1. The Ombudsman and Health Care

2. For more details… Throughout the presentation, when you see this symbol, you can click on it for more details:

3. What is an Ombudsman? A parliamentary Ombudsman works to ensure that citizens are treated fairly by government institutions. – Appointed by Legislative Assembly – Provides independent, impartial and objective review of administrative fairness*

4. *For more information, see our information sheet Administrative v. Clinical Decision at http://www.ombudsman.sk.ca/uploads/document/fil es/admin-vs-clinical-decisions-en-1.pdf More…

5. What Does Ombudsman Saskatchewan Do? Promotes and protects fairness in the design and delivery of public services. – Independent and objective reviews of administrative fairness – Promotes fairness – Works to resolve complaints from members of public toward agencies of government – Investigates system-wide issues – Makes recommendations

6. What organizations fall within our jurisdiction? Provincial government: – agencies – boards (including Regional Health Authorities and the Saskatchewan Cancer Agency) – commissions, Crown corporations – Ministries (including the Ministry of Health) – New : health care organizations, including affiliates as defined in The Regional Health Services Act – New : others, on special request

7. Limits to Our Authority We do not look at complaints against: – federal & municipal government – decisions of cabinet – courts, police – school boards – individuals – clinical decisions of health care professionals* – private companies (with exceptions, such as certain ambulance services)

8. *For more information, see our information sheet Administrative v. Clinical Decision at http://www.ombudsman.sk.ca/uploads/document/fil es/admin-vs-clinical-decisions-en-1.pdf More…

9. How do we handle complaints? It depends. We have a range of services and use them to address complaint appropriately. InvestigationMediationNegotiation Facilitated Communication Coaching Appropriate Case Resolution

10. What to Expect An unbiased approach. – We will talk with the complainant. – We talk with the government agency. – We decide how to proceed. – We are not advocates for either side; but we advocate for fairness!

11. Our Authority to Inquire Clause 25(7)(b) of the Act allows the Ombudsman to collect information, even when the information we seek is normally protected information pursuant to legislation such as HIPA Subsection 25(9) of the Act protects those who provide information at the request of the Ombudsman

12. Clause 25(7)(b) states: a provision of an Act requiring a person to maintain secrecy in relation to, or not to disclose information relating to, any matter shall not apply with respect to an investigation by the Ombudsman Subsection 25(9) states: No person is liable to prosecution for an offence against any Act by reason of the persons compliance with any requirement of the Ombudsman pursuant to this section. More…

13. How do we assess fairness?

14. The Ombudsman Act, 2012* *A revised Act that came into force in September 2012 Implications for Health Jurisdiction previously included: – Regional Health Authorities, The Saskatchewan Cancer Agency and The Ministry of Health Jurisdiction now expanded to include: – A health care organization, including an affiliate, as defined in The Regional Health Services Act

15. *The Ombudsman Act, 2012 is available online at: http://www.ombudsman.sk.ca/info/legislation More…

16. The Regional Health Services Act Clause 2(1)(h) of the Act defines a health care organization as: – (i) an affiliate (which is defined in the Act as a hospital or not for profit special care home that was in existence when that Act came into force); or – (ii) a prescribed person that receives funding from a regional health authority to provide health services

17. Who are Affiliates? To be within our jurisdiction, an affiliate must: – have been in operation prior to 2002; and – have been approved pursuant to The Hospital Standards Act or The Housing and Special Care Homes Act

18. Sec. 2(1)(a) of The Regional Health Services Act states: affiliate means a person who immediately before coming into force of this section, is the operator of a hospital approved pursuant to The Hospital Standards Act or not-for-profit special-care home licensed pursuant to The Housing and Special- care Homes Act, and includes any successor to that operator but does not include a regional health authority or a prescribed person. (We have jurisdiction over affiliates, which are entities that, as of August 1, 2002, were operators of approved facilities as described in the definition of affiliate, including the successors of these entities.) More…

19. Who are Prescribed Persons? Need to be listed in Table 1 of The Regional Health Services Administration Regulations*; and Need to be in receipt of funding from a Regional Health Authority; and Need to be providing a health service (as defined in subsection2(2.2) of the regulations)

