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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, with a specific focus on reducing and addressing the spread of the outbreak in the long-term care sector.

Several provinces and territories are also now considering how to re-open certain areas of business and everyday life. This bulletin summarizes select 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, up to April 5, 2020, up to April 12, 2020 and up to April 19, 2020.

Alberta

On April 20, 2020, the Government of Alberta announced additional funding to support continuing care facilities.  The additional supports include the following:

  • increased health care aide staffing levels (about 1,000 additional full-time staff);
  • a wage supplement of $2.00 per hour for health care aides;
  • up to 1,000 paid student practicums to fast-track certifications and get more staff into continuing care facilities; and
  • an additional $24.5 million being advanced to operators to help address immediate cost pressures due to COVID-19.

Locations of all active outbreaks in acute care and continuing care facilities in Alberta are now posted online and updated twice a week. On April 24, 2020, the Chief Medical Officer of Health announced that Alberta would, in the next week, begin posting health care worker case numbers.

On April 22, 2020, the Alberta government announced that it has launched a new tool, the Alberta Cares Connector, to connect Alberta residents with volunteer opportunities, including sewing masks or scrub bags, or making meals for essential workers.

Alberta is also in the final stages of releasing a voluntary contact tracing app. The Office of the Information and Privacy Commissioner of Alberta released a brief statement about the use of a tracing app on April 23, 2020.

On April 24, 2020, the Minister of Labour and Immigration issued an order to support the implementation of the April 10th order of the Chief Medical Officer of Health requiring each operator of a health care facility to restrict the movement of staff among health care facilities, recognizing that provisions of the Labour Relations Code and Employment Standards Code may impede compliance. The Minister of Labour and Immigration's April 24th order replaces his April 10th order, described in our earlier bulletin. Implementation of the restriction on staff movement was supposed to come into full effect no later than April 23, 2020, but was delayed so that the scope can be clarified.

Alberta also announced on April 24, 2020, that community specialists (ophthalmologists, surgeons, radiologists) will be able to order personal protective equipment for their clinics through their Alberta Health Services Zone's point of contact. 

British Columbia

On April 20, 2020, the Minister of Health and the Provincial Health Officer announced expanded testing criteria, allowing any symptomatic person to be tested (as opposed to limiting testing to individuals at the most risk, such as those in long-term care, critically ill people, and health care workers).

Also on April 20, 2020, the Premier of British Columbia announced a collaborative framework to improve health care services and respond to the COVID-19 pandemic in rural, remote, and Indigenous communities. Immediate action as part of the framework includes:

  • improved medical transportation to and accommodation near larger centres with more medical services;
  • faster COVID-19 testing technology and contact tracing that respects privacy in small communities;
  • access to Virtual Doctor of the Day, to connect remote communities to a doctor or nurse practitioner via videoconferencing; and
  • increased mental health supports.

On April 21, 2020, the Minister of Health issued an order approving amendments to the bylaws of the College of Psychologists of British Columbia. The amendments provide for temporary (emergency) registration of qualified former and non-practicing registrants, as well currently registered psychologists from other jurisdictions, through an expedited process, for the purpose of providing assistance during an emergency.

Also on April 21, 2020, the Minister of Social Development and Poverty Reduction announced funding through Community Living BC to support people with developmental disabilities. Service providers who provide residential services can request funding to address overtime costs or staffing shortages and to access additional supplies for delivering disability-related supports.

On April 22, 2020, the Minister of Public Safety and Solicitor General replaced the Protection Against Liability (COVID-19) Order, described in our earlier bulletin, with the Protection Against Liability (COVID-19) Order No. 2. The order protects a person from damages that result, directly or indirectly, from exposure to COVID-19 when the person is providing an essential service, provided that the person was operating or providing the essential service, or reasonably believed that he or she was operating or providing the essential service, in accordance with applicable emergency and public health guidance. The order includes an exception for gross negligence. The new order incorporates an updated list of essential services.

Manitoba

On April 20, 2020, the Chief Provincial Public Health Officer issued a new version of the order mandating self-isolation, described in our bulletin last week.

