Update for Professionals

Number 11– July, 2007

Overview of Bill 171: The Health Systems Improvements Act, 2007

By Sharan Basran

The Ontario Government recently enacted Bill 171, also known as The Health Systems Improvements Act (the “Act”). The Government has stated that the purpose of Bill 171 is to “...make the health care system more responsive to the needs of Ontarians” by promoting accountability and promoting public health. It remains to be seen whether these stated purposes are achieved by the Act, the contents of which we review below.

The Act is an omnibus piece of legislation which addresses a wide range of issues in the health care system including amendments to the regulatory system for health care professionals, the addition of four new regulated professions, the creation of a new public health agency, and important changes to the management of infectious diseases. Bill 171 is divided into schedules, each of which deals with different pieces of legislation and associated amendments.

Some of the significant highlights of Bill 171 are as follows:

The Ambulance Act

  • The Bill amends the Ambulance Act and introduces a new ambulance system for the transfer of critical care patients between facilities, that integrates both air and land transportation across the province.

The Regulated Health Professions Act (RHPA)

The Act makes a number of important changes to the Regulated Health Professions Act, including:

  • There are changes to the complaints and reporting process at Colleges. The functions of multiple committees have been merged into a single Inquiries, Complaints, and Reports Committee (ICR). This new Committee has replaced the former Complaints Committee, and will also take over some functions which formerly belonged to the Executive Committee and Board of Inquiry. The ICR will consider complaints, reports made by the Registrar, and inquiries into the capacity of a Member.
  • There are new rules respecting the publication of information respecting health care professionals. Colleges are now required to publish a broader range of information in a more accessible form. The Act mandates that certain information not only be available on the public register but also on College websites. This includes general practice information and restrictions. Further, all matters referred to the Discipline Committee and the results of every disciplinary and incapacity proceeding, including a synopsis of the decision must also be posted on the website. Colleges are required to post decision summaries on the website.
  • Findings of malpractice and professional negligence, as well as a guilty finding of a criminal offence where the offence is considered to relate to the suitability of the Member to practice, must also be published.
  • As well, Colleges now have the discretion to confirm whether a Member is under investigation in the case where the public may be at risk.
  • There are new limitations on what information Colleges may disclose to the public about a member. The Registrar has the discretion not to publicize information, where it believes that disclosure may jeopardize the safety of an individual. In addition, a Registrar is prohibited from disclosing the personal health information of a Member. The Registrar is also prohibited from posting the result and summary of a decision where the penalty was only a reprimand or a fine, or if more than six years have passed since the information was prepared or last updated.
  • The Act allows health care professionals to apply to the relevant committee to remove the information from public access if the information is no longer relevant to the member’s suitability to practice.
  • Bill 171 also expands on the mandatory reporting obligations by facilities under section 85.2, which previously only required reporting allegations of sexual abuse of a patient, to now also encompass cases where a Member is incompetent or incapacitated.

Four New Regulated Professions

  • The Act adds four new health care professions as subject to regulation under the RHPA. The professions of naturopathy, kinesiology, homeopathy, and psychotherapy each have their own specific Acts that creates a new College and regulatory system.

Chase McEachern Act (Heart Defibrillator Civil Liability), 2007

  • This was initially a private member’s bill, introduced in order to respond to the ever growing use of defribrillators (also known as AEDs) in public places. The Act essentially protects individuals and health care professionals from liability for damages that may occur in relation to their use of an AED to save a life during an emergency, unless damages are caused by gross negligence. It also protects owners and occupiers of premises on which an AED is installed.

New Physician Billing Review Process

  • Bill 171 amends the Health Insurance Act and sets up a new medical audit process to review billing by physicians under OHIP. The Act endeavours to establish a process to resolve disputes respecting billing, and employs four phases to do so.
  • The first phase is more informal and takes a conciliatory approach to resolve any differences between the General Manager of OHIP and the physician. If a phase does not resolve the issue, then a physician may proceed through progressive phases which increasingly move towards a formal and adjudicative model.
  • The first phase involves education and support for physician to ensure correct billing procedures. If further intervention is required, the second means employed is the OHIP Payment Review Program and involves an audit of claims. If the matter remains unresolved after this review, the Act creates a new Physician Review Board to conduct formal hearings and adjudicate disputes. The final phase is a right of appeal, which may be exercised by OHIP or the physician.

