1. whether designation of the professions of
   
   
   • chiropractic;
     
   • dentistry;
     
   • emergency medical assistance;
     
   • medicine;
     
   • naturopathy;
     
   • nursing, registered;
     
   • nursing, registered psychiatric;
     
   • optometry;
     
   • podiatry; and
     
   • psychology
   
   
   under the Health Professions Act would be in the public interest or whether there are unique features of the health professions, or other relevant factors, that justify a continuing need for a separate statute; and
   
   
2. what amendments, if any, are required to the current statute, rules, regulations and bylaws for each of the professions to provide adequately for the regulation of the profession in the public interest and to ensure that the current statute contains the core principles of professional regulation reflected in the Health Professions Act and discussed in Schedule B to the Terms of Reference.
   

1. THE PURPOSE OF THE REVIEW
   
   
2. THE BACKGROUND OF THE REVIEW
   
   
3. THE ANALYTICAL FRAMEWORK
   
   
   1. The Core Principles of Professional Regulation
      
   2. The Terms of Reference
   
   
4. THE PROCESS FOR THE REVIEW

1. MANDATE OF THE REGULATORY BODY
   
   
   1. Barriers to Interdisciplinary Practice
      
   2. Relationship Between Regulatory Body and Professional Association
      
   3. Power to Approve Educational Programs
      
   4. Interim/Permanent Injunction Powers
   
   
   
2. REGISTRATION REQUIREMENTS FOR ENTRY INTO THE PROFESSION
   
   
   1. Requirement of "Good Character"
      
   2. External Appeal of Registration Matters
      
   3. Registration Process
   
   
   
3. QUALITY ASSURANCE MECHANISMS
   
   
   1. Continuing Education
      
   2. Committee Structure
   
   
   
4. COMPLAINTS AND DISCIPLINARY PROCESS
   
   
   1. Inquiry Committee Procedures
      
   2. Right to Internal Appeal
      
   3. Separation Between Investigative and Adjudicative Functions
      
   4. Open Disciplinary Hearings
      
   5. Mediation and Alternative Dispute Resolution
      
   6. Offences
      
   7. Uniform Complaint and Disciplinary Process
   
   
   
5. ACCOUNTABILITY MECHANISMS
   
   
   1. Cabinet Approval of Rules
      
   2. Cabinet Rule-Making Power
      
   3. Public Access to Register and Bylaws
   
   
   
6. THE HEALTH PROFESSIONS ACT BYLAWS
   
   
   1. Open Board and Committee Meetings
      
   2. Public Membership on Committees
      
   3. Mandatory Liability Insurance
      
   4. Discipline Committee Records
   
   
   
7. CONCLUSIONS FROM COMPARATIVE ANALYSIS

1. POLICY FRAMEWORK
   
   
2. THE PROFESSIONS' SUBMISSIONS
   
   
   1. Tradition and Jurisprudence
      
   2. Size and Complexity
      
   3. Uniqueness
   
   
3. CONCLUSIONS

1. CRITICISMS OF THE HEALTH PROFESSIONS ACT
   
   
   1. The Registration Process and the Registrar's Duties and Powers
      
   2. The Complainant as a "Party" to a Disciplinary Hearing
      
   3. Appeal Right from a Decision of the Discipline Committee
      
   4. Cabinet Approval of Bylaws
      
   5. Delay in Rule Approval
      
   6. "Professional Misconduct", "Conduct Unbecoming" and "Sexual Misconduct"
      
   7. Reporting and Investigation Requirement of Investigative Committee
      
   8. Written Reasons for Disciplinary Orders
      
   9. Particulars of Evidence
      
   10. Mediation and Alternative Dispute Resolution
       
   11. Power of Interim/Permanent Injunction
   
   
   
2. REVISIONS FROM HEALTH PROFESSION-SPECIFIC STATUTES
   
   
   1. Limited Registration
      
   2. Registrants' Reporting Requirements
      
   3. Peer Assessment
      
   4. Stay of Penalty Pending Outcome of Appeal
      
   5. Special Deputy Registrar
      
   6. Committee Legal Assistance
      
   7. Summary Membership Termination
      
   8. Discretionary Reinstatement
      
   9. Termination or Refusal of Registration
   
   
   
