The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province.
Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.
The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period:
- Health Care Providers must still consider which services should continue to be provided remotely (e.g., by telephone or virtually) and which services can “safely” resume in person.
- Resumption of service still requires “appropriate hazard controls” and, of course, sufficient PPE.
- In determining which services to provide, health professionals should be guided by the following principles:
- Proportionality – decisions should include consideration of the real or anticipated capacities to provide those services
- Minimizing Harm to Patients – decisions should strive to limit harm to patients whenever possible, including the prioritization of activities based on respective risks and burdens of more delay for patients
- Equity – the same clinical needs should be treated the same way, and special attention should be paid not to further disadvantage patients who might already be disadvantaged or vulnerable
- Reciprocity – a recognition that the health system has an obligation to ensure that patients who are particularly burdened by the system’s limited capacity have their health monitored and receive appropriate care.
The updated Directive #2 expressly recognizes that health care providers are in the best position to determine which services should continue to be provided remotely and which in person (again, likely because of the breadth and variety of situations involved).
However, that does not mean that health professionals are free to make whatever decisions they want, without restriction or oversight. Decisions must be guided by and comply with the requirements, principles, and expectations of the Directive #2 and the professional’s respective governing College. The updated Directive expressly states that Health Care Providers should be guided by best clinical evidence and must adhere to the guidance of their College.
Before making any decision on how to transition back, health professionals should check the website of their respective College for the most up-to-date statement of expectations or restrictions.
In general terms, the following considerations should also be kept in mind:
- In considering risk of treatment, consider the risks of treatment not only to the patient and yourself, but also to other patients, your staff, and the public in general.
- Perform active screening of the patient for COVID-19 risk factors in advance and over the phone before scheduling the in-person treatment sessions.
- Use additional signage in your clinic such as the following developed by public health or as required by your College:
- Take precautions including physical distancing as much as possible and observe the highest levels of hygiene protocols;
- Use appropriate PPE;
- Stay within your scope of practice even if the patient is pressing for more due to the scarcity of other healthcare services (except as may otherwise be expressly permitted by your College);
- Document your decision-making around your gradual restart; and
- Don’t take shortcuts – although this is a pandemic, unless expressly stated otherwise, the usual policies, standards, and guidelines of your College apply.
NOTE: This blog was written on May 28, 2020, and was current as of that date. A blog post is never a substitute for legal advice specific to your situation, and that is particularly so when circumstances arechanging so rapidly.
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