The Health Professions and Occupations Act contains more than 600 provisions and applies to all health professions regulated by a professional college, including doctors, pharmacists, dentists and dietitians.Jennifer Gauthier/The Globe and Mail
The expert whose 2018 report on B.C.’s dental college sparked a sweeping overhaul of health professional oversight in the province says the move away from self-regulation is overdue and reflects the need to strengthen public accountability.
But while Harry Cayton lauded the shift to merit-based regulatory-board appointments under the Health Professions and Occupations Act, he said the legislation is overly complex and leaves room for political influence.
The 276-page act, which received royal assent in 2022 and came into force on Wednesday, contains more than 600 provisions and applies to all health professions regulated by a professional college, including doctors, pharmacists, dentists and dietitians.
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It updates disciplinary structures and procedures, establishes a new oversight superintendent and replaces a statutory right to appeal with an internal judicial-review process. Additionally, regulatory-board members are now provincially appointed rather than elected by licensees, on recommendation of the superintendent, among a slew of other changes.
Mr. Cayton said he had recommended the equivalent of an independent oversight superintendent but, under the act, the position is appointed by the lieutenant-governor on advice of the executive council.
“The superintendent is now a government official and seems to be taking an approach to direct the regulators, rather than support the regulators,” he said in an interview from London, England, on Wednesday.
“I’m concerned that there is too much government oversight of what should be independent regulation in the public interest.”
The advocacy group Doctors of B.C., among others, has echoed the same concern, saying the structure amounts to provincial overreach and could open the door to political interference in the board appointment, investigative and disciplinary processes.
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Doctors of B.C. has also raised concern over the elimination of the statutory right to appeal decisions, which was not something Mr. Cayton had recommended.
Under the previous legislation, colleges investigated complaints and determined and enforced disciplinary orders. Under the new act, colleges continue to investigate complaints, but a new director of discipline appointed by the Minister of Health will strike a three-person tribunal to determine disciplinary action.
Mr. Cayton likened the new structure to the separation of judge and jury and said it should result in fairness.
“But I have to say, I think they will find it hard in the long term to sustain that model of lack of independent appeal,” he said.
Mr. Cayton added that the new legislation is “much more complicated” than he would have liked, and said regulators should be able to design their complaints processes to reflect the risk involved. Being too prescriptive adds to administrative cost, he said.
Ultimately, the success of the model will depend on how new powers are exercised, Mr. Cayton said.
“It will fall to the superintendent to demonstrate that they really are independent, and it will fall to the government not to interfere unnecessarily,” he said.
Former health minister Adrian Dix hired Mr. Cayton in 2018 to review the College of Dental Surgeons of BC and the previous Health Professions Act.
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In his resulting report, Mr. Cayton noted that the college sometimes prioritized the interests of dentists over those of the public, citing as an example a 2015 decision not to cancel the registration of a dentist who “permanently brain damaged a young woman through his own deliberate acts,” instead levying only a three-month suspension and a fine.
In reviewing the Health Professions Act, he concluded that a “complete overhaul of the way health professional regulation is conceived and delivered is required.”
Current Health Minister Josie Osborne says the new legislation is critical to better protect patients and ensure consistent oversight of the health profession.
Her ministry has also cited cases that exemplified deficiencies under the old legislation, such as a naturopath who shared misleading claims about autism, a psychologist who chose to retire rather than face a hearing for his role in child-custody cases and a chiropractor who resigned from a college board after posting an anti-vaccine video.
The act also puts into force new anti-racism standards and vaccination requirements against some diseases as a condition of licensing, in addition to stronger penalties for breaches of professional standards and greater transparency around complaints.