1. 1 MÉNARD, MARTIN, AVOCATS THE RIGHT TO SAFE CARE LEGAL ISSUES By: Mtre. Jean-Pierre Ménard, Ad. E.

2. 2 PATIENT SAFETY DEFINITION SAFETY:FREE FROM ACCIDENTAL INJURY ADVERSE EVENT: INJURY CAUSED BY MEDICAL MANAGEMENT RATHER THAN BY THE PATIENT’S UNDERLYING CONDITION FAULT: BREACH OF DUTY, BREACH OF STANDARD OF CARE

3. 3 RECENT AWARENESS REGARDING PATIENT SAFETY AN IMPORTANT NUMBER OF PATIENTS SUFFER FROM ADVERSE EVENTS AN IMPORTANT PART OF THOSE ADVERSE EVENTS CAN BE PREVENTED DETRIMENTAL ASSOCIATED EFFECTS TO ADVERSE EVENTS ARE : -INDIVIDUAL -FINANCIAL IMPACT -SOCIETAL IMPACT IT IS POSSIBLE TO REDUCE ADVERSE EVENTS AND THEIR CONSEQUENCES WE MUST LEARN FROM EXPERIENCE AND/OR ERRORS

4. 4 PATIENT SAFETY EMERGING ISSUES IN HEALTH CARE SERVICES DEVELOPMENT OF PATIENT SAFETY GROUPS INTERNATIONAL TREND INVOLVES LEGAL DEVELOPMENT

5. 5 BASIS OF A SAFETY PROCESS TO INCREASE PATIENT SAFETY -REPORTING ADVERSE EVENTS -PROTECTING THE PATIENT -ANALYSING ADVERSE EVENTS -RECOMMENDATION -IMPLEMENTATION

6. 6 BILL 113 – NOW INCLUDED IN THE ACT RESPECTING HEALTH SERVICES AND SOCIAL SERVICES (RSQ c. S-42.2) PATIENT’S RIGHT TO SAFETY OF CARE SAFETY OF CARE AS A MANAGEMENT AND CLINICAL FACTOR OBLIGATION TO REPORT INCIDENTS AND ACCIDENTS OBLIGATION TO DISCLOSE ACCIDENTS MEASURES TO BE TAKEN TO AVOID RECURANCE SUPPORT TO VICTIMS AND THEIR RELATIVES CREATE A RISK AND QUALITY MANAGEMENT COMMITTEE CREATE A: - LOCAL REGISTER - NATIONAL REGISTER FOR ACCIDENTS

7. 7 SAFETY OF SERVICES RIGHT TO SAFETY Section 5 HSSS (Health services and social services, An Act respecting, R.S.Q. c. S-4.2) EVERY PERSON IS ENTITLED TO RECEIVE, WITH CONTINUITY AND IN A PERSONALIZED AND SAFE MANNER, HEALTH SERVICES AND SOCIAL SERVICES WHICH ARE SCIENTIFICALLY, HUMANLY AND SOCIALLY APPROPRIATE.

8. 8 SAFETY OF SERVICES INTERPRETATION GUIDELINES Section 3 HSSS For the application of this Act, the following guidelines shall guide the management and provision of health services and social services: 1) the person requiring services is the reason for the very existence of those services; 2) respect for the user and recognition of his rights and freedoms must inspire every act performed in his regard;

9. 9 SAFETY OF SERVICES INTERPRETATION GUIDELINES (CONTINUED) Section 3 HSSS 3) the user must be treated, in every intervention, with courtesy, fairness and understanding, and with respect for his dignity, autonomy, needs and safety; 4) the user must, as far as possible, play an active role in the care and services which concern him; 5) the user must be encouraged, through the provision of adequate information, to use services in a judicious manner.

10. 10 DUTY TO REPORT INCIDENTS AND ACCIDENTS DEFINITIONS INCIDENT: An action or situation that does not have consequences for the state of health or welfare of a user, a personnel member, a professional involved or a third person, but the outcome of which is unusual and could have had consequences under different circumstances (183.2 (4) HSSS)

11. 11 DUTY TO REPORT INCIDENTS AND ACCIDENTS DEFINITIONS (CONTINUED) ACCIDENT: An action or situation where a risk event occurs which has or could have consequences for the state of health or welfare of the user, a personnel member, a professional involved or a third person. (8 (3) HSSS)

12. 12 DUTY TO REPORT INCIDENTS AND ACCIDENTS Who must report: (233.1 HSSS) Any employee of an institution Any professionnal practicing in the institution Any person undergoing training Any person under a service contract