As reported in our previous bulletin, on April 7, 8 and 9, Manitoba issued a series of three procurement bulletins. On April 20, 2020, Procurement Bulletin #4 was released, renewing the previous request for medical gloves and masks. The province is calling on businesses to produce new personal protective equipment, or donate personal protective equipment they have on hand. On April 23, 2020, Manitoba announced that it had received a large shipment of personal protective equipment. On April 24, 2020, the province thanked Manitoba-based companies and organizations for their responses.

On April 24, 2020, the Government of Manitoba announced that after a month of non-urgent surgical and diagnostic procedures being postponed, a number of facilities across the province will begin to increase their surgical activity.  Surgeries will be scheduled for the most urgent cases first, and will be subject to precautions.  The announcement also acknowledged the province's participation in nation-wide sharing of medical and personal protective equipment.  Vital sign monitors intended for Manitoba have been diverted to hospitals in Toronto and Montreal as part of this initiative.

On April 25, 2020, the Government of Manitoba announced further time-limited tariffs for additional virtual medical visits, including virtual primary care visits for residents of personal care homes who need routine care for chronic illnesses, consultations by telephone or video between family physicians and specialists to help Manitobans manage their acute, chronic and complex health conditions, and consultations by developmental pediatricians for families with children who have developmental difficulties. Doctors Manitoba also has information on its website.

Manitoba's volunteer matching program, for people in need of or able to offer help, has had over 6,600 users sign up. 

Shared Health Manitoba has posted a number of new resources for health care providers and facilities.

New Brunswick

The Government of New Brunswick announced on April 23, 2020 that the 30-day limit on prescription drugs in the province will be eliminated where shortages do not exist; however, the government will create a working group which will identify those drugs which could experience a shortage and put in place a 30-day supply limitation if necessary.

This measure is reflected in the Renewed and Revised Mandatory Order issued on April 24, 2020.

The province also announced on April 24, 2020 that it is beginning to lift certain public health restrictions.

Newfoundland and Labrador

On April 22, 2020, Newfoundland and Labrador's Chief Medical Officer of Health issued an Updated Exemption Order, which exempts certain groups of people from the requirement to self-isolate for 14 days upon arriving in Newfoundland and Labrador from outside the province, including asymptomatic health care workers essential to the provision of critical health care in the province, only while these workers are travelling to and from their home and place of work.

Northwest Territories

On April 24, 2020, the Government of the Northwest Territories announced that in order to support health care providers, frontline staff and other essential workers in working to respond to COVID-19 in the Northwest Territories, it is providing $5.106 million to create four temporary child care initiatives for parents providing essential services during the pandemic.

Nova Scotia

On April 22, 2020, the Government of Nova Scotia announced that it would cover extra dispensing fees for pharmacare clients for refills on prescriptions that would usually be filled for longer periods. The $5.00 prescription co-pay for clients of the Income Assistance program and the Low Income Pharmacare for Children program will also be waived.

On April 23, 2020, Nova Scotia's Medical Officer of Health revised the Health Protection Order by amending Schedule A, which contains directions for long-term care homes.

Nunavut

As of 5:00 pm (EST) on April 26, 2020, there have been no recent legislative changes or orders affecting the health sector in Nunavut, and the government continues to report that there are zero confirmed or probable cases in the territory.

Ontario

On April 22, 2020, the Province of Ontario issued an order (O. Reg. 165/20) renewing and extending the orders made under the Emergency Management and Civil Protection Act ("EMCPA") until May 6, 2020.

On April 22, 2020, order (O. Reg. 163/20) was issued under the EMCPA, authorizing mental health and addictions agencies to take any reasonably necessary measures to respond to and prevent the outbreak of COVID-19 with respect to work deployment and staffing. Regardless of any other policies, statutes or collective agreements, mental health and addictions agencies are authorized to:

