2. Irwin Fefergrad, C.S., B.A., B.C.L., LL.B
Building Transparency and Trust into Health Regulation Professional Standards Authority Building Trust in People and Places
March 10, 2017
Irwin Fefergrad, C.S., B.A., B.C.L., LL.B
Registrar, RCDSO
(Certified as a Specialist by the Law Society of
Upper Canada in Civil Litigation and Health Law)

3. Statutory Mandate Regulated Health Professions Act, 1991 (RHPA)
Acting in the public’s interest
Patient first

4. Who is the Audience? The Public The Complainant The Government
The Minister of Health
The Membership
The Member
The Media
Health Professions Appeal and Review Board (HPARB)
Appellate Courts

5. Balance What the Public needs to know What the Public wants to know
What the Legislation requires
What is the Right Thing to do as a regulatory body
What is Fair to the member

6. Public Consultation
POLLARA
Results from Public Consultation Process

7. Key Findings Public wants to know: Criminal Convictions
Status of Licence
Complaints resulting in Discipline and Educational Action

8. Pressures: Media

9. Pressures: Media

10. Pressures: Media

11. Pressures: Media

12. Pressures: Media

13. Pressures: Sometimes the Media gets it wrong

14. Pressures: Sometimes the Media gets it wrong

15. Pressures: Sometimes the Media gets it wrong

16. Pressures: Sometimes the Media gets it wrong

17. What is Public? Deficiencies on inspections: Discipline hearing status
Sedation
CT Scans
Discipline hearing status
Discipline hearing results including full Reasons
Full Notice of Hearing
Criminal findings of guilt
Bail conditions
Cautions
Registrations in other jurisdictions
Discipline findings in other jurisdictions
Criminal charges relevant to the practice
Health facility privileges
SCERPs
Terms, Conditions, Limitations

18. What is Public?
Website

19. CLINICAL/PRACTICE ISSUES MODERATELY CONCERNING
Risk Analysis Tool
LEVEL OF CONCERNS
CLINICAL/PRACTICE ISSUES
N/A
NO CONCERNS
SOMEWHAT CONCERNING
MODERATELY CONCERNING
SERIOUSLY CONCERNING
OTHER FACTORS
Patient Harm/Patient Safety
Clinical Knowledge/Understanding
Clinical Skill/Execution
Professional Judgement
Recordkeeping
Communication
Patient Informed Consent
Practice Management/Protocols
Billing/Financial
Proactive Remediation/Willingness to Address Issues
Insight/Reflection
Dishonesty/Breach of Trust
DEFINITIONS OF OUTCOMES
NO ACTION
Outcome is reflective of no or minimal risk
Information does not support taking any regulatory action
This outcome does not appear on the public register
ADVICE AND RECOMMENDATIONS
Outcome is reflective of low risk
Low risk – unlikely to have a direct impact on patient care, safety, or the public interest
Provided to the member where some room for improvement has been identified
Can include best practice advice and/or recommendations to review particular standards, articles, College publications, etc.
REMEDIAL AGREEMENT
Low risk – Unlikely to have a direct impact on patient care, safety, or the public interest
A voluntary agreement between the member and the College in which the member agrees to upgrade his or her skills in a non-clinical area of practice
Agreements may include in a period of practice monitoring
Agreements relate to non-clinical issues
SPECIFIED CONTINUING EDUCATION OR REMEDIATION PROGRAM (SCERP)
Outcome is reflective of moderate risk
Moderate risk – clinical issues requiring remediation or significant improvement through didactic or hands-on courses, mentoring, assessments and/or evaluations
A requirement for a member to upgrade his or her skills in a clinical area of practice
SCERPs will include a period of practice monitoring at the member’s expense
SCERPs relate to clinical issues that can have a direct impact on patient care and safety
This outcome appears on the public register until the SCERT has been successfully completed
UNDERTAKING
Outcome is reflective of moderate or high risk
Prior History
Effect on Public Interest/Confidence
One Time Incident vs. Pattern of Conduct
Governability
Wilfulness/Awareness/Level of Control
Cooperation with College
OTHER MITIGATING/AGGRAVATING FACTORS:

20. Risk Assessment Framework1.
No/Minimal Risk
No Action 2.
Low Risk
Advice/
Recommendation Remediate Agreement 3.
Moderate Risk
Caution
SCERP
Undertaking 4.
High Risk
Referral to Discipline
Interim Order
Undertaking – Restrict
Undertaking – Resign
Definitions of Risk Categories
No or Minimal Risk
Information does not support taking regulatory action
Low Risk
Unlikely to have a direct impact on patient care, safety, or the public interest
Moderate Risk
Clinical issues requiring remediation or significant improvement through didactic or hands-on courses, mentoring, assessments and/or evaluations
Concerns related to an aspect of the member’s conduct or practice that may have a direct impact on patient care, safety, or the public interest if not addressed
High Risk
Serious concerns regarding the member’s conduct or practice that are likely to have a direct impact on patient care, safety, or the public interest
Concerns cannot be addressed through other remedial actions, or previous remedial actions have been attempted unsuccessfully
Clinical issues requiring restrictions or conditions on practice, or a withdrawal or resignation from practice.
PUBLIC
(On or after October 1, 2015)

21. Questions?

22. Irwin Fefergrad, C.S., B.A., B.C.L., LL.B
Building Transparency and Trust into Health Regulation Professional Standards Authority Building Trust in People and Places
March 10, 2017
Irwin Fefergrad, C.S., B.A., B.C.L., LL.B
Registrar, RCDSO
(Certified as a Specialist by the Law Society of
Upper Canada in Civil Litigation and Health Law)