An amended Quality of Care Information Protection Act, 2016 (QCIPA, 2016) (QCIPA) came into force in 2017 following recommendations made by a Review Committee with respect to greater transparency around quality of care reviews and investigations into critical incidents.
The Reason the Changes Were Made
Prior to these recent changes, the previous version of the Act had been in place since 2004. The purpose of the original Act was to encourage health professionals to freely discuss medical errors in confidence. The intent was to improve overall quality of patient care by allowing doctors to discuss errors without fear of reprisal.
The provisions of the original Act were quite powerful and permitted hospitals to refuse to disclose certain information about how a serious medical error happened to families of patients affected by the medical error, to the public, and to other hospitals.
In a series of investigations, the Toronto Star revealed several internal hospital investigations that had been kept secret under the previous Act, including:
- A baby that had been wrongly pronounced dead;
- A 33-year old woman who died after being admitted to hospital for a dental abscess; and
- A 20-year old man who was able to commit suicide while in hospital on suicide watch.
In each of these cases, neither the families of the patients nor the public received any information about the outcome of the hospitals’ investigations into the deaths. Due to this and other high-profile instances, the Act became seen by the public as a way for hospitals to shield themselves from lawsuits and legal liability.
In response to public outrage about the Act, a special committee made up of medical and legal experts was convened and tasked with finding ways to improve critical incident reporting. In September 2015, the committee made 12 recommendations for changing the Act.
The Purpose of the Amended QCIPA
The amended QCIPA is intended to encourage patients to participate in their health care and to encourage health care professionals to share information and have open discussions around improving the quality of health care in Ontario. This is evident in the legislation’s preamble, which states that:
The people of Ontario and their Government:
Believe in patient-centred health care;
Remain committed to improving the quality of health care provided by health facilities and maintaining the safety of patients;
Believe that quality health care and patient safety is best achieved in a manner that supports openness and transparency to patients and their authorized representatives regarding patient health care;
Recognize that health care providers and other staff in health facilities sometimes need to hold confidential discussions to identify and analyze errors affecting patients, systemic problems and opportunities for quality improvement in patient health care;
Believe that protections are needed to encourage and enable health care providers and other staff of health facilities to share all available information, provide honest assessment and opinions and participate in discussions to improve patient health care without fear of retaliation;
Believe that sharing information about critical incidents and quality improvement helps to improve the quality of health care for patients;
Are committed to ensuring that measures to facilitate the sharing of information for quality improvement purposes do not interfere with the right of patients and their authorized representatives to access information about their health care or with the obligations of health facilities to disclose such information to patients and their authorized representatives; and
Affirm that the inclusion of patients and their authorized representatives in the process of reviewing a critical incident helps to improve patient care, and therefore quality of care information protection must be implemented in a manner that supports such inclusion.
Some of the Changes Made
The new legislation and its related regulations attempt to strike a balance between protecting confidentiality of quality of care information in certain instances (such as in disclosure in lawsuits), giving patients and their families greater participation in the process, and providing them with more transparency.
Some noteworthy amendments to the Act include a definition of “critical incidents.” This new definition of critical incidents includes any unintended event that occurs when a patient receives health care from a health facility resulting in death, or serious disability, injury, or harm that was not from the patient’s underlying medical condition or from a known risk inherent in providing that health care. This new definition is the same as the definition of critical incident that previously existed in the Public Hospital’s Act.
Information that is collected by or prepared by a quality of care committee for the sole or primary purpose of carrying out its functions, and discussions by such a committee may be protected (i.e. private) under the amended QCIPA.
However, information that is not protected under the amended QCIPA (and must therefore be disclosed where necessary) include:
- Information contained in a patient record;
- Information contained in a record that is required by law to be created or to be maintained;
- Information relating to a patient involved in a critical incident which outlines:
- The facts of what occurred during the incident;
- What the quality of care committee, hospital, or other health care facility identifies as the cause(s) of the incident;
- The consequences of the critical incident for the patient;
- The actions that were taken or recommended to be taken to address the consequences of the critical incident (including any treatment);
- The systemic preventative steps (if any) that a hospital or other health care facility is taking or has taken to avoid similar incidents going forward.
- Facts contained in a record of incident involving the provision of health care to a patient.
If you or your child have been seriously injured due to medical error or negligence, contact Sommers Roth & Elmaleh. We are one of the oldest medical malpractice firms in Toronto, are highly respected amongst other lawyers, and have frequently been mentioned in the news. We offer compassionate and knowledgeable guidance on every aspect of a medical malpractice claim, and have helped clients from across Canada, including throughout Ontario, and in Alberta, British Columbia, Saskatchewan, and the Maritimes. Call us at 1-416-961-1212 or contact us online for a free consultation.
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