20. *The Regional Health Services Administration Regulations are online at http://www.qp.gov.sk.ca/documents/english/Regulations/Regulations/r8-2r1.pdf http://www.qp.gov.sk.ca/documents/english/Regulations/Regulations/r8-2r1.pdf The Regional Health Services Administration Regulations: Subsection 2(2.2) For the purposes of subclause 2(1)(j)(i) of the Act, the following services are health services. Prescribed Services could include the following: alcohol, drug or substance abuse or addiction assessment, education and treatment services; (b) chronic disease management services; (c) community health services; (d) convalescent care and palliative care services; (e) counseling services; (f) diagnostic imaging services; (g) disability management services; (h) disease and injury prevention services; (i) emergency medical response services; (j) emergency stabilization services; (k) health assessment and screening services; (l) health education services; (m) health promotion services; (n) home care services; (o) hospital services; (p) laboratory services; (q) long-term care services; (r) medical services; (s) mental health services; (t) nursing services; (u) personal care services; (v) physician services; (w) provision of drugs, medical supplies and surgical supplies; (x) public health services; (y) registered nurse or nurse practitioner services; (z) rehabilitation services; (aa) specialty and subspecialty medical services and surgical services; (bb) therapy services; (cc) any other goods and services ancillary or incidental to health promotion and protection or respecting the care, treatment or transportation of sick, infirm or injured individuals. More…

21. New In-Jurisdiction Bodies Examples of health care organizations that now fall within our jurisdiction: – special care homes (both affiliates &/or those listed in the regulations) – mental health services – emergency medical services – ambulances – hospitals & health care centers – addiction services & treatment centers – residential treatment centers

22. New Obligations Subsection 20(4) of The Ombudsman Act, 2012 creates an obligation on designated facilities with residents in care to develop procedures and provide the means for residents to communicate in private with the Ombudsman, and to inform residents in care of their right to communicate in private with the Ombudsman, the services provided by the Ombudsman, and how to reach the Ombudsman.

23. Section 10 of The Regional Health Services Act: Designation of Facilities 10 The minister may designate all or part of a facility operated by a regional health authority or, a health care organization or the cancer agency to one of the categories of facilities established in the regulations. Section 4 of The Mental Health Services Act: Facilities 4 (1) The minister may designate mental health centres, mental health clinics, psychiatric wards and any other buildings or parts of buildings for the purpose of providing mental health services. (2) A facility may not change its name or be given a name without the prior written approval of the minister. Section 3 of The Youth Drug Detoxification and Stabilization Act: Detoxification facilities 3 Subject to the regulations, the minister may: (a) designate a building or part of a building as a detoxification facility for the purposes of this Act; and (b) designate the person or persons who are in charge of the detoxification facility. More…

24. Definitions… Designated facility means a facility owned or operated by a publicly funded health entity that is designated by the minister pursuant to: – Section 10 of The Regional Health Services Act – Section 4 of The Mental Health Services Act – Section 3 of The Youth Drug Detoxification and Stabilization Act Resident in care means a person who is located in a designated facility and is receiving services.

25. Resident in care, in a designated Facility: The Act doesnt specify the definition of resident in care any more than this. We believe that in order to fall within this section 20, the facility must provide services to residents in care. It is the type of relationship that the patient has with the facility that should dictate whether he or she is a resident in care. For example, a person in an emergency room for a few hours is likely not caught by the definition. But a person receiving convalescent care in a hospital for a week or two could be considered a resident in care. Special care, long term care, for example. More…

26. Reduced Authority in Health Normally the Ombudsman has the authority to compel a person to give evidence. Clause 25(7)(d) of the new legislation says this authority does not apply to documents prepared and evidence given in certain health-related proceedings as described in section 10 of The Evidence Act and section 58 of The Regional Health Services Act.