Health Promotion and Protection Act

There are two significant amendments made to the Health Promotion and Protection Act:

a. Creation of Ontario Agency for Health Protection and Promotion

  • The Act seeks to promote public health through the establishment of the Ontario Agency for Health Protection and Promotion, described as a specialized centre for public health excellence that would provide research, scientific and technical advice and support to the health care system in the areas of infectious disease, and infection control prevention.
  • The Agency would develop knowledge and research on infectious diseases, health promotion, emergency preparedness, public health research, surveillance, epidemiology, similar to that provided by the Center for Disease Control and Prevention in the United States.
  • The Agency, an arm’s length agency independent from government and other players was criticized by Justice Campbell, as potentially exacerbating the divided authority and accountability that proved to be a significant obstacle in dealing with the SARS outbreak. In particular, Justice Campbell stated that the SARS response was weakened by the fact that there was no one clearly in charge and there was a lack of clarity surrounding the roles of various positions. He did not agree with the creation of another independent or autonomous body since SARS had demonstrated the dangers of uncoordinated entities. Instead, the Justice recommended an agency which would be an adjunct to the Chief Medical Officer of Health, rather than a separate autonomous entity. The new Agency would appear to be inconsistent with these insightful comments.

b. New Powers in event of Outbreak

  • Bill 171 also creates new emergency powers to respond to an outbreak of a communicable diseases. These powers are conferred on both the Ministry and the Chief Medical Officer of Health (CMOH). These powers are exercised in respect of hospitals, health boards, and health custodians, such that legally binding orders may now be made against these third parties to respond to outbreaks.
  • Medical Officers are granted broad powers to make orders against health facilities and hospitals to deal with communicable disease outbreaks at the institution. In particular, a medical officer of health is granted the power to “...make an order requiring a public hospital or an institution to take any actions specified in the order for the purposes of monitoring, investigating, and responding to an outbreak of communicable diseases at the hospital or institution.”
  • In addition, Provincial Public Health Powers have been significantly expanded so that the Chief Medical Officer of Health can issue binding directives or orders to respond to a risk to the public’s health. The Act confers on the CMOH, where a situation exists that may constitute a risk to the health of any person, to investigate the situation and “take such action as he or she considers appropriate to prevent, eliminate or decrease the risk.” This includes the following specific powers:
    • The CMOH now has the power to exercise the powers of boards of health and to require a board of health to produce information. A CMOH may even apply to a judge of the Superior Court to obtain a court order against a board of health to take such action to respond to the presented risk.
    • If there exists an immediate and serious risk to the health, the Chief Medical Officer of Health may order health care providers to provide information required to help the CMOH investigate and manage risks to human health, including personal health information.
    • The legislation grants the CMOH the authority to issue directives against health care providers or a health care entity respecting precautions and procedures to be followed in the event there is an immediate risk to the health of any person.
    • Significantly, the Government adopted the precautionary principle when dealing with infectious disease outbreaks. In particular, where there is a risk of an infectious or communicable disease outbreak, the chief medical officer is required to consider the precautionary principle in issuing directives related to worker health and safety in the use of any protective clothing, equipment, or device.

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“Progressive Discipline” ousts “Safe Schools”

By Janina Fogels

The Education Amendment Act (Progressive Discipline and School Safety), 2007 will come into force on February 1, 2008.

The new legislation is the end result of the so-called “Safe Schools Action Team”, appointed by the McGuinty government in December 2004. The Action Team was tasked with gathering and reviewing data and trends associated with student suspension and expulsion right across the province. The Ministry of Education was interested in discovering the impact of the Harris government’s Safe Schools Act, 2000. As many readers will know, this prior regime focussed on zero-tolerance policies and strict disciplinary measures. Many critics said that it failed to address the causes of anti-social and violent behaviour by students. Legal proceedings were even initiated at the Ontario Human Rights Commission, which viewed the Safe Schools Act as having a disproportional impact on racialized students and students with disabilities. A number of complaints were settled with the Ministry of Education agreeing, in part, to continue this review of the Act.

By way of background, during the 2000-2001 academic year, just prior to when the Safe Schools Act was implemented locally, it is reported that 113,778 Ontario students were suspended and a further 106 students were expelled. However, suspensions and expulsions spiked in the first two years after the Act was introduced. By the third year, in 2003-2004, the number of suspended students was 152,626 and the number of expelled students was 1,909. However, when the Ontario government released data on school discipline in November 2005, it also reported that the most recent trend in 2002 to 2003 showed a reduction of eight per cent in the number of suspensions. (1)

The Safe Schools Action Team issued a final report in June 2006. The McGuinty government then introduced Bill 212, An Act to Amend the Education Act in respect of behaviour, discipline and safety (“Bill 212"), which its first reading April 17, 2007. Bill 212 received Royal Assent about two months later, on June 4, 2007. It repeals sections 306 through 311 of the Education Act, replacing them with new provisions that substantially alter Part XIII of the Act with respect to the suspension and expulsion of pupils.

