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Proposed legal changes would see the health minister playing a greater role in the governance of health professions, a move critics say signals a lack of confidence in self-regulating bodies like the College of Physicians and Surgeons of Ontario.
One of the changes would give the minister the power to make regulations regarding college committees and panels, meaning that, eventually, discipline panels of the colleges could be made up predominantly of members from outside the health profession.
Currently, at the CPSO for example, most of a panel’s members are doctors. The present law states that just two people on the panel must be members of the public who are appointed to the college’s governing body, known as council.
“I think there is a benefit to having more lay members on the discipline panels because of the inherent bias of a profession judging itself,” said medical malpractice lawyer Paul Harte. “Even with the best of intentions, there has to be a subconscious desire to protect the profession.”
Health Minister Eric Hoskins announced in the Ontario legislature in December that the Liberal government would bring in amendments to the Regulated Health Professions Act to better protect patients.
The major proposed change is an expansion to the list of acts of sexual abuse that would lead to the mandatory revocation of a health professional’s licence.
Hoskins’ announcement was the result of a task force report on the issue, which was sparked by a 2014 Star investigation into doctors still practising after having been found guilty by the CPSO’s discipline committee of sexually abusing their patients.
One of the task force’s main recommendations was the creation of an independent tribunal to prosecute sexual abuse allegations by health care professionals, though Hoskins has said little about the proposal except to say it warrants further study.
The minister told the Star in early December that there is still work to be done regarding his proposals, and he wants to have discussions with stakeholders, including the colleges, before the amendments come into force, which could happen this spring.
The amendments represent what critics say is a shift in the way the health professions, including doctors, nurses and psychologists, are regulated in Ontario.
The Health Ministry has generally left the bulk of the work, including discipline, up to the self-regulating colleges, and remained at arm’s length from day-to-day operations.
Another proposed change that could have important implications is requiring colleges to provide the minister with personal information, including health information, “about any member of the college to the extent necessary in order to allow the minister to determine if the college is fulfilling its duties and carrying out its objects or if the minister should exercise certain of the minister’s powers,” according to the proposed amendments.
This would include information on health professionals under investigation.
“That’s big,” Harte said. “The ministry has always, I think, enjoyed the fact that there is a separation (from the colleges), so what this is doing is allowing the college to share details with respect to specific physicians and their investigations relating to those physicians, which suggests that the minister is going to have a more active role in overseeing the colleges, which I think is appropriate.
“But it also reflects a significant lack of confidence in the colleges, and which again raises the question as to why we have self-regulated colleges in the first place. Isn’t the end game here that the government should simply step in and start regulating health professionals?”
The Health Ministry did not return requests for comment for this article.
A CPSO spokeswoman said the college is continuing to review the proposed legislation and intends to “participate fully” in the legislative process.
“Public members of council make an outstanding contribution to medical regulation in Ontario,” said Kathryn Clarke, regarding possible changes to the makeup of discipline panels. “Any questions about the government’s intentions with regard to committee membership is best directed to them.”
Although it’s unclear at this point what kind of regulation the minister might actually impose regarding committee and panel composition, lawyer Lindsay Kantor said decreasing the role of professionals in disciplinary hearings would be a concern.
“The legislation already protects the minimum involvement of the public in disciplinary hearings in order to ensure that members of the profession are not judged entirely by members of their profession,” said Kantor, who specializes in health law and professional discipline, and who has represented health professionals before discipline panels.
“And so it’s worrisome to me that these proposed revisions could create an environment where members of the profession are not being overseen by members of their own profession.”