In a new act which has recently received Royal Assent,
Safeguarding Health Care Integrity Act, 2014, S.O. 2014,
c. 14., the legislature has significantly expanded a hospital's
duty to report to the College of Physicians and Surgeons of Ontario
("CPSO") where there are concerns about physician's
competence, negligence or conduct.
The current reporting obligation in the Public Hospitals
Act, R.S.O. 1990, c. P. 40, provides:
(a) the application of a physician for appointment or
reappointment to a medical staff of a hospital is rejected by
reason of his or her incompetence, negligence or
(b) the privileges of a member of a medical staff of a
hospital are restricted or cancelled by reason of his or her
incompetence, negligence or misconduct; or
(c) a physician voluntarily or involuntarily resigns from a
medical staff of a hospital during the course of an investigation
into his or her competence, negligence or conduct,
the administrator of such hospital shall prepare and forward
a detailed report to The College of Physicians and Surgeons of
Once the new act comes into force (there is no proclamation date
at present), s. 33 (c) will be repealed and replaced with the
(c) a physician resigns from a medical staff of a hospital
or restricts his or her practice within a hospital
and the administrator of the hospital has reasonable grounds to
believe that the resignation or restriction, as the case may be, is
related to the competence, negligence or conduct of the physician;
(d) a physician resigns from a medical staff of a hospital
or restricts his or her practice within a hospital
during the course of, or as a result of, an investigation into his
or her competence, negligence or conduct,[emphasis added]
This amendment is in-line with the legislative evolution in
Ontario towards enhanced patient safety and transparency.
The effect of this amendment will be to decrease the scope for
discretion on the part of hospital administrators when considering
whether or not to report a physician to the CPSO. Historically,
there was no express statutory obligation to report to the CPSO,
where, for example, a physician voluntarily restricted his/or her
practice while a mid-term or other review was unfolding in
With this new amendment, whenever there is a resignation from
staff or a restriction in practice (even without formal alteration
of a physician's privileges) related to issues of competence,
negligence or conduct, a report is mandatory.
It would be unfortunate if this amendment had the effect of
discouraging physicians from voluntarily agreeing to restrict their
practices pending the results of a review. In order to minimize
this risk, reports to the CPSO should include enough detail to
distinguish between cases where the hospital has insufficient
information to come to any conclusion about competency (for example
where cases of concern are being investigated but the conclusion
remains uncertain) and cases where there is compelling evidence of
Although not required by the legislation, we recommend that
whenever possible, a physician be given advance notice of any CPSO
report, and be copied on the report. There may be circumstances
where the administrator may wish to invite the physician's
comments on the draft report before it is finalized. In the event
that a voluntary restriction is being considered, being afforded
this opportunity may have a positive influence on the
There is statutory immunity under the Public Hospitals
Act for certain individuals (including a member of a committee
of the medical staff) in respect of good faith reports to the
The Public Hospitals Act is only one source of a
hospital's reporting obligations in respect of physicians. This
new legislation also similarly expands reporting obligations for
all persons who employ or grants privileges to any member of any
regulated health profession. Notably the new legislation also
provides Colleges with more latitude to communicate information to
hospitals about College investigations.
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