“I know that even though a family doctor may have received training in surgery 20 years ago, I don’t want that doctor doing a hip replacement on me,” Raylene Langor told the legislature’s Law Amendments Committee yesterday.
Langor is a practicing lawyer with expertise in regulation and describes herself as a concerned citizen. She is one of more than a dozen health profession regulators who say changes are needed to the government’s proposed legislation to improve access to health care.
Langor wants to see the language in Bill 256 tightened up to prevent the government from expanding the scope of practice without authorization from the College of Physicians and Surgeons of Nova Scotia or regulatory body that is expert in that area.
Langor noted that “not once” in the wording of Bill 256 does the phrase “public safety” appear. It’s also difficult to find the word “competent” in the proposed Patient Access to Care Act.
The purpose of regulatory bodies such as the College of Physicians and Surgeons of Nova Scotia, Nova Scotia College of Pharmacists, the Nova Scotia College of Nursing, and many others is to protect the public from poorly trained or unethical professionals by way of licensing and monitoring procedures, Langor reminded the committee.
Langor said in the government’s haste to allow professionals to take on a broader range of services to provide better access to health care, it may be putting patients at risk. Section 5(ii) of the Act to Improve Patient Access to Care is an example of what she and other presenters describe as poor drafting or a poor choice of words.
The intent of Section 5(ii) is to allow more internationally trained health professionals to get licensed more quickly so they can work in Nova Scotia.
None of the presenters took issue with that goal, but rather the language used to get there. The bill requires regulatory bodies to license applicants who are in “good standing” in their home country. According to lawyer Langor, “good standing” is such a poorly defined term it could be interpreted to mean simply having paid the annual dues or professional fees to practice in that location.
“If left as is, this provision enables the government to require the regulator to license the applicant who may have a criminal background, may lack language proficiency, competence, and professional liability insurance,” Langor said. “It creates a dangerous environment for patients.”
At the very least, Langor suggested the wording of Bill 256 be amended to required “authorization” from regulatory bodies such as the Nova Scotia College of Nursing and College of Physicians and Surgeons before the government unilaterally changes regulations around who can be licensed to practice and what type of expanded services health professionals can take on.
Representatives from many self-regulating professions also appeared before the Law Amendments Committee.
Mark Williams is the executive director of the Nova Scotia College of Physiotherapists.
“Overall, we support the legislation, but we also have recommendations to improve it,” “said Williams.
The college said it realizes allowing the government to use a stroke of the pen to change regulations offers a much faster route for physiotherapists to provide more services to the public than if the College had to wait for amendments to its own governing legislation.
Williams told the committee physiotherapists want to be part of the team in emergency departments where their expertise in assessing sprains and soft-tissue injuries could reduce some of the burden on other health care professionals.
Physiotherapists have seen their scope of practice expanded to emergency departments in other provinces, particularly Quebec, where up to 25% of patients arrive with muscle-skeletal injuries.
Like other speakers who came before the committee, Williams said the phrase “in good standing” is problematic when it comes to determining who gets licensed to work in Nova Scotia. The Nova Scotia College of Physiotherapists does not use that wording and urged government to replace it with competency standards to be determined by the licensing body.
Government did not consult health profession regulators
“It’s unfortunate neither health care regulators nor the Nova Scotia Regulated Health Professions Network was consulted by the government about the content of Bill 256, potentially eroding trust between the government and regulators,” said Ryan Baxter, the lawyer for the Health Professions Network. Baxter told the committee his comments were his own and not those of the Network, whose executive director also made a presentation.
“Unquestionably, Nova Scotians deserve increased access to care, full stop,” Baxter said. “The network supports the intent of the legislation as drafted and welcomes it. But we have concerns with the drafting that need to be fixed… We must ensure that care is provided by competent professionals. It’s inappropriate and contrary to public safety to require regulators to automatically license professionals from other jurisdictions anywhere in the world without first exercising some degree of due diligence to ensure they are competent, and they have the character to provide care to our fellow citizens.”
“We support reducing barriers for competent professionals,” Baxter concluded. “But without the revisions suggested by the Network, we believe the legislation will lead to some unintended consequences.”
Following more than three hours of presentations from representatives of various health professions, Liberal MLA Kelly Regan (Bedford) put forward a motion.
“We need more time to get this right,” Regan said.
The Liberal motion would have permitted more debate within the Law Amendments Committee to consider several amendments proposed by health regulators on how to improve language in the bill before sending it back to the legislature. That idea was supported by members of the NDP but the Progressive Conservative majority on the committee rejected the motion.
The upshot is Bill 256 will return as it is, its flaws flagged and proposed amendments left on the cutting room floor, back to the legislature for one final debate (and the possibility it could still be amended there) before being passed into law within a few weeks.