What is professional regulation?
The Health Professions Procedural Code (the Code) under the Regulated Health Professions Act, 1991 (the RHPA) sets out 12 objectives for a regulatory college. They are to:
- Represent the public’s interest
- Regulate the practice of the profession and govern the members in accordance with profession-specific legislation, the Code, the RHPA and related regulations and bylaws
- Develop, establish and maintain standards of qualification for persons to be issued certificates of registration (licences to practise)
- Develop, establish and maintain programs and standards of practice to assure the quality of practice of the profession
- Develop, establish and maintain standards of knowledge and skill as well as programs to promote continuing evaluation, competence and improvement among the members
- While respecting the unique character of individual health professions and their members, enhance interprofessional collaboration and consultation with other colleges, and develop standards of knowledge, skill and judgement relating to the controlled acts common to health professions
- Develop, establish and maintain standards of professional ethics for the members
- Develop, establish and maintain programs to assist individuals to exercise their rights under the Code and the Regulated Health Professions Act, 1991
- Administer profession-specific legislation, the Code and the Regulated Health Professions Act, 1991 related to the profession, and perform other duties and exercise other powers that are imposed or conferred on the College
- Promote and enhance relations between the College and its members, other health profession colleges, key stakeholders and the public
- Develop, establish and maintain standards and programs to promote the ability of members to respond to changes in practice environments, advances in technology and other emerging issues
- Any other objects relating to human health care that the Council considers desirable.
Acting in the public interest
The authority vested in the College comes as a delegation of regulatory function through provincial legislation. In the case of the health professions, including dentistry, delegation is through the Regulated Health Professions Act, 1991 and profession-specific acts such as the Dentistry Act.
The RHPA clearly sets out what Council can do by way of enacting bylaws to manage the administrative and internal affairs of the College. The profession is accountable to the public, through the Minister of Health and Long-Term Care, for effective regulation. The College Registrar is accountable to Council and to the Minister of Health & Long-Term Care.
As such, the College represents the interests of the public not the profession; our first duty is to the patients, not the dentists. To adequately deliver to that mandate, the College’s decisions are based on accessibility, accountability and transparency.
To ensure compliance, the Minister of Health and Long-Term Care has the power and authority to dismiss a council and replace it with government appointees, all at the members’ expense. Both the Government of Ontario and the Office of the Fairness Commissioner (OFC) have authority to audit College activities at the expense of the College.
Over the past decade, RCDSO has taken on new and active leadership roles as a regulator. We have led the way on issues such as privacy, preventing and treating periodontal disease, creation of a Canada-wide standard on mercury waste, access to dental care in the long-term care sector, labour mobility, transparency initiatives, spousal treatment exemption, guidelines for sedation and anesthesia, incorporation for health care professionals, dental CT scanners, electronic recordkeeping, chronic pain management, fluoridation, and wellness programs for the profession. The College has also made a significant commitment to continuing education for dentists.
Work continues to enhance support for people who report sexual abuse and misconduct, increase access to information on the College’s website, enhance member education and guidance, and provide Council and Committee training on sexual abuse prevention.
Fairness in Regulation
As a health regulatory College, the RCDSO is mandated by legislation to demonstrate fairness in both our registration/application practices and our complaints investigation processes.
All RHPA colleges are required by Ontario’s Office of the Fairness Commissioner to register anyone that is competent and meets all legislated requirements. We must review our registration processes, submit reports to the OFC and undergo compliance audits.
As the regulator of the profession, our complaints process balances the principles of public protection with fairness and privacy for dentists and complainants. It is designed to be transparent, impartial and fair to all parties.
Transparency in Regulation
The RCDSO trusts the principle of open and effective dialogue which focuses on a collaborative exchange of information and ideas, while respecting the legal restrictions on sharing some types of information either with dentists and or the public.
Legislative Framework for Regulated Health Professions
Several pieces of legislation impact the regulation of the practice of Ontario dentists and the environment in which they practice:
- Protecting Patients Act, 2017
- Regulated Health Professions Act, 1991 (RHPA)
- Health Professions Procedural Code (the Code), which is Schedule 2 to the RHPA
- Dentistry Act, 1991
Other legislation guides regulation and practice:
- Statutory Powers Procedure Act – legislation governing adjudicative processes
- Health Care Consent Act, Substitute Decisions Act, Healing Arts Radiation Protection Act, Occupational Health and Safety Act, Workplace Safety and Insurance Act – legislation which addresses issues related to the setting or conditions in which health care is provided
- Ontario’s Human Rights Code, Employment Standards Act – overarching legislation which is relevant to health professions
- Constitution Act, 1982 – Part 1, Canadian Charter of Rights and Freedoms (federal)
- Personal Information Protection and Electronic Documents Act
- Personal Health Information Protection Act
- Emergency Management and Civil Protection Act
- Fair Access to Regulated Professions and Compulsory Trades Act
- Narcotics Safety and Awareness Act
- Blind Persons Rights Act
- Child and Family Services Act
- Accessibility for Ontarians with Disabilities Act
- Substitute Decisions Act
Putting Patients First - The Protecting Patients Act, 2017
The Protecting Patients Act, in effect as of May 2017, strengthens the prevention of and response to incidents of patient sexual abuse, increases support for victims of sexual abuse by regulated health professionals, and improves regulatory oversight and accountability of health regulatory colleges.
The Protecting Patients Act made several important changes to the RHPA, including:
- The purposes for which the Minister may require a College to collect information from members (Section 36.1) are expanded to include health human resources research.
- The Minister is given the power to make regulations with respect to College committees and panels.
- Expanded are the matters that a College is required to record in its register.