3. OTHER ISSUES
   
   
   1. Name of the Regulatory Body
      
   2. Access to the Register of Members
   
   
4. REVISIONS TO IMPLEMENT THE HEALTH PROFESSIONS COUNCIL'S RESERVED ACTS MODEL

1. ADVANTAGES OF MANDATORY MEMBERSHIP
   
   
2. DISADVANTAGES OF MANDATORY MEMBERSHIP

1. CHIROPRACTORS ACT
   
   
2. DENTISTS ACT
   
   
3. HEALTH EMERGENCY ACT
   
   
4. MEDICAL PRACTITIONERS ACT
   
   
5. NATUROPATHS ACT
   
   
6. NURSES (REGISTERED) ACT
   
   
7. OPTOMETRISTS ACT
   
   
8. PODIATRISTS ACT
   
   
9. PSYCHOLOGISTS ACT

• The Health Professions Council recommends that the Optometrists Act and the Podiatrists Act be repealed and those professions designated under the Health Professions Act.
  
  
• The Health Professions Council recommends that the Chiropractors Act, the Dentists Act, the Medical Practitioners Act, and the Nurses (Registered) Act be repealed and those professions designated under the Health Professions Act as soon as revisions are made to the Health Professions Act to reflect the unique features of those professions.
  
  
• The Health Professions Council recommends that the Health Emergency Act not be repealed, and the profession of emergency medical assistance not be designated under the Health Professions Act.

• The Health Professions Council recommends that section 20 of the Health Professions Act be modified to provide for a more flexible registration process, which would allow the registration committee to delegate approval of applications to the Registrar.
  
  
• The Health Professions Council recommends that the Health Professions Act be amended to remove the right of the complainant to appear as a party.
  
  
• The Health Professions Council recommends that section 40 of the Health Professions Act be amended to restrict the right of appeal to the parties in a disciplinary hearing.
  
  
• The Health Professions Council recommends that section 19 of the Health Professions Act be revised to create a category of matters for which cabinet approval is not necessary.
  
  
• The Health Professions Council recommends that the Ministry of Health and Minister Responsible for Seniors take steps necessary to address the issue of delay in the bylaw approval process.
  
  
• The Health Professions Council recommends that disciplinary provisions of the Health Professions Act be clarified to ensure that they encompass both "professional misconduct" and "conduct unbecoming."
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include provision for a summary review process for complaints and a related provision for an internal appeal from a dismissal of a complaint through the summary review process.
  
  
• The Health Professions Council recommends that the Health Professions Act be amended to include a requirement that discipline committees issue written reasons for decisions made during disciplinary hearings.
  
  
• The Health Professions Council recommends that the Health Professions Act be amended to adopt a provision similar to section 42 of Ontario's Health Professions Procedural Code which provides that:
  
  
  1. Evidence against a member is not admissible at a hearing of allegations against the member unless the member is given, at least ten days before the hearing,
     
     
     1. in the case of written or documentary evidence, an opportunity to examine the evidence;
        
        
     2. in the case of evidence of an expert, the identity of the expert and a copy of the expert's written report or, if there is no written report, a written summary of the evidence; or
        
        
     3. in the case of evidence of a witness, the identity of the witness.
        
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include specific provisions for fostering use of alternative resolution, including mediation.
  
  
• The Health Professions Council recommends that the Attorney General be given the authority to enforce the provisions prohibiting persons from performing services which should only be done by registered health professionals.
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to adopt a provision similar to section 26(5)(b) of the Dentists Act which provides:
  
  

  If, after giving the applicant an opportunity to be heard, the council determines that at the time of the application an investigation, review or proceeding is taking place in this or any other jurisdiction which could result in the suspension or cancellation of the applicant's authorization to practise dentistry in that jurisdiction, the council may refuse to grant registration or grant registration for a period or subject to other terms and conditions.

