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Bulletin | Covid-19

Canadian Health Sector: Weekly COVID-19 Update

Fasken
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Health Law Bulletin

New measures implemented over the past week by governments across Canada to respond to the COVID-19 outbreak continue to focus on increasing capacity of the health care sector and reducing the spread of the outbreak, including through work allocation measures for health care workers. This bulletin summarizes key recent legislative changes, government orders and other significant developments affecting health care providers and organizations across Canada during the past week.[1]

For additional information and insights visit the Fasken Coronavirus (COVID-19) Knowledge Centre. In addition, see our previous bulletins summarizing key health sector updates across Canada in March 2020 and up to April 5, 2020.

Alberta

On April 7, 2020, the Chief Medical Officer of Health rescinded the order she issued on March 20, 2020 (reported in our earlier bulletin) restricting visitors permitted at health care facilities, including auxiliary hospitals, nursing homes, licensed supportive living accommodation, seniors lodges and residential addiction treatment facilities. The Chief Medical Officer of Health issued a new order providing that no visitors, except for those specified, are permitted in such facilities.  The order allows for visits by the “essential visitor” of a resident of a facility, only for the purpose of providing for essential care needs that would otherwise be unmet (guidance attached to the order indicates this will be a rare situation).[2] However, if a resident is at end-of-life, the resident’s family and the resident’s religious leader(s) and friends may, subject to the approval of the essential visitor, attend the health care facility to visit.  Only one visitor is permitted at a time (with the exception of visits by a child). Visits must be prearranged, and the visitor must receive a health assessment, be escorted and wear a face covering or mask.

On April 9, 2020, the Minister of Service Alberta made an order which, among other things, modified the requirements applicable to heads of public bodies under the Freedom of Information and Protection of Privacy Act (which includes hospitals and nursing homes) to respond to requests under that Act.  Timelines for dealing with access requests are modified by the order, with the possibility of further extensions (subject to prescribed conditions) in light of the effects of the pandemic.  The order extends a number of other timelines under Alberta legislation, including the time period for a medical certificate of death to be completed, signed and delivered by a physician or medical examiner under the Vital Statistics Act and the frequency that hospital administrators, nurse practitioners and midwives must deliver records required by the Vital Statistics Ministerial Regulation.

On April 10, 2020, the Chief Medical Officer of Health made an order, rescinding her previous orders issued on March 25, 2020 and April 2, 2020 outlining operational protocols and outbreak standards. The new order sets out updated requirements, including that:

●  beginning April 16, 2020, and no later than April 23, 2020, each operator of a health care facility (including an auxiliary hospital, a nursing home or designated supportive living accommodation) and contractor operating within a health care facility, must ensure that each staff member works in only one facility. Staff members must disclose their work locations to their supervisor, and are authorized by the order to be absent from health care facilities except the one in which they will continue to provide services; and

  all operators of an auxiliary hospital, a nursing home, designated supportive living accommodation, lodge accommodation under the Alberta Housing Act or a residential addiction treatment services facility must adhere to the detailed operational standards and the outbreak standards attached to the order.

On April 11, 2020, the Ministry of Health released updated Public Health Disease Management Guidelines.

Additionally, Alberta Health Services regularly posts resources for health care professionals, including Q&A documents and guidance for different areas of the health system, such as laboratory bulletins. Alberta Health Services is also implementing a continuous masking strategy.

British Columbia

On April 7, 2020, the Ministry of Municipal Affairs and Housing announced that the Province of British Columbia is working with local governments, non-profits and the hotel industry to secure spaces in which vulnerable people or people in communal spaces can self-isolate. The spaces are also being used for individuals who have been diagnosed with COVID-19 to recover, and for patients being discharged from hospitals who do not have COVID-19 and do not need emergency care, but require ongoing health care. These measures are targeted at freeing up space in the health care system.

British Columbia has announced several measures in respect of the practice of pharmacy during the COVID-19 outbreak.  The College of Pharmacists of British Columbia (the “College”) developed amendments to the Health Professions Act Bylaws of the College to enable eligible individuals to apply for temporary registration to provide pharmacy services during the COVID-19 pandemic. The amendments came into force by order of the Minister of Health on April 1, 2020.  The College has summarized information about qualifications and scope of practice. Temporary registration is granted only for the period of the declared emergency. On April 7, 2020, the College announced amendments to its policy on the delivery of opioid agonist treatment (“OAT”) (using medications such as methadone to treat opioid addiction) to allow pharmacists to authorize regulated health professionals to deliver OAT.  The amendments also allow pharmacists to authorize employees, such as pharmacy technicians and pharmacy assistants, to deliver OAT on a their behalf in exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug.  The OAT amendments are in response to Health Canada exemptions for prescriptions of controlled substances under the Controlled Drugs and Substances Act (Canada) that permit pharmacy employees to deliver prescriptions of controlled substances to patient’s locations.