  • identify staffing priorities and develop, modify and implement redeployment plans, including the following:
    • redeploying staff within different locations in, or between facilities of, a mental health and addictions agency;
    • changing the assignment of work, including assigning non-bargaining unit employees or contractors to perform bargaining unit work;
    • changing the scheduling of work or shift assignments;
    • deferring or cancelling vacations, absences or other leaves, regardless of whether such vacations, absences or leaves are established by statute, regulation, agreement or otherwise;
    • employing extra part-time or temporary staff or contractors, including for the purposes of performing bargaining unit work;
    • using volunteers to perform work, including to perform bargaining unit work; and
    • providing appropriate training or education as needed to staff and volunteers to achieve the purposes of a redeployment plan;
  • conduct skills and experience inventories of staff to identify possible alternative roles in priority areas;
  • require and collect information from staff, contractors or volunteers about their availability to provide services for the mental health and addictions agency;
  • require and collect information from staff, contractors or volunteers about their likely or actual exposure to COVID-19, or about any other health conditions that may affect their ability to provide services; and
  • suspend, for the duration of the emergency, any grievance process with respect to any matter referred to in the order.

On April 22, 2020, the Ministry of Health announced an advance payment program for eligible physicians to address cash flow issues that may arise due to COVID-19. The program will provide monthly, interest-free, automated top ups that will be set off against future OHIP payments to individual physicians. These payments will be based on an average of previous payments assessed over the last 12 months (April 1, 2019 to March 31, 2020). The program will automatically top up physicians' payments to 70% of this average. Physicians who are eligible will automatically receive payments in May, June and July 2020. By accepting the advance payment, physicians are deemed to agree with the following terms and conditions regarding set off against future OHIP payments:

  • recovery of advance payments will be made from a provider's future OHIP payments beginning in November 2020;
  • the total amount of the advance payments will be recovered in five equal installments against future OHIP payments from November 2020 to March 2021; and
  • no interest will be applied.

Physicians that do not wish to accept payment under these terms and conditions can return the funds to the Ministry of Health.

On April 23, 2020, Ontario announced the COVID-19 Action Plan for Vulnerable People (the "Action Plan") to assist vulnerable populations in the province (including people living in high-risk settings, such as homes serving those with developmental disabilities, shelters for survivors of gender-based violence and human trafficking, children's residential settings, and residential settings supporting vulnerable Indigenous individuals and families). The Action Plan focusses on three areas:

  1. Enhanced screening and reduced exposure to prevent spread - includes enhancing screening of visitors, staff, and residents, as well as restricting non-essential visitors, providing masks to staff working in congregate care settings and providing training on the use of personal protective equipment in the event of an outbreak;
  2. Infection control, managing outbreaks and limiting spread - includes enhancing testing of symptomatic staff and clients to identify the need for isolation and additional infection control measures on-site, planning to limit staff from working at more than one congregate care setting during an outbreak (specifically in developmental services, intervenor services, violence against women and anti-human trafficking settings) and providing additional training and support for high-risk settings dealing with an outbreak, including guidance on how to isolate clients; and
  3. Sustaining staffing and managing staff shortages - includes working with organizations to promote workforce stability and capacity in high-risk settings.

The government took the following recent actions, among others, to support vulnerable populations:

  • On April 21, 2020, the government announced an $11 million partnership with the Ontario Community Support Association to launch a program to expand Meals on Wheels services to reach low-income seniors and people with disabilities and chronic medical conditions across Ontario. The program will also develop the capacity of community organizations and others to help deliver medication and other essentials.
  • On April 22, 2020, the government announced that it has worked to provide targeted, on-the-ground support to long-term care homes through the following measures:
    • assisting 20 long-term care homes previously experiencing outbreaks to become outbreak free;
    • increasing testing on both symptomatic and asymptomatic staff and residents;
    • setting up a 24/7 Long-Term Care COVID-19 Response Team to assist with putting in place infection control protocols, resolving staffing issues, and fulfilling personal protective equipment needs;
    • launching 31 Infection Prevention and Control Interventions which are now in progress;
    • matching qualified people and volunteers to assist with duties, including nursing support and cleaning;
    • responding to requests from long-term care homes for personal protective equipment within 24 hours;
    • working with hospitals to provide additional staffing and infection prevention controls to long-term care homes; and
    • providing over 400 job matches for long-term care homes through the province's Health Workforce Matching Portal, with over half of Ontario's long-term care homes now using the portal.

