Health Care Professionals in Ontario Begin the Restart

by Valerie Wise May 28, 2020 3 min read

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. 



Also in Blog

Cases to Watch: Marchi v. Nelson

by Mina Karabit September 22, 2020 3 min read

In August 2020, the Supreme Court heard and granted leave to appeal in Marchi v. Nelson, a case from the British Columbia Court of Appeal. The decision is one to watch as it will likely result in a renewed discussion of the distinction of policy versus operational decisions and their impacts on liability in tort law. The discussion will likely impact many of the anticipated post-COVID-19 lawsuits against public and government institutions.
Judicial Review: New Time Limits and a Helpful Primer

by Mina Karabit September 17, 2020 4 min read

In December 2019, Ontario’s Attorney General introduced Bill 161, the Smarter and Stronger Justice Act (the “Act”), which became law on July 8, 2020. The Act hopes to simplify a complex and outdated justice system by bringing changes to how legal aid services are delivered, how class actions are handled, and how court processes are administered.

Of note, the Act has amended the Judicial Review Procedures Act (JRPA) to establish new rules as to when an application for judicial review may be brought.

Any decisions made on or after July 8, 2020 are now subject to a 30-day limit for bringing an application for judicial review unless another Act provides otherwise. Courts, however, retain powers to extend the time for making an application for judicial review if satisfied that there are apparent grounds for relief and that no prejudice or hardship will be incurred by the delay. Before these amendments, the JRPA did not set out any time limits for bringing an application, but courts had powers to extend the time to bring an application if another Act prescribed the limit.

Recent Exemptions for Psychedelic Therapy in Canada

by Mina Karabit August 14, 2020 3 min read

In early August 2020, the Federal Minister of Health granted an exemption under the Controlled Drugs and Substances Act (CDSA) to four terminally ill Canadians to use psilocybin in their end of life care.

Psilocybin is one of the active ingredients/chemicals in “magic mushrooms,” the other is psilocin. Both psilocybin and psilocin are controlled substances under Schedule III of the CDSA. The sale, possession, production, etc. are prohibited unless authorized for clinical trial or research purposes under Part J of the Food and Drug Regulations. Both have been illegal in Canada since 1974. According to Health Canada, there are no approved therapeutic products containing psilocybin in Canada. However, the purified active ingredient, i.e. psilocybin, is being studied in supervised clinical settings for its potential to treat various conditions such as anxiety and depression.