B.C.’s new health professions law reshapes medical regulation–and raises questions about professional voice

British Columbia’s controversial Health Professions and Occupations Act (HPOA or Bill 36) just came into force, with its most substantive provisions taking effect April 1. The legislation establishes significant new precedents that constrain professional self-regulation in key areas.Under the previous Health Professions Act (HPA), professional associations elected most of the regulatory college board members, with the province appointing the remainder from the public. The HPOA eliminates that model. All board members will now be appointed through a new provincial body, the Health Professions and Occupations Regulatory Oversight Office (HPOROO). There will be no elected members.Additionally, while regulatory colleges will retain professional licensing authority under the HPOA, investigative and disciplinary powers, as well as oversight, will be centralized under a new governing structure led by the Superintendent of Health Professions. This provincially appointed official will be able to exercise broad, system-level authority, with wide-ranging powers to intervene if a college is deemed to be falling short of its public interest mandate.B.C.’s self-regulation overhaul was prompted by governance concerns at the College of Dental Surgeons of B.C., which led to an independent review and a December 2018 report by Harry Cayton, former chief executive of the United Kingdom’s Professional Standards Authority. A key component of the systemic reforms that followed Cayton’s findings is the inclusion of cultural safety and humility provisions in the act.Doctors uneasyDoctors of BC has unreservedly welcomed the HPOA’s cultural safety, patient safety and anti-racism provisions, but continues to raise concerns about its impact on physician autonomy and professional safety—particularly in the handling of complaints, investigations and discipline.In a one-pager on their website, Doctors of BC has expressed concern that formal disciplinary action resulting from issues too minor to report under the previous act “must now be publicly disclosed, while information on dismissed or unpursued complaints is disclosed if requested—potentially causing undue harm to physicians’ professional and personal reputation.”The ramifications of minor infractions being disclosed are not minor these days. Details grow legs in social media and can soon become irreversibly distorted. Doctors of BC is also very concerned that the HPOA removes statutory appeal rights, leaving physicians largely reliant on judicial review rather than a full merits appeal.The medical society declined an interview with the Medical Post but provided this statement by email, attributable simply to DOBC:“Despite the appearance of extensive consultation preceding the introduction of the HPOA, only high-level concepts were presented, and the legislation goes far beyond what was initially outlined. There has never been the opportunity to discuss or provide input into the implications and change management required for an overhaul of B.C.’s healthcare regulatory environment of this scale.”Canada-wide implications?Trudo Lemmens is professor and Scholl Chair in Health Law and Policy in the Faculty of Law, University of Toronto—cross-appointed to the Dalla Lana School of Public Health—and a member of the Joint Centre for Bioethics at the University of Toronto. He maintains a strong interest in professional self-regulation (with a current research focus on how it relates to decision-making in medically-assisted death—an area he considers to be lacking in adequate regulatory oversight).“The B.C. plans to move towards more direct oversight of the medical profession by a governmental authority, with less self-governance by the profession, is in line with international trends,” he said in an email exchange with the Medical Post. “In my opinion, there are reasons to move in that direction.”“The regulatory colleges in several provinces, including Ontario and B.C., often fail to live up to their mandate to protect the public,” he said.“I have not studied all health profession regulatory systems in Canada, but I think that B.C. is indeed the first to move to a more governmentally organized structure. Ontario has a system of statutory accountability and an appeal procedure, but it fits more within the model of self-regulation.”

B.C.’s new health professions law reshapes medical regulation–and raises questions about professional voice

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