On April 25, 2020, the government announced that it is providing a temporary "pandemic pay" of $4.00 per hour on top of regular wages for frontline workers. In addition, the government will be providing monthly lump sum payments of $250 for four months to eligible frontline workers who work over 100 hours per month. In the health care and long-term care sectors, eligible workplaces include acute hospitals, long-term care homes, licensed retirement homes and home and community care, and eligible workers include personal support workers, registered nurses, registered practical nurses, nurse practitioners, attendant care workers, certain auxiliary staff, developmental services workers and mental health and addictions workers. The pandemic pay will be effective from April 24, 2020 until August 13, 2020, and is expected to support over 350,000 frontline workers.

Prince Edward Island

On April 21, 2020, the Government of Prince Edward Island published guidelines for the management and control of COVID-19 in long-term care facilities. 

Also on April 21, 2020, the Premier and Chief Public Health Officer of Prince Edward Island announced the province's plan for the easing of public health measures, which could begin as early as May 1, 2020.

Quebec

On April 20, 2020, the Minister of Health and Social Services of Quebec issued an order allowing non-participating physicians and physicians who have withdrawn within the meaning of the Health Insurance Act to practise the profession or perform any other activity in a centre operated by an institution if they obtain temporary authorization from the director of professional services, the chair of the council of physicians, dentists and pharmacists or a head of a clinical department of the institution. The order also lifted certain geographical restrictions, described in our previous bulletins.

On April 22, 2020, the declaration of a public health emergency in Quebec was renewed until April 29, 2020. Previous orders were also extended to that date.

On April 25, 2020, the Minister of Health and Social Services issued an order allowing public sector and government agency employees to be redeployed to the health sector. Redeployed personnel may benefit from, if applicable and with the necessary modifications, the bonuses and supplements available to salaried personnel in the health and social services network, as described in our previous bulletins.

Hospital services continue to be limited to urgent services, and there continues to be a large number of staff absent from the health care system as a result of the pandemic. The Premier of Quebec has turned to the Canadian Armed Forces for support in Quebec's long-term care system. The province is asking anyone with health care experience able to help to register at its Je Contribue website

Saskatchewan

The public health order issued on April 17, 2020, reported in our bulletin last week, continues to be the most current general order of the Chief Medical Health Officer. A new order was issued on April 24, 2020 limiting travel in the Northern Saskatchewan Administration District (NSAD). No person may travel to or out of the NSAD, with some exceptions including persons delivering critical public services and persons travelling for medical treatment. There is also a strong recommendation against non-essential travel between communities within northern Saskatchewan.

On April 23, 2020, the Saskatchewan Health Authority posted updated compassionate care visitor restrictions.

Also on April 23, 2020, the Premier and Chief Medical Health Officer of Saskatchewan announced a plan for re-opening the province. The declaration of a state of emergency, and measures and restrictions related to travel, gatherings and long-term care facilities/personal care homes will remain in place for the foreseeable future. Phase one (beginning May 4, 2020) includes re-opening previously restricted medical services (dentistry, optometry, physical therapy, optician services, podiatry, occupational therapy and chiropractic treatment). The plan includes specific guidelines for medical professionals.

Yukon

As of 5:00 pm (EST) on April 26, 2020, there have been no recent legislative changes or orders affecting the health sector in Yukon.

Federal

On April 22, 2020, the Canadian Government announced that it will remove the restriction on international students working a maximum of 20 hours per week while classes are in session, provided they are working in an essential service or function, such as health care.

On April 23, 2020, the Prime Minister announced more than $1 billion in support of medical research to fight COVID-19, including vaccine development and virus tracking. This will include the establishment of a COVID-19 Immunity Task Force.  Among the initiatives being funded, $600 million will be allocated to the Strategic Innovation Fund, over two years, to support COVID-19 vaccine and therapy clinical trials led by the private sector, and Canadian biomanufacturing opportunities.

 

Thank you to articling students Anna Lu, Fatima Husnain, Jessica Nolan, Marissa Di Lorenzo, Rachel Kardal and Rob Legge for their research assistance. 


[1]       This bulletin addresses updates published up to 5:00 pm (EST) on April 26, 2020.

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