“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.
So we have the same problems, we have had for the better part of 2 decades, the same length of time as the nurses profession has been wrestling with their issues. So I ask what is common to those problems; the same groups are making the rules (Regulators) the same group are monitoring(Government) those regulators, but we don’t see a difference in many, many years,so where is the problem? Could it be both the regulators and the Government; now we expect those 2 groups to fix it, not bloody likely. These are the same groups who applaud the reduction of paperwork for the doctors but are the same ones who put that paperwork in place!! (Talk about self praise is no praise and remember the definition of insanity) I truly feel for the health professionals in NS, they deserve so much better, we all do.
Another interesting observation, you name the presenter(s) but for some unknown reason you seem to provide anonymity to the 3 political party’s members, is this by design? It would seems that they are paid for by public money, in a session open to the public
why do you not name the members and how they voted? Is there some rule that keeps you from shedding light on how these members vote so they can be held accountable! Decisions made by committee with anonymity and no accountability has gotten us to this point. Now would that not be a novel idea- accountability in politics and reporting the news.
We have more than enough or at least more doctors willing and able, since trained in Canada (many at Dalhousie), to practice right here in good’ ol Nova Scotia, but can’t since they can’t get a billing number. We need to look at that before we swing the doors wide open.
That said, we need to be better at examining and accepting the training of doctors from anywhere in the world if they are willing to come to Nova Scotia.
Just another union cartel. Much like the dental cartel who protected the awful dentist for too many decades. My wife was refused registration as an RN despite being qualified in Scotland and then became part of a rapid response medical team at a major regional hospital in England that was using drugs that were not used in Nova Scotia until almost 20 years later. Her training and experience were greater than any nurse in the Halifax region and so she studied and passed the RN exams. The regulatory authorities spent years maintaining a closed shop and I know of doctors who trained and worked in Britain but where required to pass exams set by the NS Medical society in order to practice here.
Amazing. We’ve been talking about these issues for decades yet the government needs to rush through legislation without even talking to regulatory authorities and other experts? It boggles the mind.
There have been cases of health care professionals who can demonstrate many years of successful practice in their countries of origin, yet have found it virtually impossible to practice here. If someone has successfully practiced as a cardiac surgeon for a decade in India, have they not demonstrated competence? Are Canadians built differently?
Maybe there are language and standards issues that need to be addressed but there often appear to be barriers so expensive and time consuming to obtain the right to practice here, that they effectively deter these people from coming here. Some of these barriers may be government red tape, like limits on residencies which are presumably within the government’s control. Others seem to come from the professional associations themselves, who often appear like closed shops. I’ve been expecting this kind of push back against doctors who were not trained in Canada.
To the extent that there are demonstrable concerns about the competence of individuals, I have no issue.
If this is more about keeping outsiders out, preserving earnings etc. then I am less sympathetic. We are short of health care professionals and we cannot afford to be turning away competent people.
The rub of course is who can determine health care competence in not health care professional associations? I hope the province is working on a good answer to that question.