  
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to adopt a provision similar to article 5.05(e) of the Dentists Act Rules which provides:
  
  

  Reporting actions of registrants. Members must advise the registrar without delay if they have reasonable grounds to believe that a current or former registrant:
  
  

  1. has contravened the act or a rule made under it;
     
  2. has failed to comply with a limitation, term or condition imposed under the act or the rules;
     
  3. has been convicted in Canada or elsewhere of any offence that, if committed by a registrant, would constitute conduct unbecoming a registrant or unprofessional conduct;
     
  4. has incompetently practised dentistry or carried out the duties and procedures delegated to him as a registrant;
     
  5. has engaged in conduct unbecoming a registrant;
     
  6. has engaged in unprofessional conduct;
     
  7. has failed to comply with an agreement that is binding on him under section 4.1(3) of the act; or
     
  8. is suffering from a physical ailment, emotional disturbance or an addiction to alcohol or drugs that impairs his ability to practise dentistry or carry out the duties and procedures delegated to him.
     

  
  
• The Health Professions Council recommends the adoption of a peer assessment program similar to that described in section 51 of the Medical Practitioners Act, but only if restrictions on use of information during such a process, such as those set out in section 83(1) to 83(4) of Ontario's Health Professions Procedural Code, are included.
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to provide a provision similar to section 71(4) of the Medical Practitioners Act which provides:
  
  

  The executive committee may, on the terms it sees fit, stay the operation of any punishment or penalty imposed on a person appealing under this section until the outcome of the appeal, and may require the giving of reasonable security for its costs of the appeal and payment of a fine already imposed as a condition of granting the stay.

  
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include a provision similar to section 21 of the Medical Practitioners Act which provides:
  
  
  

  Special deputy registrar
  21 (1) The council must designate a person appointed under section 20 (3) as the special deputy registrar.
  
  (2) The special deputy registrar must
  
  

  (a) receive and investigate complaints of sexual misconduct made to the college;
  
  (b) on completion of an investigation of a complaint of sexual misconduct, review the findings of the investigation and recommend the action the sexual misconduct review committee should take under section 28 (2) (d); and
  
  (c) perform other duties as directed by the sexual misconduct review committee or the registrar.
  

  
  (3) With the prior approval of the sexual misconduct review committee, the special deputy registrar may authorize an inspector to complete an investigation under this section under the supervision of the special deputy registrar.
  
  (4) The special deputy registrar may attempt to resolve a complaint of sexual misconduct informally if the complainant consents and
  
  

  (a) the circumstances warrant informal resolution of the complaint in the opinion of the special deputy registrar, or
  
  (b) a direction has been made under section 28 (2) (d) (iii) to make the attempt.

  
  
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include a provision similar to section 67(2) of the Medical Practitioners Act which provides:
  
  

  On an inquiry or hearing, the council, executive committee or inquiry committee may employ, at the college's expense, the legal or other assistance it thinks necessary or proper.

  
  
  
• The Health Professions Council recommends that section 35 of the Health Professions Act be amended to add a duty to notify a registrant as well as provide an opportunity to respond to the allegations prior to action being taken under the section, with an exception for cases involving substantial risk to the public, in which case action may be taken without prior notice to the registrant.
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include a provision similar to section 62 of the Medical Practitioners Act which provides:
  
  

  Reinstatement of entry in register
  62 (1) If the council directs the erasure from the register of a person's name or of another entry, that person's name or entry must not be again entered on the register except by direction of the council or by order of the Supreme Court or of the Court of Appeal on an appeal.
  
  (2) If the council thinks fit, the council may direct the registrar to restore to the register a name or entry erased from it, with or without payment of a registration fee, and the registrar must restore it.

  
  
  
• The Health Professions Council recommends that the Health Professions Act be revised to include a provision similar to section 50 of the Medical Practitioners Act which provides:
  
  

  (1) A person who has been convicted of an indictable offence by a court in British Columbia or elsewhere is not entitled to be registered and the council may erase the person's name from the register.
  