The following changes to the disciplinary process in schools are the most notable:

  • Principals, not teachers, are responsible for suspending students and making recommendations to the Board for expulsion;
  • Individually-tailored penalties replace cookie-cutter punishment in that principals must now exercise discretion, taking into account the circumstances of the student and mitigating factors prior to imposing suspensions or expulsions;
  • “Bullying” is now on the list of infractions which may lead to suspension;
  • Conduct that takes place outside of school but impacts the “school climate” may lead to expulsion or suspension;
  • Suspended or expelled students must be provided with programs in accordance with policies or guidelines issued by the Minister; and,
  • Students now enjoy broader procedural rights, including appeal rights challenging suspensions and expulsions.

Commentary

The forthcoming changes to the disciplinary process in schools appear to be responsive to the concerns members have raised over the years, specifically concerning their responsibility and liability in the suspension process, the importance of life skills programming for disciplined students, and the inclusion of bullying as a behaviour that triggers serious consequences.

We see the inclusion of bullying as an extremely positive development, especially considering that surveys have documented a growing problem vis-a-vis aggressive, disruptive and violent behaviour against teachers by students. The bullying of teachers, of course, has negative effects on the classroom and as well as adverse personal impact on individual members. We note that bullying is not defined in the Act. It may be further defined by regulation in the very near future. Current bullying-related case law does not require a power imbalance in the assessment of bullying behaviour. Should the definition end up including the concept of power imbalance, it will be under-inclusive of many instances of bullying where students may gang up on a teacher or other administrative employees. The power imbalance criterion, if accepted, may prevent cases from falling into the definition.

At the same time, it is hoped that cyber-bullying of teachers on the internet could be caught by the inclusion of “bullying” in s.306, targeting student actions such as manipulation of images and posting of defamatory commentary about teachers on websites like Facebook. This looks to be especially likely considering the language in s.306(1) and s.310(1): the impugned activity does not have to take place at school per se. The activity must merely have “an impact on the school climate”.

Finally, we welcome this legislation in light of the fact that teachers will no longer attract risk or legal liability with respect to this kind of discipline. Instead, the power to suspend will shift to the principals and school boards, in accordance with their overall responsibility to manage the schools.

  1. Ministry of Education, “McGuinty Government Releases Data on School Discipline”, 23 November 2005, online: http://ogov.newswire.ca/ontario/GPOE/2005/11/23/ c8925.html?lmatch=&lang=_e.html

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Responding to the “Cyberbullying” of Teachers on Facebook

By Shaun O’Brien

Stories relating to the pitfalls of the internet site “Facebook”, particularly for teachers, have recently exploded in the media. In particular, as has been repeatedly reported over the last several months, students are using Facebook to post defamatory comments and otherwise engage in “cyberbullying” of teachers. While teachers and their representatives can take a variety of actions in response to Facebook cyberbullying, it is hoped that the provincial government’s introduction of amendments to the Education Act will provide one effective avenue to address this burgeoning problem.

Facebook allows internet users to establish their own personal “profile”, that is, a personal web page on which the user can post personal information, commentary, messages, and photos. In addition to a host of other functions, users can exchange messages with other users (like e-mail), grant other users access to their profiles and post messages on another user’s profile (once access has been granted). A student, therefore, can post defamatory comments or lewd photo manipulations of teachers and publish these for the access of all of his or her friends and acquaintances.

In Toronto, the granting of Facebook access rights to friends and acquaintances has wide-ranging implications. Toronto has one of the largest number of Facebook users of any city in the world. Anecdotally, almost every high school student in Toronto has a Facebook account. This means that the information a student posts on Facebook can have an audience of an entire high school and more. In addition, while the news media stories have for the most part focussed on students or groups of students who have been identified for inappropriate Facebook use, one of the real dangers of Facebook is that defamatory material can be posted anonymously. That is, the information a user provides to establish a Facebook profile can be entirely fictional such that there is no public accountability for the student.

There are a variety of courses of action that teachers and their representatives can take in response to cyberbullying on Facebook, from insisting on the imposition of discipline at the school board level to various types of legal action grounded in defamation. However, one benefit of the recent surge of attention to Facebook is that it has coincided with the provincial government’s introduction of Bill 212, An Act to Amend the Education Act in respect of behaviour, discipline and safety.

