train procurement staff on leading a debriefing and on identifying questions that are out of scope of a debriefing; and
  • educate staff on the confidentiality obligations that a purchaser owes to the proponents in a procurement process.

If you are interested in DDO providing your organization with advice on debriefings, or if you have any specific questions related to debriefings, please do not hesitate to reach out to me:

Now Underway – Consultation on a Future Framework for Palliative Care in Canada

The federal government passed a private member’s bill (C-277), the Framework on Palliative Care in Canada Act, on December 12, 2017. As required by the Act, the federal government is consulting on the future of palliative care in Canada – specifically, in the context of the availability of physician-assisted death. The goal is to develop a framework for access to high quality palliative care in hospitals, home care, long-term care facilities and residential hospices.

According to is website, the federal government is now seeking input from health care professionals across Canada, health system experts, caregivers, people living with life-threatening illnesses, and interested Canadians about their long-term vision for palliative care in Canada, including access, education, support and training for caregivers. The consultation seeks ideas and experiences on the following topics:

  • Definition of palliative care
  • Advance care planning
  • Person and family-centred care
  • Challenges facing people living with life-threatening illness
  • Consistent access to palliative care
  • Special populations (i.e., Indigenous, infants, children and youth, homeless, rural and remote communities, LGBTQ2, people living with disabilities, immigrants and refugees, and others)
  • Health care provider education, training and supports
  • Caregiver training and supports
  • Community engagement
  • Bereavement

This is a great opportunity to have your organization’s voice heard and to give your administrators and health care staff a chance to contribute to the development of public policy.  The voices of health care providers, caregivers and their families are also an integral part of these consultations about the future of palliative care in Canada.

Submissions are due by July 13, 2018 and may be made in writing or on-line.  For help making a submission, please get in touch with me: If you are interested in reading the Act, it is available here:

By December 11, 2018, the report of the federal Minister of Health that sets out the framework for palliative care must be presented to the House of Parliament and 10 days after that the report must be posted on Health Canada’s website.  Watch this blog to stay informed.



Treatment and Transport: Proposed Changes for Ambulatory Response and Firefighter Responsibilities   

We are all familiar with emergency response: a person picks up the phone, dials 9-1-1, has a conversation with a dispatcher, and, ideally within minutes, a rescue team arrives. Normally, if a patient is calling in regards to his or her health, a paramedic arrives at the scene, assesses the situation, occasionally provides some form of care on the field, and takes the patient to the nearest available hospital. If a person is calling regarding a fire, a fire truck rushes over.

Recently, the Ontario government has begun to suggest changes to these long-standing protocols. Amendments to the Ambulance Act and the Fire Protection and Prevention Act are set to be tabled in the coming months:

  • Currently, ambulance operators are required to take patients to hospitals. The proposed changes to the Ambulance Act would allow paramedics to take patients to primary care or community care centers (family physicians, walk-in clinics, etc.) instead of to hospitals, based on what level of care the patient requires.
  • The proposed changes to the Fire Protection and Prevention Act relate to increasing responsibilities of firefighters who have paramedic training. The proposal includes allowing them to provide medical care on firetrucks, including responding to calls that relate to minor injuries and providing relief for some of the higher-priority calls.

Changes to these two key pieces of legislation are said to be implemented in full in two years, but enactment could begin as early as March 2018 in two municipalities (that are yet to be determined) as part of the Ministry of Health and Long-Term Care’s pilot project. There are talks of this being a voluntary change, taken on by each municipality by opting in to these new protocols; it is, however, important to recognize that there are several implications that these amendments will bring.

The Ontario government and other proponents of these changes argue that the new protocols will allow more flexibility in the system, which would result in reduced emergency room visits and potentially lower wait times. On the other hand, there are risks associated with not taking a person to a hospital, as opposed to a clinic or to see a family doctor because hospitals tend to have more resources, which makes them better-equipped to handle a larger variety of illnesses and emergencies.

Below are some key questions to consider:

  • Would there be any safety measures in place? For example, if the incorrect decision is made or a family/community care center is unable to adequately take care of a patient, would there be standby ambulances ready to transport the patient to the nearest hospital?
  • How much decision-making power would the first responders have compared to the base hospital in terms of where to take the patient?
  • How voluntary would these changes be? Are there any parameters where municipalities would be forced, by law, to take on these changes?
  • Who would pay for any excess costs these protocols will have – the Ministry or the municipality? Some costs that have been discussed include training for firefighters to be able to give medical care on the ground. The government would also have to consider the legal liabilities involved when an incorrect judgement is made as to where a patient should go or what treatment he or she should receive on scene under the direction of these new protocols.

It will be interesting to see how this plays out both on the government level and on the ground. We hope for clear, well thought-out guidance. DDO Health Law will be keeping a close eye on these revelations and would be happy to discuss what the amendments could mean for health care organizations.