People enter Vancouver General Hospital on March 26.Jennifer Gauthier/The Globe and Mail
B.C. Health Minister Josie Osborne is defending her province’s most significant overhaul of how health professionals are regulated in decades as a critical step in protecting patient safety, pushing back on concerns that the change could politicize boards of regulatory bodies and drive health care workers away.
Speaking with reporters on Tuesday, Ms. Osborne said the Health Professions and Occupations Act is in the best interest of both the public and health care providers.
“This is new legislation that will improve patient safety by increasing transparency and ensuring strong and consistent oversight in governance of health regulators,” she said.
“At the same time, the central role that regulatory colleges continue to play will be consistent and based on merit-based governance. So for health care professionals, what this means is clearer expectations and more support from regulators so that they can stay focused on patient care.”
The act, previously known as Bill 36, comes into force on Wednesday. The legislation spans 276 pages, with more than 600 provisions, and significantly reshapes the regulation of health care professionals in the province for the first time in 30 years.
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The legislation ushers in changes for all health care professionals regulated by a professional college, including doctors, dentists, nurses and pharmacists. Changes include the amalgamation of colleges, new disciplinary procedures, updated conditions for licensing and the introduction of an oversight superintendent.
Additionally, board members will be provincially appointed rather than elected by college licensees and health professionals will no longer be allowed to appeal disciplinary decisions.
However, health professionals have raised concerns about provincial overreach into their sector and say some of the new measures are unfair. There are broader concerns the legislation could hinder retention and recruitment of medical professionals.
Part of the motivation to create the legislation, according to a government document shared with media on Tuesday, were a handful of publicized cases of health practitioners who came under investigation for their views or practice, including anti-vaccine claims and behaviour during the COVID-19 pandemic.
Among the examples were 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.
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The legislation is also the outcome of a 2018 report from Harry Cayton, a regulatory administrative expert who was commissioned by the province to look into health professional regulations, centred on dentistry.
He raised concerns about record keeping, internal communications and patient safety, and also called for a sweeping assessment of how all medical practitioners are regulated in B.C.
Benson Cowan, who will lead a newly created discipline tribunal as director, has said the act’s expanded disciplinary scope will likely increase complaints, but not significantly. Doctors say this process is time-consuming and harmful to their mental health even when no misconduct is found.
The advocacy group Doctors of B.C. says the legislation will increase fear of complaints and decrease trust in investigative and disciplinary processes among members, which may foster a culture of “defensive medicine” – such as ordering costly unnecessary tests to protect themselves from complaints – and ultimately drive them from the profession.
Ms. Osborne said Tuesday that the new disciplinary process stemmed from years of complaints not only from members of the public, but also from health care professionals themselves, about how serious cases of misconduct were handled. The new legislation is intended to strengthen public trust and confidence, she said.
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The government has stressed that the respondent of a disciplinary order may still request a review – not an appeal – or file a legal challenge. An appeal challenges a decision, whereas a review examines the decision-making process.
Asked about concerns that college boards will be politicized, Ms. Osborne said the boards will still have equal numbers of practitioners to public members, arguing guardrails are in place to protect against it becoming a “political process.”
Other critics include individual practitioners and opposition politicians, including interim B.C. Conservative leader Trevor Halford, who has called on the ruling NDP to repeal the legislation.
As of Wednesday, Mr. Cowan, the director of discipline, will be responsible for establishing a three-person tribunal to determine disciplinary action, which used to be the role of colleges. Colleges, however, will continue to investigate complaints but, upon completion, will forward them to the new director.
Adriane Gear, president of the B.C. Nurses’ Union, said in a statement on Tuesday that the union shares the government’s goal of strengthening public safety, improving accountability and advancing cultural safety and anti-discrimination in health care with the legislation.
But she said it is essential that it “maintains a careful and deliberate balance between the public interest and the rights of regulated professionals.” The regulatory changes must also not create barriers to recruitment and retention in an already strained system, nor create risks to nurses, Ms. Gear said.