Bill 212 received Royal Assent on June 4, 2007 and is scheduled to come into force on February 1, 2008. While the Bill does not specifically address cyberbullying, it does introduce “bullying” as an activity which may lead to a student’s suspension (s. 306(1)). It also provides that conduct which takes place outside of school but which impacts on the school climate may lead to suspension or expulsion (s. 306(1)). Finally, suspended students must be provided with programs containing academic and non-academic elements (s. 306(5)).

Partly due to recent incidents, legislators and teachers’ representatives have examined Bill 212 in the context of Facebook issues. Teachers’ representatives have had the opportunity to lobby the government regarding cyberbullying and the Minister of Education has recently described Bill 212 as specifically intended to address cyberbullying. In addition, Bill 212's requirement of programs for suspended students may provide an opportunity for educational programs and policies aimed at cyberbullying. For example, it is hoped that students could be required to complete modules on defamation and harassment during a suspension for cyberbullying.

Once implemented, then, Bill 212 may be a means to discipline students for cyberbullying and to educate students with respect to this problem. It is hoped that the implementation of this legislation, together with other actions by teachers and their representatives, will help curb the harmful uses of Facebook.

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Employee Prevented from Suing Employer for Sexual Harassment where Collective Agreement contains Harassment Provision

By Brian Hanulik

In Oliver v. Severance et al., 2007 PESCAD 02 (C.A.), a Court in PEI recently dismissed an action for harassment and sexual harassment in the workplace, holding that the complaint arose under the collective agreement. As such, the Appeals Court found that it had no jurisdiction to hear the case. Although the collective agreement only dealt with sexual harassment, the Court found that the employer had a duty under the collective agreement to provide a safe and healthy workplace, which covered general harassment complaints. In June 2007, the Supreme Court of Canada denied leave to appeal in this case.

The Facts

The Plaintiff, Ms Oliver, was employed as a curator at the P.E.I. Museum and Heritage Foundation (the “Foundation”), a provincial Crown corporation. She alleged that the executive director, Mr. Severance, harassed her by making demeaning, lewd, and offensive over a three year period. Oliver claimed to have suffered psychological and psychiatric issues as a result of this ongoing harassment. Oliver had to cease her employment as a result of these difficulties in August 1995 and ultimately obtained a severance package from the employer in 1999.

Oliver sued Severance in 2001 and alleged that the Foundation Board of Directors (or the Minister responsible for the Foundation) knew or ought to have known about the alleged harassment. She claimed that Severance abused his power and authority over her by humiliating her through the ongoing harassment and, as a result, that she was entitled to general, special and punitive damages. The defendants brought a motion to strike out the cause of action, claiming that the dispute arose under the collective agreement and, therefore, the Court did not have jurisdiction. The motions judge refused to strike out the action and the defendants appealed to the Appeals Division of the PEI Supreme Court.

All versions of the collective agreements between the employer and the union since 1990 contained grievance and arbitration procedures, and included an employee’s right not to be discriminated against on the ground of sex. Each agreement also contained provisions barring harassment. Until 1998, the relevant Article barred sexual harassment only, but after this date it was broadened to prohibit harassment generally. The collective agreement also contained a provision that employees wishing to pursue a concern arising from sexual harassment or harassment may submit a grievance to the final level in the grievance process.

The Arguments

Oliver claimed that Severance’s conduct amounted to separate, actionable torts for assault and sexual harassment, and breach of fiduciary duty. As such, Severance’s conduct went beyond sexual harassment to include general harassment and abusive conduct, which were not covered by the collective agreement. Therefore, it was her view that the grievance procedure outlined in the collective agreement did not apply and the Court had jurisdiction to hear her complaint.

The defendants’ position was that the complaint arose under the collective agreement and/or the relevant workplace policy. As such, the jurisdiction of the Court was ousted and the matter should have been brought in a grievance under the procedure outlined in the collective agreement. The defendants’ argued that the grievance procedure was the exclusive process for any complaints of sexual harassment, general harassment or verbal abuse.

The Decision

The majority of the Court held that the Court did not have the jurisdiction to hear an action for sexual harassment arising from the workplace when harassment is covered by a collective agreement. The motion to dismiss Oliver’s claim was upheld.

In determining whether the Court had jurisdiction, the majority applied the test set out in the Supreme Court of Canada decision Weber v. Ontario Hydro, [1995] 2 S.C.R. 929, specifically that the binding arbitration provisions contained in labour relations legislation give arbitrators exclusive jurisdiction if the essential character of the dispute arises from the interpretation, application, administration, or violation of a collective agreement.

