HEALTH PROFESSIONS REGULATORY REFORM IN BRITISH COLUMBIA
British Columbia’s health professions regulatory framework is currently undergoing significant reform. This reform initiative is being guided by the reports and recommendations of the former Health Professions Council, particularly the report “Safe Choices: A New Model for Regulating Health Professions in British Columbia” delivered to government in 2001. There are 26 regulated health professions in British Columbia. They are regulated by 22 self-governing bodies and two government-appointed licensing boards, under four separate statutes. Currently, 21 of these professions are fully regulated by 20 colleges under the Health Professions Act. A list of all professions along with the statutes and regulations applicable to each, and summaries of recent changes to the regulations and regulatory body rules and bylaws, is available here.
The repeal of the Hearing Aid Act and relevant provisions of the Emergency and Health Services Act (formerly the Health Emergency Act) were enacted in the Health Planning Statutes Amendment Act, 2002. The repeals of the Chiropractors Act, the Dentists Act, the Medical Practitioners Act, the Nurses (Registered) Act, the Optometrists Act and the Podiatrists Act were enacted in the Health Professions Amendment Act, 2003. The repeal and replacement of the Pharmacists, Pharmacy Operations and Dug Scheduling Act was provided for in the Health Professions Amendment Act (No. 2), 2003 and the Pharmacy Operations and Drug Scheduling Act (also enacted in 2003). On April 6, 2004, the Ministry gave initial notice of the proposed Optometrists Regulation. Notice of a proposed Nurses (Registered) and Nurse Practitioners Regulation was given on November 2, 2004 and notice of proposed bylaws for a new college was given on January 12, 2005. Registered nurses became regulated under the Health Professions Act effective August 19, 2005, and in the course of that transition, nurse practitioners became a recognized category of registered nurse under the new College of Registered Nurses. Repeal of the Nurses (Registered) Act was brought into force effective April 1, 2006. In early 2006, the Board of Examiners in Optometry submitted proposed bylaws for the new College of Optometrists under the Health Professions Act, and the Ministry gave notice of those proposed bylaws on March 22, 2006. In Spring 2006, further technical amendments were made to the Health Professions Act to facilitate the remaining transitions. These amendments were enacted in the Health Statutes Amendment Act, 2006. On November 21, 2006, the Ministry gave initial notice of the proposed regulations for chiropractors, dentists, medical practitioners and pharmacists. In late 2006, the College of Dental Surgeons submitted proposed bylaws for the College under the Health Professions Act and the Ministry gave notice of the proposed bylaws on December 20, 2006. On May 3, 2007, the Ministry gave initial notice of the proposed Speech and Hearing Health Professionals Regulation, to designate audiology, hearing instrument dispensing and speech-language pathology as three distinct professions within a single college. On July 4, 2007, the Ministry gave notice of a revised draft of the proposed Regulation. On October 24, 2008, the Ministry gave notice of the final drafts of the proposed regulations for chiropractors, dentists, medical practitioners, pharmacists and speech and hearing health professionals. On December 11, 2008, the government announced that, effective December 15, 2008, the professions of audiology, speech-language pathology and hearing instrument dispensing are designated under the Health Professions Act, and the new College of Speech and Hearing Health Professionals is established. This College will be fully responsible for regulating the three professions as of April 1, 2010. On December 12, 2008, the government announced effective dates for the transition of five professions to the Health Professions Act and the repeal of their current statutes, as follows:
On December 12, 2008, the Ministry gave notice of the final draft of the proposed Optometrists Regulation and the Board of Examiners in Optometry gave notice of the final draft of proposed bylaws for the new College of Optometrists. On February 3, 2009, the College of Chiropractors gave notice of proposed bylaws under the Health Professions Act. On February 9, 2009, the College of Pharmacists gave notice of proposed bylaws under the Health Professions Act and the Pharmacy Operations and Drug Scheduling Act. On March 1, 2009, the government announced completion of the transition of optometry to the Health Professions Act. On March 1, 2009, the government announced completion of the transition of chiropractic to the Health Professions Act. On March 16, 2009, the College of Dental Surgeons gave notice of the final draft of the proposed bylaws under the Health Professions Act. On April 1, 2009, the government announced completion of the transitions of dentistry and pharmacy to the Health Professions Act. On May 1, 2009, the College of Physicians and Surgeons gave notice of proposed bylaws under the Health Professions Act. On June 1, 2009, the government announced completion of the transition of medicine to the Health Professions Act.
Implementation of Health Professions (Regulatory Reform) Amendment Act, 2008 The Health Professions (Regulatory Reform) Amendment Act, 2008 (Bill 25) received Royal Assent on May 29, 2008. Bill 25 made a number of important changes to the Health Professions Act. Among other changes, Bill 25 transferred most of the regulation-making powers in the Health Professions Act from the Lieutenant Governor in Council to the Minister of Health Services. Full implementation of this change required that all regulations previously made under the Health Professions Act be repealed in their entirety by the Lieutenant Governor in Council and then re-enacted in new regulations made by the Lieutenant Governor in Council and the Minister in accordance with their respective regulation-making authorities. These changes came into force effective October 17, 2008. Links to the new profession-specific regulations are available here. Section 17.11 of the Health Professions Act, enacted by section 13 of Bill 25, came into force effective October 17, 2008 (see BC Reg. 270/2008). Sections 39.1, 39.2 and 39.3 of the Health Professions Act, enacted by section 41 of Bill 25, came into force effective November 1, 2008 (see BC Reg. 268/2008 and BC Reg. 269/2008). On December 8, 2008, the government announced the appointment of the chair and members of the Health Professions Review Board, and that the Review Board will begin receiving applications for review in March 2009. The Bill 25 amendments to section 22 of the Health Professions Act and a related amendment to the Health Professions General Regulation each came into force on December 15, 2008. The regulation amendment preserves the status quo as established in the former section 22 of the Health Professions Act, on an interim basis pending future development of additional regulations. Section 2 (3) of the Health Professions Designation Regulation was enacted effective December 15, 2008, to designate audiology, speech-language pathology and hearing instrument dispensing. It was amended on March 1, 2009, to designate chiropractic and optometry, on April 1, 2009 to designate pharmacy, on April 3, 2009, to designate dentistry and on June 1, 2009 to designate medicine. On March 24, 2009, the government announced the Health Professions Review Board is now accepting applications for review.