On April 10, 2020, the Provincial Health Officer made an order, replacing her previous March 27, 2020 order[3] restricting the movement of staff between facilities.  The order, among other things:

●   requires Regional Health Boards to form working groups for the purpose of making recommendations regarding assigning staff to a single long-term care facility, private hospital, assisted living residence or provincial mental health facility (each, a “facility”). Before making recommendations, working groups must, to the greatest extent practicable, provide a preliminary staff assignment list to the licensee, registrant or operator of the facility, and contractors, subcontractors and unions representing staff at the facility, and take into consideration issues, concerns or circumstances raised;

●   requires medical health officers, after considering the information from the working groups, to make orders assigning staff to facilities; and

●    requires licensees, registrants and operators of facilities covered by the order to:

  direct staff to work at the facility to which they are assigned;

  not permit staff to work at a facility unless they have been assigned there;[4]

  not permit a student’s faculty supervisor to attend a facility if they have reason to believe they are supervising at other facilities; and

○  ensure that a person who volunteers does not volunteer at any other facility.

Contractors and subcontractors who provide staffing for facilities must also comply with certain of the above requirements. Employees and contractors at facilities must only work at the facility they are assigned to (but are not restricted from other employment, not at a facility). Volunteers must only volunteer at one facility and educational institutions must not make arrangements for students to be placed at more than one facility or for staff to attend more than one facility to supervise. The order does not apply to dieticians, medical laboratory technologists or assistants, nurse practitioners, paramedics, pharmacists, physicians, speech language pathologists, inter-facility transport staff, delivery persons, trades people, waste removal people, biomedical engineers, visitors or any other person permitted by the medical health officer.

The Government of British Columbia has also developed a new labour agreement, intended to ensure equitable wages and hours for employees while they work at a single site. On April 10, 2020, the Minister of Public Safety and Solicitor General made the Health Care Labour Adjustment (COVID-19) Order. Pursuant to the order, a provincial health officer or medical health officer may make a “single site order” in respect of a specified health care employer[5]  and its staff. Attached to the order is the “single site transition framework”, to assist the transition to requiring staff to work at only one health care facility, entered into by the Minister of Health, the Health Employers Association of British Columbia (“HEABC”), the bargaining associations representing unionized staff of members of the HEABC and the bargaining agents representing unionized staff of health care employers who are not a party to the single site transition framework.

Also on April 10, 2020, the BC Centre for Disease Control and the BC Ministry of Health issued a guidance document for essential workers (including individuals who provide health services) returning to the province, explaining how federal and provincial orders apply to them, and what protocols they must follow.

Manitoba

As reported in our last bulletin, the Minister of Health, Seniors and Active Living announced an order easing the registration requirements for nurses, to allow former members of the College of Registered Nurses of Manitoba to become registered in a timely manner. That order is now available online.

On April 7, 8 and 9, 2020, the Government of Manitoba issued a series of procurement bulletins.  The first bulletin asked businesses and individuals that have personal protective equipment on hand, or can make the following items in Manitoba, to make a submission: N95 masks, surgical masks, gloves, medical gowns, and additional medical supplies to aid in the fight against COVID-19. The second bulletin was a special request for gloves. Businesses in the health and wellness industry, such as dentist offices, salons, therapy clinics or other groups that are no longer using personal protective equipment have been asked to contact the provincial government. The third bulletin was directed to the garment industry, seeking non-medical cotton gloves, suits, gowns and other products requiring sewing to be used by social service workers.  It also reiterated the need for previously requested supplies (i.e., medical gowns, suits, gloves and masks). On April 11, 2020, the Government of Manitoba called on the local business community, seeking manufacturers able to produce a new mask that has been designed by medical experts at Winnipeg’s Health Sciences Centre.

New Brunswick

On April 7, 2020, the Government of New Brunswick published an updated guidance document for Home Support Agencies.

Newfoundland and Labrador

As of 5:00 pm (EDT) on April 12, 2020, there have been no recent legislative changes or orders affecting the health sector in Newfoundland and Labrador.