27. The Evidence Act: Evidence before quality improvement committees privileged 10(1) In this section: committee means a committee designated as a quality improvement committee by a health services agency to carry out a quality improvement activity the purpose of which is to examine and evaluate the provision of health services for the purpose of: (a) educating persons who provide health services; or (b) improving the care, practice or services provided to patients by the health services agency; (« comité ») health services agency means: (a) a regional health authority as defined in The Regional Health Services Act; (b) a health care organization as defined in The Regional Health Services Act; (c) the operator of a facility as defined in The Mental Health Services Act; (d) the Saskatchewan Cancer Agency continued by The Cancer Agency Act; or (e) the Athabasca Health Authority Inc.; (« organisme de services de santé ») legal proceeding means any civil proceeding or inquiry in which evidence is or may be given, and includes a proceeding for the imposition of punishment by way of fine, penalty or imprisonment to enforce an Act or a regulation made pursuant to an Act. (« instance judiciaire ») More… Continued…

28. The Regional Health Services Act Critical incidents 58 (1) In this section: (a) critical incident means an incident that: (i) arises as a result of the provision of a health service by a regional health authority, a health care organization or the cancer agency; and (ii) is listed or described as a critical incident in the Saskatchewan Critical Incident Reporting Guideline, 2004 published by the department, as amended from time to time, or any subsequent edition of the Saskatchewan Critical Incident Reporting Guideline; (b) legal proceeding means any civil proceeding or inquiry in which evidence is or may be given, and includes a proceeding for the imposition of punishment by way of fine, penalty or imprisonment to enforce an Act or regulation made pursuant to an Act, but does not include any prescribed proceeding; (c) regional health authority, with respect to a critical incident that arises as a result of a health service provided by a health care organization, means the regional health authority of the health region in which the health service was provided. (2) A regional health authority shall, in accordance with the regulations: (a) give notice to the minister of the occurrence of any critical incident that arises as a result of a health service provided by the regional health authority; and (b) investigate any critical incident mentioned in clause (a) and provide a written report to the minister with respect to that critical incident and investigation. More… Continued…

29. ( 3) A health care organization shall, in accordance with the regulations: (a) give notice to the regional health authority of the occurrence of any critical incident that arises as a result of a health service provided by the health care organization; and (b) investigate any critical incident mentioned in clause (a) and provide a written report to the regional health authority with respect to that critical incident and investigation. (4) A regional health authority shall: (a) give notice to the minister of any critical incident with respect to which the regional health authority receives notice from a health care organization; and (b) provide the minister with a copy of any report with respect to a critical incident received by the regional health authority from a health care organization. (4.1) The cancer agency shall, in accordance with the regulations: (a) give notice to the minister of the occurrence of any critical incident that arises as a result of a cancer care service provided by the cancer agency; and (b) investigate any critical incident mentioned in clause (a) and provide a written report to the minister with respect to that critical incident and investigation. More… Continued…

30. (5) Subject to subsection (7), a witness in a legal proceeding, whether a party to it or not: (a) is not liable to be asked any question, is not permitted to answer any question and is not permitted to make any statement, with respect to an investigation of a critical incident; and (b) is not liable to be asked to produce, and is not permitted to produce: (i) any notice or report mentioned in this section; or (ii) any information in a notice or report mentioned in this section or any documentation used to prepare a notice or report mentioned in this section. (6) Subject to subsections (7) and (8), a notice or report mentioned in this section is not admissible as evidence in any legal proceeding. (7) The privileges described in subsections (5) and (6) do not apply: (a) to information in a notice or report that discloses the facts of a critical incident unless the facts relating to that incident are also fully recorded in a record other than the notice or report and are available to the patient; or (b) to information that is prepared for the purpose of providing care or treatment to a patient, unless that information is also fully recorded in a record other than the notice or report and is available to the patient. (8) Nothing in this section affects any privilege that may exist pursuant to section 10 of The Evidence Act with respect to: (a) a notice or report mentioned in this section; (b) any information provided in a notice or report mentioned in this section; or (c) any documentation used to prepare a notice or report mentioned in this section. More…

31. Is there a way to be proactive about fairness? We think so. Thats why we: – deliver Fair Practices training. – meet to talk about how we look at fairness and what we expect. – encourage staff and officials to ask our advice when they are deciding how to roll out new programs or policies(Fairness Lens).

32. We want to hear from you Questions? Advice? Feedback? About … the Ombudsmans role in health raising awareness (in general and with new jurisdiction and procedures) respecting our neutrality

33. Regina Phone: 1-800-667-7180 Fax: 1-306-787-9090 Address: 150 – 2401 Saskatchewan Drive Regina, SK S4P 3V7 Saskatoon Phone: 1-800-667-9787 Fax: 1-306-933-8406 Address: 315 – 25 th Street East Saskatoon, SK S7K 2H6 www.ombudsman.sk.ca Contact us…