BCMJ, Vol. 44, No. 9, November 2002, page(s) 466-467—Personal View
H. Ewart Woolley, MD
A new era
May I, through the courtesy of your columns, draw attention to proposed changes to the Health Professions Act? The minister of Health Planning informs us that these changes, which are to be introduced to the legislature in the Fall of 2002, are “consistent with the governments (sic) New Era vision of providing high-quality patient care and improving the health and wellness (sic) of British Columbians.” This sentence, which piquantly contains a neologism, a tautology, and a solecism, would have delighted my English teacher.
The minister goes on to say, “I believe the proposed changes to the Health Professions Act will make important strides in (sic) improving the regulation of Health Care delivery…”. Perhaps the minister means strides toward. The ostensible grounds for the change are that, “From time to time some colleges have encountered difficulties in effectively carrying out their mandate and have failed to act in the public interest in carrying out their regulatory responsibilities.” Unsurprisingly, neither the colleges nor the nature of their failures are elucidated by the minister. This must be inconsequential, for she (or perhaps her bureaucrats) continues, “Under the amendments, government will have new powers to enquire into the function of a college and to direct a board of a college to act where it is deemed necessary. In addition the government will have the ability to appoint a public administrator to carry out the functions of a board….”
Trust me, I am a politician.
In the preamble, the minister states, “The specialized practice of health professions makes direct regulation by the government difficult. The self-governing model relies on the expertise of practitioners….” Despite this, the Quality Assurance Programme under 26.2(2) must include “members, equal in number to at least one third of the total membership of the committee who are members of the health profession.” In spite of being self-governing, we might well have our most important committee controlled two to one by lay persons.
Under section 26.1 subsection 12 (1), Alternative Medicine, the College “must not act against a registrant or an applicant for registration solely on the basis that the person practises a therapy that departs from prevailing medical practice unless it can be demonstrated the therapy poses a greater risk to patient health or safety than does prevailing medical practice.” Reflect on this for a moment. A committee of the College is currently studying the merits of a procedure which, over a period of 45 centuries, has been performed more than a thousand-million times, i.e., circumcision of the male. Obviously, evidence-based medicine has its limitations.
There is one striking omission in the “Uniform Regulatory Framework for Health Professionals,” which includes the following: “Physicians, optometrists, dentists, podiatrists, chiropractors and registered nurses.” Despite their licence to investigate, prescribe, and operate, nowhere in this list, which appears in the document 13 times, is any mention made of the College of Midwives. Perhaps they will be covered by “The new system (which) will create shared scopes of practice, and many of the reserved actions will be shared among the qualified health professions.” Interestingly, these are to be developed in regulations and will not be established in the draft legislation. To this end, the present Act is to be amended, Section 12 (2.1) b, “2 or more health professions are included in the designation of a college.”
In summary, the minister is proposing to significantly change the Health Practitioners Act based upon colleges having failed to carry out their mandate in some unspecified manner. All the colleges, save the College of Midwives, will be brought under the same omnibus Act. Disciplinary committees, despite the minister’s lip service to the need for self-regulation, may have as many as two-thirds lay persons. The government, should it be dissatisfied with the actions of a college, may sweep away the board and appoint an administrator. Existing colleges may, under the regulations, be forced to take in other, unspecified, health care personnel.
Am I alone in watching with trepidation as the minister brings in this “New Era” of medical care?
—H. Ewart Woolley, MD
Burnaby