Northwest Territories

On April 6, 2020, the Northwest Territories’ Minister of Municipal and Community Affairs announced the extension of the territory-wide state of emergency under the Emergency Management Act to ensure the Emergency Management Organization continues to be in a position to support the orders issued by the Chief Public Health Officer.

On April 11, 2020, the Northwest Territories’ Chief Public Health Officer issued an order prohibiting all gatherings, except for limited circumstances including:

●   members of the same household;

●   persons offering necessary in-home care to others; and

●   facilities offering health and social services to at-risk populations, including but not limited to sobering centres and shelters. 

Nova Scotia

As of 5:00 pm (EDT) on April 12, 2020, there have been no recent legislative changes or orders affecting the health sector in Nova Scotia.

Nunavut

As of 5:00 pm (EDT) on April 12, 2020, there have been no recent legislative changes or orders affecting the health sector in Nunavut.

Ontario

An order (O. Reg 120/20) under the Emergency Management and Civil Protection Act was announced on April 6, 2020, effective April 3, 2020, whereby new emergency measures were adopted to protect first responders in Ontario. The order allows police, firefighters, and paramedics to obtain COVID-19 positive status information about individuals they interact with in the provision of their duties. The order requires labs and medical officers of health to take reasonable steps to provide timely disclosure of an individual’s COVID-19 status information in response to a request for such information.  The disclosure is to be direct to the requesting person, unless the Ministry of Health has developed a system to facilitate access to the information (in which case the disclosure would be to the Ministry of Health so that the Ministry may make it available to the requesting person).  Pursuant to the order, the Ministry of Health is authorized to collect this information to make it available to the specified persons. The information to be disclosed is limited to an individual’s name, address and date of birth, and whether the individual tested positive for COVID-19.

On April 7, 2020, the government announced increased action through further recruitment of health care workers to increase the capacity of staff in hospitals, assessment centres and clinics. The province announced a new online tool, called Health Workforce Matching Portal, to match frontline workers with employers. Candidates would include retired or non-active health care professionals, students, volunteers, and internationally-educated professionals.

On April 10, 2020, the government announced the implementation of the next phase of its strategy to expand COVID-19 testing. In addition to the current level of testing to the public and in the 100 assessment centres across the province, the government will now step up testing of several priority groups including hospital inpatients, residents of long-term care and retirement homes, health care workers, caregivers, health providers and paramedics.

On April 11, 2020, the government announced the extension of all emergency orders in place to date under the Emergency Management and Civil Protection Act until April 23, 2020.

In addition, on April 11, 2020, the government announced new measures, intended to increase capacity in retirement homes and allow the repurposing of existing buildings and temporary structures, which include:

●   making it easier to repurpose buildings to build temporary structures, such as tents, to ease pressure on health care facilities; and

●   temporarily enabling hospitals to increase capacity by using beds and services of retirement homes without certain labour relations implications during the declared provincial emergency.

Additionally, Ontario has introduced new legislative and regulatory changes over the past week in response to the outbreak of COVID-19:

Pharmacy Act, 1991

Effective April 7, 2020, O. Reg 126/20 was filed, which amends O. Reg 202/94 under the Pharmacy Act, 1991. The amendment adds the “coronavirus exemption[6], creating an exemption from the restriction on a member[7] with respect to adapting or renewing a prescription for a controlled substance as defined in the Controlled Drugs and Substances Act (Canada) or a drug designated as a monitored drug by the regulations under the Narcotics Safety and Awareness Act, 2010 during the period of time in which the coronavirus exemption is in effect, to the extent that the coronavirus exemption or the Controlled Drugs and Substances Act (Canada) authorizes the member to adapt or renew a prescription for a controlled substance under that Act. The “coronavirus exemption” in the Pharmacy Act, 1991 will be revoked on April 7, 2022.

Drug Interchangeability and Dispensing Fee Act

On April 6, 2020, O. Reg 124/20 was filed under the Drug Interchangeability and Dispensing Fee Act, effective April 1, 2020, which amends Regulation 935 by revoking section 9, which stipulated that private label products shall not be designated as interchangeable.[8] In addition, O. Reg 124/20 revokes Regulation 433/19, its predecessor amending regulation.