  ...
  
  (3) The registration of a person must not be refused and the name of a person not be erased for a conviction for a political offence or for an offence that ought not, in the council's opinion, either from the nature of the offence or from the circumstances under which it was committed, to disqualify the person from practising under the Act.

  
  
  
• The Health Professions Council recommends that all regulatory bodies be called "colleges." This will require changes to the legislation governing registered nursing, optometry and podiatry.
  
  
• The Health Professions Council recommends that section 22 of the Health Professions Act be amended to provide discretion not to disclose a member's address or phone number where there are reasonable grounds to believe that disclosure may jeopardize the member's safety.

• The Health Professions Council recommends that the Health Emergency Act be amended to include sections 16(2)(d), 16(2)(f) and bylaw 18 of the Health Professions Act which provide:
  
  

  16(2) A college has the following objects:
  
  

  (d) to establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice amongst registrants;
  
  (f) to establish, for a college designated under section 12 (2) (h), a patient relations program to seek to prevent professional misconduct of a sexual nature.

  
  
  Patient relations committee
  18. (1) The patient relations committee is established consisting of [6] persons appointed by the board.
  
  (2) The patient relations committee must include at least [2] public representatives, at least 1 of whom must be an appointed board member.
  
  (3) The patient relations committee must
  

  (a) establish and maintain procedures by which the college deals with complaints of professional misconduct of a sexual nature,
  (b) monitor and periodically evaluate the operation of procedures established under paragraph (a),
  (c) develop and coordinate, for the college, educational programs on professional misconduct of a sexual nature for members and the public as required,
  (d) establish a patient relations program to prevent professional misconduct, including professional misconduct of a sexual nature,
  (e) develop guidelines for the conduct of registrants with their patients, and
  (f) provide information to the public regarding the college's complaint and disciplinary process.

  
  
  (4) For the purposes of this section, "professional misconduct of a sexual nature" means
  
  

  (a) sexual intercourse or other forms of physical sexual relations between the registrant and the patient,
  (b) touching, of a sexual nature, of the patient by the registrant, or
  (c) behaviour or remarks of a sexual nature by the registrant towards the patient;

  
  but does not include touching, behaviour and remarks by the registrant towards the patient that are of a clinical nature appropriate to the service being provided.

  
  
  Prior to the enactment of this provision, both the Emergency Health Services Commission and the Emergency Medical Assistants Licensing Board should be consulted about which body is best able to fulfill the duties required by these programs.
  
  
• The Health Professions Council recommends that the provisions in the Health Emergency Act dealing with the complaints and discipline process be amended to ensure that the investigative and adjudicative functions are entirely separate, and that complainants are afforded a right of internal appeal regarding dismissed complaints.
  
  
  
• The Health Professions Council recommends that the Health Emergency Act be amended to provide for a general rule that disciplinary hearings are open to the public, subject to the list of exceptions set out in bylaw 12(5)(a) to (d) of the Health Professions Act Bylaws.
  
  
• The Health Professions Council recommends that the following Health Professions Act provisions be added to the Health Emergency Act:
  
  
  1. section 33(4) which deals with the inquiry committee's power to take any action it considers appropriate to resolve a complaint, including mediation;
     
     
  2. section 36 which provides that the inquiry committee may resolve complaints by way of registrants' undertakings or consents;
     
     
  3. section 37 which describes the contents of a citation;
     
     
  4. section 38 which sets out the procedure for a discipline committee hearing; and
     
     
  5. section 40 which provides for an appeal by a person aggrieved or adversely affected by a decision of the discipline committee.

• The Health Professions Council recommends the repeal of any provision in any professional statute, rule or regulation that requires members of a regulated health profession to belong, or to pay dues, to a professional association.

• The Health Professions Council recommends a process be established by the Minister of Health and Minister Responsible for Seniors for the Health Professions Council to provide ongoing review and oversight of the regulatory colleges.

Last Revised: July 21, 2005