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Introduction to the Health Professions Appeal and Review Board

An Overview of Ontario’s Self-regulating Health Profession System

The Health Professions Appeal and Review Board is an adjudicative body with a review and appeal mandate established by provincial legislation under the Regulated Health Professions Act, 1991 (the RHPA). The RHPA provides a common framework for regulating Ontario’s self-regulated health professions. According to section 3 of the RHPA, there are several underlying objectives:

  • To ensure that the health professions are regulated and co-ordinated in the public interest;
  • To ensure that appropriate standards of practice are developed and maintained;
  • To ensure that individuals have access to services provided by the health professions of their choice; and
  • To ensure that individuals are treated with sensitivity and respect in their dealings with the health professionals, the Colleges, and the Board.

The Board is an integral component of the self-regulating health profession system in Ontario. It is responsible for conducting complaint and registration reviews and hearings concerning the Registration, Accreditation and Inquiries, Complaints and Reports Committee decisions of 28 self-regulated health professions in Ontario:

  • Audiology and Speech-Language Pathology
  • Chiropody
  • Chiropractic
  • Dental Hygiene
  • Dental Technology
  • Dentistry
  • Denturism
  • Dietetics
  • Transitional Council of Homeopathy
  • Transitional Council of Kinesiology
  • Massage Therapy
  • Medical Laboratory Technology
  • Medical Radiation Technology
  • Medicine
  • Midwifery
  • Transitional Council of Naturopathy
  • Nursing
  • Occupational Therapy
  • Opticianry
  • Optometry
  • Pharmacy
  • Physiotherapy
  • Psychology
  • Transitional Council of Psychotherapy
  • Registered Practical Nursing
  • Respiratory Therapy
  • Transitional Council of Traditional Chinese Medicine and Acupuncturists
  • Veterinary Medicine

The practice of each of these health professions and its members is governed by a College, pursuant to the provisions of the Health Professions Procedural Code (the Code). The Code is schedule 2 to the RHPA and is deemed by section 4 of the RHPA to be part of each health profession’s constituting act.

The Code requires that each College have its own Governing Council composed of members of the profession and the public, as well as certain specific committees to deal with complaints concerning members, registration matters, disciplinary matters, etc. Each College is responsible for developing and maintaining standards of qualification, practice, knowledge, continuing competence and ethics for its profession. The Colleges administer programs designed to protect the public interest. Each of the professions has a specific statute and regulations that set-out qualifications for registration, definitions of professional misconduct, and the composition and procedures of the governing councils.

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The Role of the Health Professions Appeal and Review Board

Through reviews and hearings, the Board monitors the activities of the Colleges' Inquiries, Complaints and Reports Committees and Registration or Accreditation Committees, in order to ensure they fulfill their duties in the public interest and as mandated by legislation. The Board provides a neutral forum for members of the public as well as for health professionals.

The Board also hears appeals concerning physicians’ hospital privileges in Ontario, pursuant to the Public Hospitals Act.

The Board is obliged to provide its written decision with reasons to the concerned parties and to the College.

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Organization of the Board

Pursuant to the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998, the Board is to consist of at least twelve members. One of its members is designated as the Chair, and two are designated as Vice-Chairs. Members are appointed by the Lieutenant-Governor in Council on the Minister’s recommendation for terms not exceeding three years, and may be reappointed. The practice is, however, not to re-appoint any given member for more than one additional term.

Proceedings before the Board are considered by a panel of one or three members, one of whom shall be the Chair, a Vice-Chair, or a Vice-Chair designated by the Chair.

Administrative and fiscal support is provided to the Board by the Ministry of Health and Long-Term Care. The support is provided through the Health Boards Secretariat, a branch of the Ministry. The Secretariat provides similar services to three other provincial adjudicative agencies affiliated with the Ministry. Certain services, staff, and facilities are shared.

The Secretariat also carries financial responsibility for all public appointees to the Colleges.

Offices of the Board and the Secretariat are located at 151 Bloor Street West, 9th floor, Toronto.

