BC’s Government quietly passed a bill that could have huge implications for how British Columbia’s healthcare system operates and how safe our personal information is, according to a Vancouver-based healthcare worker who was recently contacted by their regulatory college, warning of upcoming changes. This source declined an interview, for fear of retaliation, prompting me to read Bill C-36 – Health Professions and Occupations Act in its entirety:
… all 278 pages:

Bill C-36 was passed into law November 2022 and it appears, on the surface, to be aimed at streamlining the healthcare system and protecting the public in British Columbia. It’s no secret that our healthcare system has been overwhelmed. Reducing regulatory colleges and removing red tape simplifies things. Yet, multiple healthcare professionals have raised concerns, the president of Doctors of BC has spoken out, as has the BC Nurses Union.
So, where’s the controversy!?

One criticism is that the new law gives too much power to government over how healthcare providers are disciplined, with medical professionals guilty of serious misconduct facing fines of up to $200,000 or up to six months in jail. Health Minister Adrian Dix argues the government will provide better oversight.

Another criticism is around the lack of consultation and media coverage. “Physicians and others who are impacted by this bill were not aware of what the content was,” said BC United Party health critic, Shirley Bond, leaving many healthcare professionals, and the general public, blindsided. BC Green Party Leader, Sonia Furstenau, has called on the government to re-open the bill, “so questions can be answered and [the government] can rebuild trust and accountability.”

Dr. Kevin Mcleod, an internal medicine specialist at Lions Gate Hospital, expressed concern that when “somebody makes a frivolous complaint, that now is investigated in a very public way.”

The Act is a response to a Harry Cayton’s 2019 report, urging BC to completely overhaul the Health Professions Act. Cayton’s concerns related to regulatory colleges prioritizing protection of their members over patient safety.

Privacy concerns and the ability for the government to seize personal and confidential information stood out repeatedly when reading through the Health Professions and Occupations Act:

Court Orders & Judicial Review
According to Section 506, a Judge can order search & seizure against a person who has contravened, is contravening, or likely will contravene a provision of this act, or a licensee not fit to practise. Section 511 allows for warrantless searches when a fear of destruction of evidence exists. Seized records may be kept up to 90 days, or longer with the record holder’s agreement.

Meanwhile, section 490 states “a person must not be compelled to give evidence, in a court or in proceedings of a judicial nature, concerning knowledge gained in the exercise of powers or performance of duties under this act, and are not compellable in a court or in proceedings of a judicial nature.”
Rules for thee but not for me?

Under the new power structure, healthcare will be amalgamated into categories of “health professions” and “health occupations,” as decided by the Minister of Health (currently Adrian Dix), on the recommendation of a Superintendent. 6 colleges will replace the current 15 and they will be overseen by boards appointed by the Minister. This is a departure from the previous system, where board members were elected by medical professionals.

The Office of the Superintendent of Health Profession and Occupation Oversight
Is established as an office of the government. The Superintendent must comply with general or special directions from the Minister. Oversight complaints are made to the Superintendent, who has the power to order medical professionals to answer questions or produce records, and may enter a regulators office to inspect & copy records, including personal or confidential information. You can be held in contempt for failure to comply with a Superintendent’s order, as if in breach of an order by the Supreme Court.

Minister of Health
The Minister can dictate how a new board operates, and may appoint a Public Administrator to discharge the powers and duties of a board of a regulatory college, if they believe it to be in the public’s interest. This Public Administrator may be given powers and duties in addition to those given to a board.

Boards
A board must appoint an employee of their regulatory college as a Registrar, and may appoint that same employee, or another, to be the Health Occupation Director. A board may make bylaws authorizing the inclusion of personal and confidential information in the registry for a regulatory college, while information kept in the registry must be made publicly available. Except where prohibited by the act, a board must make bylaws “respecting” the collection, use and disclosure of personal information.

Registrar
A Registrar must appoint a Deputy to act in their absence and can appoint Quality Assurance Assessors, Investigators, and Capacity Officers. A Registrar can order records about a complainant, a person who made regulatory report, a respondent, or for other personal & confidential information. A Registrar may require medical professionals give up personal information for the purpose of an information collection order.

Health Occupation Director
A Health Occupation Director is not bound by the bylaws of a regulatory college. The Minister may grant powers and impose duties on the Health Occupation Director that are not laid out in the act, as well as waive regulations. A Health Occupation Director may order a complainant or respondent to provide records, including personal or confidential information. They may also hire help, and may appoint an Investigator, who also has access to personal & confidential documents

Investigative Committee
An Investigative Committee may begin an investigation with or without a regulatory complaint being made, and may direct a Registrar to gather information/records.

Investigator
An Investigator may show up to a medical provider’s workplace, during regular hours, to inspect equipment & materials, copy records on site, including confidential personal information, and observe business operations (though patients must not be observed without their consent).

Capacity Officers
An Investigative Committee can order a respondent to undergo a capacity evaluation, for which a licensee is appointed who reports to the Capacity Officer. The Capacity Officer is identified by the Registrar (yeah, it gets confusing). A Capacity Officer may disclose personal information or records if the information is deemed necessary for making a summary protection order or carrying out disciplinary actions.

Discipline Panel
A Discipline Panel, conducting a discipline hearing, is tasked with deciding whether to respect the confidentiality of sensitive personal records or not.

Quality Assurance Officers
Patient information is to be made available to Quality Assurance Officers, but Quality Assurance Officers are not to disclose personal information to anyone except another Quality Assurance Officer, unless permitted under division 8. Section 102 outlines how confidentiality is intended to be protected.

So…

Under this new law, our confidential medical information may be made accessible to Quality Assurance Officers, Discipline Panels, Directors of Discipline, Capacity Officers, Investigators, Investigative Committees, Health Occupation Directors, Registrars, Deputy Registrars, Regulatory College Boards, the Superintendent and the Minister of Health.

Whether or not personal information is protected is up to the discretion of most of these entities and, ultimately, the provincial government. This is where you decide if you find that concerning or not.

A Registrar, Investigative Committee, Health Occupation Director or Director of Discipline may disclose protected information if they believe doing so protects the public, though they can’t release any names that aren’t already public.

With Saskatchewan and New Brunswick having introduced healthcare reform to prevent gender diverse people from accessing medically necessary care, and with Alberta set to follow-suit shortly, concerns around government overreach in the healthcare field are heightened.

Another notable aspect of this law, not as closely related to privacy, is 49(3)(f), which allows a board to implement bylaws requiring vaccinations against transmissible illnesses. This is especially interesting with BC’s Public Health Officer, Bonnie Henry, currently defending herself against a civil claim filed by healthcare workers who were fired for refusing to get Covid vaccinations.

The amalgamation of some smaller regulatory colleges is expected to begin in June. The date of full implementation is yet unknown.

– Nicola Spurling –
22/02/24



Sources:
https://www.leg.bc.ca/content/data%20-%20ldp/Pages/42nd3rd/1st_read/PDF/gov36-1.pdf

https://www.timescolonist.com/opinion/comment-bill-gives-government-sweeping-power-over-your-health-care-6366386

https://bc.ctvnews.ca/now-is-not-the-time-b-c-faces-growing-backlash-from-health-care-professionals-over-bill-36-1.6210733

https://vancouversun.com/news/local-news/why-bc-doctors-upset-about-changes-to-disciplinary-colleges