British Columbia is also implementing a new shared scope of practice/restricted activities regulatory model, similar to that already adopted in Alberta and Ontario. This model is characterized by two essential elements: scope of practice statements and restricted activities.
Scope of practice statements are the concise descriptions, in broad, non-exclusive terms, of each regulated profession's activities and areas of professional practice. These statements describe in general what each profession does and how it does it. They are not exhaustive lists of every service the profession may provide, nor do they exclude other regulated professions or unregulated persons from providing services that fall within a particular profession’s scope of practice.
Restricted activities (formerly called reserved actions) are a narrowly defined list of invasive, higher risk activities that must not be performed by any person in the course of providing health services, except members of a regulated profession that has been granted specific legislative authority to do so, based on their education and competence. Individual professions will be granted a list of specific restricted activities from the ‘master list’ as appropriate to their education and competencies, which may be performed while providing the services described in their respective scope of practice statements. The same restricted activities may be granted to more than one profession. Not all professions will be granted restricted activities. Unregulated individuals or classes of individuals may be exempted from the prohibition. The 'master list' and any exemptions will be established in regulations. This approach abandons the historical notion of professional exclusivity in which legislation prohibits any person other than a member of the profession from performing certain services or procedures, except where another profession is also specifically authorized in legislation to perform them. Under the new model, many aspects of the scope of practice of each health profession may overlap, or be shared, with those of other health professions, and may also be performed by unregulated persons (to the extent that no restricted activities are involved in the service). This approach is expected to support enhanced interprofessional and multidisciplinary practice and increased consumer choice, while maintaining patient safety and public protection. Implementation Status On November 21, 2006, the Ministry gave initial notice of the proposed Reserved Actions Regulation. On December 12, 2008, the Ministry gave notice of a revised list of proposed restricted activities (to be added to the Health Professions General Regulation). This replaces the proposed Reserved Actions Regulation released in 2006. On April 9, 2009, the government announced that amendments have been made to the Nurses (Registered) and Nurse Practitioners Regulation, Naturopathic Physicians Regulation, and Midwives Regulation. These amendments implement the February 2008 Throne Speech commitments regarding the scopes of practice for these three professions, and the shared scope of practice/restricted activities model for midwives and naturopathic physicians. As of April 9, 2009, regulations for the following professions incorporate the new regulatory model and the current proposed list of restricted activities:
Reserved titles, prescribed under section 12 of the Health Professions Act as being for the exclusive use of registrants of regulatory colleges, are a central and critical public protection element of British Columbia’s health professions regulatory framework. As a matter of policy, the Ministry applies the following statement of the former Health Professions Council in the scope of practice review portion of its “Safe Choices” report:
The Health Professions Act was amended in 2008 to add a new section 12.1 which expressly prohibits a person other than a registrant of a regulatory college from using a reserved title, an abbreviation of the title or an equivalent of the title in another language to describe the person’s work, in association with or as part of another title describing the person’s work, or in association with a description of the person’s work. Some very limited exceptions to this prohibition are permitted. Section 12.1 also prohibits a person other than a registrant of a regulatory college from using any name, title, description or abbreviation of a name or title, or an equivalent of a name or title in another language, in any manner that expresses or implies that the person is a registrant or is associated with the college. In addition to the protection of specific reserved titles, the government has in recent years also identified significant concerns about the use by unregulated practitioners of a descriptive terms such as “regulated”, “registered”, “certified” and “licensed” in association with a noun or abbreviation to form a title describing a health care practitioner. As the former Health Professions Council noted in the scope of practice review portion of its “Safe Choices” report, such use is not in the public interest as it implies a level of objectively proven competency, and government endorsement or recognition of the occupation or profession, which does not exist. Consequently, the Health Professions Act was amended in 2003 to add a new section 52.1 (not yet in force) that will prohibit the use of specified descriptive terms by non-registrants of a college, subject to some very limited exceptions. Section 52.1 was subsequently amended in 2006 and again in 2008. It will now prohibit a person who provides services or does work covered by the definition of “health profession” in section 1 of the Health Professions Act, but who is not a registrant of a college established under the Health Professions Act, from using the terms “regulated”, “registered”, “certified” or “licensed”, or abbreviations or equivalents in another language of those terms, in association with or as part of a title describing the person’s work or in association with a description of the person’s work. Exceptions will apply where a person is authorized by a regulatory body in another jurisdiction to use the term and uses the term in British Columbia only to indicate whether the person is authorized to practice in the other jurisdiction, or is a member of an organization exempted by the Minister from this prohibition. While the policy for determining Ministerial exemptions under section 52.1 of the Act has not yet been completed, it will be based on an assessment of the need to protect the public from significant risk of harm and the need to minimize confusion between regulated professions and unregulated occupations.
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