Ontario Drug Benefit Act

On April 6, 2020, two amending regulations were filed under the Ontario Drug Benefit Act. The first, O. Reg 123/20, effective April 6, 2020, amends O. Reg 201/96 to implement certain changes with respect to setting the drug benefit price of an interchangeable product. The second, O. Reg 125/20, effective April 1, 2020, revokes section 12.0.2 of O. Reg 201/96, which stipulated that a drug product that is a private label product shall not be designated as a listed drug product. O. Reg 125/20 also revokes its predecessor O. Reg 432/19, effective April 6, 2020.

Prince Edward Island

As of 5:00 pm (EDT) on April 12, 2020, there have been no recent legislative changes or orders affecting the health sector in Prince Edward Island.

Quebec

On April 7, 2020 the Government of Quebec adopted an order renewing the public health emergency until April 16, 2020. This order also extends all previously adopted orders to the same date.

Also on April 7, 2020, the Minister of Health and Social Services issued an order adding to previous orders that restricted access to certain territories within the province. On April 9, 2020, the Minister of Health and Social Services issued an order restricting movement in the Laurentides health region.

In our bulletin last week, we reported that, pursuant to an order of the Minister of Health and Social Services, individuals working in certain health sector environments where they are exposed to COVID-19 cases would receive bonus pay.  On April 8, 2020, the Minister of Health and Social Services issued another order, providing a temporary bonus of 8% for ambulance technicians and a temporary bonus of 4% for salaried persons, whether unionized or not, in the pre-hospital emergency sector.

In our bulletin last week, we also reported that the College of Physicians of Quebec and the Professional Order of Physiotherapy of Quebec had agreed to allow physiotherapists to perform COVID-19 screening tests. On April 8, 2020, the College of Physicians of Quebec and the Professional Order of Physiotherapy of Quebec issued a notice (in French only) specifying what can be done by physiotherapists for COVID-19 testing.

On April 10, 2020, the Minister of Health and Social Services issued two orders:

●   an order that, despite any provision of the collective agreements or national, local or regional agreements, any person employed by school boards and colleges established under the General and Vocational Colleges Act (except personnel whose work duties are essential to maintain appropriate educational and teaching services) may be redeployed to perform other duties or functions within the health and social services network; and

●   an order that grants nurses in public institutions or for the Nunavik Regional Board of Health and Social Services the right to certify the death of a person of full age, draw the attestation of death and fill out the certificate of death, unless the nurse cannot establish the probable cause of death on the basis of a known diagnosis or the death appears to the nurse to have occurred as a result of negligence or in obscure or violent circumstances.

Saskatchewan

Effective April 4, 2020, the Chief Medical Officer of Health rescinded his earlier public health order dated March 26, 2020 and issued a new order respecting the control of transmission of COVID-19.  Restrictions imposed or restated by the new order include:

●   that visitors of long-term care homes, hospitals, personal care homes, and group homes are restricted to family or designates visiting for compassionate reasons, and all visitors must undergo additional health screening prior to entry;

●   mandatory self-isolation for anyone who has travelled with exceptions for specific health care workers and workers who provide emergency health care services, if supervised by Infection Prevention and Control Officers or Occupational Health and Safety in the workplace;

●   that dentists, optometrists, ophthalmologists, physical therapists, occupational therapists, podiatrists and chiropractors only provide urgent services or procedures; and

●   that all businesses that are not a critical public service or allowable business service must close. The list of critical and allowable services includes a number of health services/facilities, and businesses that provide produces and/or services that support the health sector.

Regularly updated resources for health care workers are available online from the Saskatchewan government. Specific information is available about personal protective equipment, virtual care and for physicians, pharmacists and EMS Workers.

Yukon

On April 2, 2020, an order was made under Yukon’s Civil Emergency Measures Act. The order requires individuals to self-isolate for 14 days upon returning to Yukon, as well as requires individuals who seek to enter Yukon to provide a signed declaration containing certain information. However, the order provides an exception to the requirement to self-isolate for critical service workers, which includes health care workers.

Federal

On April 6, 2020, the Minister of Seniors announced flexibility for organizations under the New Horizons for Seniors Program, which funds projects that help to improve the well-being of seniors and foster social inclusion. Organizations with approved projects for 2019-2020 will be permitted to use funding previously received to provide immediate and essential services to seniors impacted by COVID-19.  Activities can include, for example, supporting the delivery of food and medication to self-isolated seniors at home; assisting seniors to undertake essential activities, such as visits to the doctor; and hiring staff to replace a loss of a volunteer due to the outbreak. [9]


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