HEALTH PROFESSIONS REGULATORY REFORM IN BRITISH COLUMBIA
As part of the implementation of the Health Professions (Regulatory Reform) Amendment Act, 2008, the Ministry is proposing the repeal and replacement of all current regulations made under the Health Professions Act. See details below.
There are 24 regulated health professions in British Columbia. They are regulated by 21 self-governing bodies and two government-appointed licensing boards, under nine separate statutes. A list of the professions and the statutes and regulations applicable to each, along with summaries of recent changes to the regulations and regulatory body rules and bylaws, is available on the Legislation and Professional Regulation Home Page.
British Columbia ’s health professions regulatory framework is currently undergoing significant reform.
This reform initiative is being guided by the reports and recommendations of the former Health Professions Council, particularly the report “Safe Choices: A New Model for Regulating Health Professions in British Columbia” delivered to government in March 2001.
LEGISLATIVE REFORM
Individual profession-specific statutes and statutory provisions are being repealed and all regulated professions are being brought under the umbrella legislative framework of the Health Professions Act. The statutes and statutory provisions being repealed are the Chiropractors Act, the Dentists Act, sections of the Health Emergency Act related to emergency medical assistants, the Hearing Aid Act, the Medical Practitioners Act, the Nurses (Registered) Act, the Optometrists Act, the Pharmacists, Pharmacy Operations and Drug Scheduling Act and the Podiatrists Act.
The repeal of the Hearing Aid Act and relevant provisions of the Health Emergency Act were enacted in the Health Planning Statutes Amendment Act, 2002.
The repeals of the Chiropractors Act, the Dentists Act, the Medical Practitioners Act, the Nurses (Registered) Act, the Optometrists Act and the Podiatrists Act were enacted in the Health Professions Amendment Act, 2003. The repeal and replacement of the Pharmacists, Pharmacy Operations and Dug Scheduling Act is provided for in the Health Professions Amendment Act (No. 2), 2003 and the Pharmacy Operations and Drug Scheduling Act.
On April 6, 2004, the proposed Optometrists Regulation was released.
Registered nurses became regulated under the Health Professions Act effective August 19, 2005, and in the course of that transition, nurse practitioners became a recognized category of registered nurse under the new College of Registered Nurses of British Columbia. Repeal of the Nurses (Registered) Act was brought into force effective April 1, 2006. Proclamation of the other repeals is pending.
In Spring 2006, further technical amendments were made to the Health Professions Act to facilitate the transition of professions. These amendments were enacted in the Health Statutes Amendment Act, 2006.
On November 21, 2006, the Ministry of Health released the following proposed regulations:
On May 3, 2007, the Ministry released the proposed Speech and Hearing Health Professionals Regulation, which will designate audiology, hearing instrument dispensing and speech-language pathology as three distinct professions within a single 'umbrella' college. On July 4, 2007, the Ministry released a revised draft of the proposed Regulation.
Implementation of Health Professions (Regulatory Reform) Amendment Act, 2008
The Health Professions (Regulatory Reform) Amendment Act, 2008 (Bill 25) received Royal Assent on May 29, 2008. Bill 25 made a number of important changes to the Health Professions Act.
Among other changes, Bill 25 transferred most of the regulation-making powers in the Health Professions Act from the Lieutenant Governor in Council to the Minister of Health Services. Full implementation of this change requires that all current regulations made under the Health Professions Act be repealed in their entirety by the Lieutenant Governor in Council and then re-enacted in new regulations made by the Lieutenant Governor in Council and the Minister in accordance with their respective regulation-making authorities. Links to all the proposed new regulations are set out below.
The current Health Professions Regulation will be replaced by two separate regulations: the Health Professions Designation Regulation, to be made by the Lieutenant Governor in Council, and the Health Professions General Regulation, to be made by the Minister. In addition, the Health Professions General Regulation will include the following new provisions to implement other aspects of Bill 25:
- The board member oath of office required under section 17.11 of the Health Professions Act.
- The prescribed number of days after filing that a bylaw comes into force (i.e., the ‘bylaw disallowance period’) under section 19 (3.1) of the Health Professions Act.
- The prescribed trade agreements for the purposes of section 20.4 (2) of the Health Professions Act.
- The prescribed periods for the purposes of section 50.55 (2) and (3) of the Health Professions Act regarding the timeliness of inquiry committee disposition of complaints and investigations.
Section 2 (3) of the Health Professions Designation Regulation will provide for the designation of those professions that are not yet regulated under the Health Professions Act. While notice of this provision is being given now, it will not be included in the initial Health Professions Designation Regulation. These designations will be added by amendment at future dates, as and when each profession’s transition to the Health Professions Act is ready to proceed.
Each of the profession-specific regulations will be made by the Minister. The ‘reserved titles’ section in each regulation has been revised for alignment with the regulation-making authority in section 12 of the Health Professions Act and the prohibitions in section 12.1 of the Health Professions Act. Other minor revisions have been made throughout for horizontal consistency and alignment with current Ministry of Attorney General drafting style and format.
