Health profession regulators share concerns about public safety in proposed bill

A collection of health regulators told members of a Nova Scotia legislative committee on Monday that politicians should not tread on their expertise to expand scopes of practice at the potential expense of public safety, but government MLAs were unmoved.

At issue is a bill before the legislature that, among other things, would allow for scopes of practice to be broadened and changed without having to reopen legislation.

Dr. Gus Grant, registrar of the College of Physicians and Surgeons of Nova Scotia, said he is supportive of the government's attempt to expand access to health-care providers and to reduce barriers for professionals wanting to work in the province, but Grant and others pointed to language in the bill that creates unintended consequences.

As an example, Grant cited a provision in the bill that would allow scope of practice to be expanded based on a professional's training. Using his own background as an example, Grant explained to MLAs why it would be more appropriate for the provision to instead be based on competency.

"I delivered my last baby 20 years ago," he told the committee. "We're trained to deliver babies — I'm not competent to deliver babies today."

Grant also flagged concerns about a section of the bill that would give the government the power to identify international jurisdictions where Canadian license requirements could be waived. 

While the college is keen to get more international doctors and the credentials of some countries are already recognized, Grant said that doesn't make it an automatic fit for everywhere.

Medical training and practice vary greatly around the world, particularly when it comes to issues such as abortion, mental health, contraception, informed consent and medical assistance in dying. 

For that reason, Grant said, regulators must be involved in any such changes.

One by one, registrars and executive directors for 13 regulated professions in the province highlighted problems with the bill that, no matter how well meaning, opens the door to potential public safety problems.

Potential public safety problems

Stacy Bryan, registrar of the College of Dental Hygienists of Nova Scotia, pointed to a provision in the bill that calls for the mandatory waiving of registration and licensing requirements for anyone from another Canadian jurisdiction deemed to be in good standing.

The problem, Bryan and others noted, is that there is not a consistent definition of "good standing" across jurisdictions or professions — and many professions avoid the term for that reason.

As written, the bill could require regulators to license applicants from other jurisdictions who are "incompetent, incapacitated, lack character or have engaged in misconduct" because they are in good standing in the jurisdiction they're applying from. 

"And this is not consistent with a regulator's duty to ensure that Nova Scotians are protected in the delivery of health-care services," Bryan told MLAs.

The bill also includes a provision that removes the ability for regulators to assess whether an applicant has a disciplinary history elsewhere and would require a person to be licensed even if they do not have professional liability insurance. 

Byran said she is "certain that the government is not intending to permit uninsured health-care professionals to practise in this province."

"However, that's what the current wording of Bill 256 would allow."

At all times, Nova Scotians are entitled to receive care from competent and ethical professionals.- Ryan Baxter, specializes in health and regulatory law

Ryan Baxter, a lawyer who specializes in health and regulatory law, said the problems in the bill could have been avoided if the government consulted with regulators while it was being drafted.

Baxter presented a series of recommended changes, endorsed by regulators, that would address concerns about public safety while continuing to advance the government's objective of speeding up the regulatory process and improving patients' access to care.

But Baxter said the goal cannot be "more bodies at any cost."

"At all times, Nova Scotians are entitled to receive care from competent and ethical professionals," he told committee members.

The proposed changes would also address language that, as written in the bill, could require regulators to license someone even if they've been convicted of a criminal offence, he said.

"That's an unacceptable risk to the public, that's an unacceptable risk to Nova Scotians."

Opposition members of the committee attempted to hold the bill in committee until the recommendations from regulators could be considered by Health Department officials. 

They also proposed amendments in line with those recommendations.

But Tory MLAs Trevor Boudreau, John White, Melissa Sheehy-Richard, Steve Craig and Dave Ritcey used their majority on the committee to defeat those efforts and move the bill along to the next stage unchanged.

Boudreau, a chiropractor by training who is a member of a regulated body, said the government would give the submissions by regulators close consideration, adding that "robust and thoughtful regulations" would be coming with the act to ensure safety.

Grant told MLAs that if the government is not willing to amend the bill, it must include regulators in the drafting of regulations before enacting it.