Applying the test in this case, the Court held that the allegation was that Severance, as Oliver’s supervisor, abused his power and authority. All of the alleged incidents occurred at work. The majority rejected the trial judge’s view that the conduct was not work-related because it “served no legitimate workplace purpose”. The Appeals Court held that harassment never served a legitimate purpose and that Oliver’s allegation that the employer was vicariously liable only made sense if the misconduct was related to the workplace. Justice McQuaid, for the majority, found that:

“The appellant was the respondent’s immediate supervisor. His alleged harassment and abusive conduct all occurred in the workplace and in the performance of his duties in that capacity.”

And further:

“The manner in which the allegations are framed by the pleadings (as an actionable tort and a breach of fiduciary duty) does nothing to alter the factual basis of the dispute. As all the authorities caution, the court in determining the essential character of the dispute should not be distracted by the manner in which the pleadings have framed the legal issues.”

Having found that the dispute arose in the workplace, the majority then had to determine, as per Weber, whether the dispute was explicitly or implicitly within the collective agreement. In this case, it was found that it came under both Article 5 (sexual harassment) and Article 26 (grievance procedure) of the collective agreement.

Justice McQuaid found that the relevant provisions of the collective agreement governed the harassment in this case, even though the policy dealing with non-sexual harassment was not incorporated into the collective agreement until 1998. He found that the definition of sexual harassment under the collective agreements prior to 1998 was broad enough so as to include “all forms of vexatious conduct, verbal abuse, physical abuse and harassment”. He also noted Article 29.01, which stated that:

“The Employer shall make all necessary provisions for the occupational safety and health of employees.”

Justice McQuaid found that harassing and/or abusive conduct that let to an employee’s emotional breakdown, such as occurred in this case, would also be a violation of the employer’s obligation to provide a safe workplace.

As such, the Court held that:

“On a complete reading of the collective agreement in the case at bar, I am satisfied the signatories intended that disputes arising from the type of misconduct alleged on the part of the supervisor (the appellant) toward another employee (the respondent) would be addressed within the ambit of the collective agreement which had, as one its purposes, the establishment of general working conditions for the employees covered by the agreement. Harassment and abusive, vexatious conduct in the workplace are generally inconsistent with the stated purposes of the agreement and specifically inconsistent with the employer’s obligation to provide for the health and safety of its employees. Therefore, the type of alleged misconduct of the appellant agreement and the dispute between the parties is within the ambit of the collective agreement.”

Conclusion

While these cases will largely turn on the exact language of the relevant collective agreement provisions, unionized employees who are the targets of harassment (whether sexual or general in nature) and/or abusive conduct at the workplace will want to involve his/her union representative to assist in determining whether a remedy is best pursued through the grievance arbitration system or through other legal proceedings. This further application of the test set out in the Supreme Court of Canada decision in Weber demonstrates that courts may no longer have or assume the jurisdiction to deal with these matters. As such, harassment issues arising from workplace disputes such as may need to be pursued through a grievance under the collective agreement rather than through civil proceedings.

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Link to CHSMC’s Summary of Landmark Decision Protecting Collective Bargaining Under the Charter

On Friday 8 June 2007, the Supreme Court of Canada released a landmark decision on freedom of association ruling for the first time that collective bargaining is protected under s.2(d) of the Canadian Charter of Rights and Freedoms. The Court's decision expressly overturns its 1987 freedom of association trilogy and extends Charter protection beyond the right to unionize that was recognized in its 2001 decision in Dunmore.

The decision in Health Services and Support-Facilities Subsector Bargaining Association v. British Columbia, 2007 SCC 27, marks a significant victory for the labour movement and establishes a new platform for analysing the right to freedom of association under the Charter. The decision will have significant implications for protecting collective action by union members. While the decision deals specifically with laws that affect collective bargaining and actions by the government as employer the decision is significant for workers in both the public and private sectors.

Fay Faraday has summarized this landmark decision in our Human Rights Update newsletter, which can be viewed by clicking here. To view a copy of the Supreme Court of Canada decision, click here.

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To find out more information about the firm and its lawyers and the scope of our practice generally, visit our web site at www.cavalluzzo.com. If you have specific questions regarding the regulated professions, you may contact Elizabeth McIntyre at 416.964.5501 or at emcintyre@cavalluzzo.com.

Providing this information does not constitute individualized legal advice, and does not establish any form of lawyer-client relationship with our firm or with any of our lawyers. Readers should not rely on or take any action based on this information; professional advice should be obtained. While we strive for accuracy, mistakes are possible and there may be errors and omissions. We disclaim any liability for such errors and omissions.

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