Links to Proposed New Regulations:
Health Professions Designation Regulation
Health Professions General Regulation
Dental Hygienists Regulation
Dental Technicians Regulation
Denturists Regulation
Dietitians Regulation
Massage Therapists Regulation
Midwives Regulation
Naturopathic Physicians Regulation
Nurses (Licensed Practical) Regulation
Nurses (Registered) and Nurse Practitioners Regulation
Nurses (Registered Psychiatric) Regulation
Occupational Therapists Regulation
Opticians Regulation
Physical Therapists Regulation
Psychologists Regulation
Traditional Chinese Medicine Practitioners and Acupuncturists Regulation
SCOPE OF PRACTICE REFORM
British Columbia is also implementing a new shared scope of practice/restricted activities regulatory model, similar to that already adopted in Alberta and Ontario. This model is characterized by two essential elements: scope of practice statements and restricted activities.
Scope of Practice Statements
Scope of practice statements are the concise descriptions, in broad, non-exclusive terms, of each regulated profession's activities and areas of professional practice. These statements describe in general what each profession does and how it does it. They are not exhaustive lists of every service the profession may provide, nor do they exclude other regulated professions or unregulated persons from providing services that fall within a particular profession’s scope of practice.
Restricted Activities
Restricted Activities (formerly called reserved actions) are a narrowly defined list of invasive, higher risk activities that must not be performed by any person in the course of providing health services, except members of a regulated profession that has been granted specific legislative authority to do so, based on their education and competence. Individual professions will be granted a list of specific restricted activities from the ‘master list’ as appropriate to their education and competencies, which may be performed while providing the services described in their respective scope of practice statements. The same restricted activities may be granted to more than one profession. Not all professions will be granted restricted activities. Unregulated individuals or classes of individuals may be exempted from the prohibition. The 'master list' and any exemptions will be established in regulations.
This approach abandons the historical notion of professional exclusivity in which legislation prohibits any person other than a member of the profession from performing certain services or procedures, except where another profession is also specifically authorized in legislation to perform them. Under the new model, many aspects of the scope of practice of each health profession may overlap, or be shared, with those of other health professions, and may also be performed by unregulated persons (to the extent that no restricted activities are involved in the service). This approach is expected to support enhanced interprofessional and multidisciplinary practice and increased consumer choice, while maintaining patient safety and public protection.
TITLE PROTECTION
Reserved Titles
Reserved titles, prescribed under section 12 of the Health Professions Act as being for the exclusive use of registrants of regulatory colleges, are a central and critical public protection element of British Columbia’s health professions regulatory framework. As a matter of policy, the Ministry applies the following statement of the former Health Professions Council in the scope of practice review portion of its “Safe Choices” report:
Reserved titles afford a means for consumers to identify the different types of health care providers, to distinguish the qualified from the unqualified and to differentiate those practitioners who are regulated from those who are not. Titles must adequately serve the public in describing the practitioner and the services being provided and must distinguish the practitioner from others performing services outside the jurisdiction of the regulatory body. The Seaton Commission explained that while it may not be in the public interest to maintain exclusive scopes of practice, it may be appropriate to grant an exclusive (reserved) title to a health profession so the public will know that the professional with whom they are dealing is regulated by a college and is therefore qualified and subject to disciplinary processes for incompetent, impaired or unethical practice.
The Health Professions Act was amended in 2008 to add a new section 12.1 which expressly prohibits a person other than a registrant of a regulatory college from using a reserved title, an abbreviation of the title or an equivalent of the title in another language to describe the person’s work, in association with or as part of another title describing the person’s work, or in association with a description of the person’s work. Some very limited exceptions to this prohibition are permitted. Section 12.1 also prohibits a person other than a registrant of a regulatory college from using any name, title, description or abbreviation of a name or title, or an equivalent of a name or title in another language, in any manner that expresses or implies that the person is a registrant or is associated with the college.
Restricted Terms
In addition to the protection of specific reserved titles, the government has in recent years also identified significant concerns about the use by unregulated practitioners of a descriptive terms such as “regulated”, “registered”, “certified” and “licensed” in association with a noun or abbreviation to form a title describing a health care practitioner. As the former Health Professions Council noted in the scope of practice review portion of its “Safe Choices” report, such use is not in the public interest as it implies a level of objectively proven competency, and government endorsement or recognition of the occupation or profession, which does not exist.
Consequently, the Health Professions Act was amended in 2003 to add a new section 52.1 (not yet in force) that will prohibit the use of specified descriptive terms by non-registrants of a college, subject to some very limited exceptions. Section 52.1 was subsequently amended in 2006 and again in 2008. It will now prohibit a person who provides services or does work covered by the definition of “health profession” in section 1 of the Health Professions Act, but who is not a registrant of a college established under the Health Professions Act, from using the terms “regulated”, “registered”, “certified” or “licensed”, or abbreviations or equivalents in another language of those terms, in association with or as part of a title describing the person’s work or in association with a description of the person’s work.
Exceptions will apply where a person is authorized by a regulatory body in another jurisdiction to use the term and uses the term in British Columbia only to indicate whether the person is authorized to practice in the other jurisdiction, or is a member of an organization exempted by the Minister from this prohibition. While the policy for determining Ministerial exemptions under section 52.1 of the Act has not yet been completed, it will be based on an assessment of the need to protect the public from significant risk of harm and the need to minimize confusion between regulated professions and unregulated occupations.
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Last Revised:
August 14, 2008