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Complaint Reviews

Most of the Board’s work consists of reviewing decisions of the Colleges' Inquiries, Complaints and Reports Committees. The Board’s review is the final legislated venue for the review of such complaint matters. Complaint reviews are oral or written proceedings, to which some provisions of the Statutory Powers Procedure Act, 1990, apply.

The review process is set-out in the Code and in the Board’s Rules of Practice. The parties to these reviews are the individual complainant(s) and the health professional(s) who are the subject(s) of the complaint. Either party may request a review and may have a lawyer or agent represent them. Although the attendance of parties is not mandatory, parties generally attend. Many complainants appear before the Board without legal counsel. Health professionals who are the subject of a complaint are often legally represented. The College, while generally represented at the review, is not a party to it.

The Board’s jurisdiction enables it to determine the adequacy of the Inquiries, Complaints and Reports Committees' investigations and/or the reasonableness of the Committees’ decisions.

After a complaint review, a number of dispositions are available to the Board pursuant to the Code. It may,

  1. Confirm all or part of the Committee’s decision;
  2. Make recommendations to the Inquiries, Complaints and Reports Committee (regarding, for example, professional standards or practice issues); or
  3. Require the Inquiries, Complaints and Reports Committee to do things it has the jurisdiction to do, such as further investigating and/or considering all or particular aspects of the complaint, or to make a particular disposition of the matter, such as,
    • Taking no further action;
    • Requiring remedial action of the member who is the subject of the complaint; or
    • Referring the member under investigation to the Discipline Committee.

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Registration Reviews and Hearings

Each of the self-governing health professions has its own requirements for registration. These requirements are part of the law and are set-out in each College’s registration regulation(s). A frequent question, and one involving the larger public interest, is whether an applicant may be exempted from aspects of the profession’s registration requirements.

Situations may involve applicants who have allowed their certificates of registration to lapse and, when reapplying, do not meet current requirements for (re)entering the profession. An educational program completed by an applicant in the 1970s or 1980s, for example, may well have met the professional requirements for registration at that time, but may not meet the educational program requirements for individuals currently seeking to enter the profession.

Registration matters before the Board often involve applicants who were trained and licensed to practice in either other provinces or other countries. In such cases, issues of equivalency of education and training, objective assessment of skills and knowledge, and the assurance of minimal standards for registration by the College commonly arise.

The Board conducts reviews and hearings of orders of the Registration Committees of the Colleges, and in the case of the College of Veterinarians of Ontario, its Accreditation Committee. The parties are the individual seeking to be registered or accredited, and the College. The applicant may choose to have either a documentary review of the Registration Committee’s order or an oral hearing before the Board.

After the hearing or review, the Board will make an order with written reasons for its decision, and provide it to the parties. The Board may,

  1. Confirm the order made by the panel of the College’s Registration Committee;
  2. Require the Registration Committee to order the College’s Registrar to issue a certificate of registration to the applicant if he or she successfully completes particular examinations or training the Committee may specify;
  3. Require the Registration Committee to order the College’s Registrar to issue a certificate of registration to the applicant, with or without the imposition of specific terms, conditions and limitations the Board considers appropriate ; or
  4. Refer the matter back to the Registration Committee for further consideration by a panel, together with any recommendations the Board considers appropriate.

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Hearings Under the Public Hospitals Act Concerning Physicians’ Hospital Privileges

Any applicant for appointment or reappointment to the medical staff of a hospital who was a party to a proceeding before the hospital board, and who considers himself or herself aggrieved by that board’s decision not to appoint or reappoint him or her to the medical staff, is entitled to a hearing before the Health Professions Appeal and Review Board.

Also entitled to a Board hearing is any member of a hospital’s medical staff who considers himself or herself aggrieved by any decision revoking, suspending, or substantially altering his or her appointment.

At the conclusion of a hearing the Board may either confirm or substitute in accordance with the Public Hospitals Act, its own opinion for the decision appealed from. The procedural provisions of the Statutory Powers Procedure Act, 1990, apply to hearings conducted by the Board under the Public Hospitals Act.

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