13. 13 DUTY TO REPORT INCIDENTS AND ACCIDENTS (CONTINUED) TO WHOM: Executive director Person designated by the executive director (Practically: to the risk and quality management committee)

14. 14 DUTY TO REPORT INCIDENTS AND ACCIDENTS (CONTINUED) WHAT: Any accident or incident WHEN: As soon as possible

15. 15 OBLIGATION TO REPORT INCIDENTS AND ACCIDENTS (CONTINUED) HOW: In the form provided for such purposes, which shall be filed in the users’s record

16. 16 DUTY TO DISCLOSE HOLDER OF THE RIGHT USER (8 (2) HSSS) Representative of an incapable user of full age (tutor, curator, person mandated by the incapable, spouse, close relative, person proving that he has a special interest in the user of full age, holder of parental authority) (235.1 HSSS) Heirs, legatees by particular title and legal representatives of a deceased user (235.1HSSS)

17. 17 OBLIGATION TO DISCLOSE CONTENT (8 (2) HSSS) Any accident having occurred during the provision of services that has actual or potential consequences for the user's state of health or welfare Measures taken to correct the consequences suffered Measures taken to prevent such an accident from recurring

18. 18 SUPPORT MEASURES (235.1 HSSS) FOR WHOM: CONTENT: USER USER’S REPRESENTATIVE RELATIVES SUPPORT MEASURES INCLUDING THE APPROPRIATE CARE HOW:BY BY-LAW

19. 19 RISK AND QUALITY MANAGEMENT COMMITTEE COMPOSITION (183. 1 (3) HSSS) Balanced representation: - Employee - User - Professionnal - Contractual - Executive director or person designated by the executive director (ex officio)

20. 20 RISK AND QUALITY MANAGEMENT COMMITTEE TRAINING (183.1 (1) AND (2) HSSS) - DESCRIBED IN THE ORGANIZATION PLAN - REGULATION : NUMBER OF MEMBERS MANAGEMENT REGULATIONS

21. 21 RISK AND QUALITY MANAGEMENT COMMITTEE FUNCTIONS (183.2 HSSS) Seeking, developping and promoting ways to: Identify and analyse the risk of incidents or accidents in order to ensure the safety of users and, in particular in the case of nosocomial infections, prevent such risks and reduce their occurrence.

22. 22 RISK AND QUALITY MANAGEMENT COMMITTEE FUNCTIONS Make sure that support is provided to the victim and his relatives. Establish a monitoring system of incidents and accidents.

23. 23 RISK AND QUALITY MANAGEMENT COMMITTEE FUNCTIONS (CONTINUED) Create a local register of incidents and accidents for the purpose of analyzing the causes of incidents and accidents Recommend to the board of directors of the institution measures to prevent such incidents and accidents from recurring and any appropriate control measures.

24. 24 RISK AND QUALITY MANAGEMENT COMMITTEE PROTECTION OF INFORMATION (183.3 HSSS) Answers, informations or documents cannot be used or be admitted as evidence A risk manager or a member of a risk management committee cannot be compelled Nothing contained in a risk management record can be construed as an admission Records and minutes are confidential (183.4 HSSS)

25. 25 HEALTHCARE SECURITY ESTABLISHMENT OF A REGISTER 1. Local register of incidents and accidents (183.2 (3) HSSS) 2.National register of incidents and accidents (431 (6.2) HSSS)

26. 26 HEALTHCARE SECURITY ESTABLISHMENT OF A REGISTER (CONTINUED) GOAL OF THESE REGISTERS MONITORING AND ANALYZING THE CAUSES OF INCIDENTS AND ACCIDENTS ENSURING THAT MEASURES ARE TAKEN TO PREVENT SUCH INCIDENTS AND ACCIDENTS FROM RECURRING ENSURING THAT CONTROL MEASURES ARE IMPLEMENTED, WHERE APPROPRIATE

27. 27 CONCLUSION - SAFETY OF CARE INVOLVE INDIVIDUAL AND COLLECTIVE RESPONSABILITY - SAFETY OF CARE IS A PATIENT’S RIGHT - SAFETY OF CARE IS EQUALLY IMPORTANT FOR ALL THE CARE’S PROVIDERS - SAFETY OF CARE PROCESS INVOLVES AN INVESTIGATION INTO THE ROOTS CAUSES OF INCIDENT OR ACCIDENT TO PREVENT THE RECURRENCE