- For the purposes of the sexual abuse provisions of the Code, the definition of “patient” is expanded to include an individual who was a member’s patient within the last year or longer depending on when they ceased to be a patient. Regulations include other criteria for determining if an individual is considered a patient.
- The Inquiries, Complaints and Reports Committee and its panels may make an order for the interim suspension of a member’s certificate of registration at any time following the receipt of a complaint or after the appointment of an investigator (not only when a matter is referred for discipline or incapacity proceedings).
- The imposition prohibition of gender-based terms, conditions or limitations being imposed on a member’s certificate of registration is prohibited.
- The grounds for mandatory revocation of the certificate of registration of a member who has sexually abused a patient are expanded, and suspension is made mandatory in sexual abuse cases which do not involve conduct requiring mandatory revocation.
- Members are required to report to the Registrar if they belong to professional bodies outside Ontario, and if there has been a finding of professional misconduct or incompetence against them by such a body.
- Members are required to report to the Registrar if they are charged with an offence, and to provide information about bail conditions.
- The mandatory program for Colleges to provide funding for therapy and counselling for patients who were sexually abused by members is expanded to include persons who are alleged to have been sexually abused while a patient, and to provide funding for other purposes provided for in the regulations.
- Increases to penalties for failing to report sexual abuse of patients.
The Regulated Health Professions Act
Drafted in 1991, the Regulated Health Professions Act (RHPA) came into force on December 31, 1993. It provides a common framework for the 26 health care regulatory colleges, including three transitional councils. These regulatory colleges govern more than 256,000 health professionals in Ontario.
The function of the regulatory colleges is to set standards for one or more health professions and make certain there is compliance with the RHPA and related laws. While the RHPA provides a common framework, there is also a series of profession-specific acts that specify such things as the scope of practice of each profession.
The RHPA gives legal jurisdiction or powers to Council and statutory committees beyond which they cannot act.
The RHPA has several underlying objectives. Most importantly it strives to:
- govern health professions in the public interest
- promote openness and accountability and transparency
- promote high quality care
- make regulated health professions accountable to the public
- provide a consistent legislative framework for all regulated health colleges.
Key Players in Regulatory Framework
The Minister has broad responsibility for administration of the legislation. The Minister’s role is “to ensure that the health professions are regulated and coordinated in the public interest” (RHPA, section 3). Under the amendments to the Regulated Health Professions Act in 2009, the Health Minister has the power and authority to dismiss a Council. With the combination of Section 5, RHPA and the Protecting Patients Act, 2017, the Minister has broad, direct supervisory responsibilities and regulatory-making authority.
The Health Professions Regulatory Advisory Council (HPRAC) is an independent body that provides policy advice to the Minister of Health and Long-Term Care on:
- which professions should be regulated or no longer regulated
- suggested amendments to the RHPA, profession-specific acts and regulations
- matters concerning quality assurance programs of the regulatory colleges
- existence of effective College patient relations programs and sexual abuse funding for therapy and counselling
- any other matter referred to HPRAC by the Minister.
Health Professions Appeal and Review Board (HPARB)
HPARB considers appeals and/or reviews from:
- complainants or members dissatisfied with a College investigation of a complaint, the timeliness of the investigation or decision, or the decision of the Inquiries, Complaints and Reports Committee (except for referrals to the Discipline Committee for which there are no appeals to HPARB)
- applicants for registration from decisions of the Registration Committee.
These courts consider decisions and/or appeals of particulars to the proceedings arising from the Discipline Committee, HPARB and the Registration Committee including judicial reviews.
The Office of the Fairness Commissioner works with the regulated professions in Ontario to ensure that they have registration practices that are transparent, objective, impartial and fair. The Office is an arm’s-length agency of the Ontario government, reporting annually to the Minister of Citizenship and Immigration. It is independent of the provincial government and of the regulated professions.
Example decision of the Fairness Commissioner: Colleges are mandated by statute to register anyone that is competent. The College is not permitted to address numbers or distribution of membership.
The Office of the Privacy Commissioner protects patient health information. The Office works very closely with the College to ensure this goal. In the course of investigations or the Registrar exercising their discretion, the RHPA is paramount over the privacy legislation.
Safeguarding Patient Safety and Protection - Regulated Health Professions Act, Section 75
In the event of “reasonable and probable grounds,” the legislation provides for the Registrar to initiate an investigation without a formal complaint filed and produce a Registrar’s report which is considered by the Inquiries, Complaints and Reports (ICR) Committee. There are three possible sources which will initiate such an investigation and report:
- without formal complaint, any concerns that come to the attention of the Registrar, such as those from insurance companies, the public where they do not wish to make a complaint, other dentists, public health units, and the media
- extreme circumstances where the Quality Assurance Committee becomes aware of risks to the public arising from a registrant not participating in the Quality Assurance 28 process, or where a Quality Assurance assessment has revealed significant concerns
- emergency circumstances where the Registrar believes that the conduct of a member exposes or is likely to expose his or her patients to harm or injury, and where immediate investigation is required and there is insufficient time to seek approval from the ICRC Committee.
The College has of number of measures in place to ensure patient safety, including a dental facilities inspection program. Through this department, the College operates inspection programs for dentists seeking authorization to:
- operate dental CT scanners, or
- provide sedation and general anesthesia services.
Any dental facility that wishes to install and operate a dental CT scanner or administer sedation and/or general anesthesia must have a facility permit issued by the College. Onsite inspections of each facility and reviews of patient records are conducted regularly to confirm that it complies with all aspects of the College’s standards of practice.
An initial dental facility inspection takes place before a facility permit is issued. Once a facility permit is issued, a dental facility is subject to inspection once every three years.
Any dentist who wishes to prescribe, order or take dental CT scans, or administer sedation and/or general anesthesia is required to have their training and qualifications approved by the College.