In early 2015, a group of health regulators in Ontario, including the College of Opticians Of Ontario (COO), formed a Working Group and began exploring the idea of regulating health clinics in Ontario. This group of health regulators have concerns with the current system where there are regulated professionals working for unregulated owners of clinics and also in cases where unregulated professionals are providing healthcare services. In Ontario some clinics are currently regulated such as pharmacies, hospitals, some dental and medical clinics, and long term care facilities. The group held webinars, town hall meetings and built a website. There was also a meeting held where professional associations were invited. The working group also accepted comments from stakeholders including the public. In all the Clinic Regulation Working Group received over 1,500 comments.
Why do we need clinics to be regulated? Below are a few examples of problem the Working Group has identified.
- A healthcare provider books 40 patient visits a day. Those patients are likely not getting quality care from the provider.
- A healthcare provider assigns most or all of the patient care to unregulated assistants. Patients may not be told that an assistant is treating them. The assistant may not have the required training and supervision to deliver the care safely.
- Clinics have poor infection control practices, such as reusing single-use instruments, or not cleaning equipment and supplies properly, exposing patients to risk of infections and contagious diseases.
- Clinics don’t keep patient records, or records are very poor quality. Patient records are not kept securely to prevent unauthorized access. Clinics refuse to release records to patients, healthcare providers, or payers when they request it.
- Clinics use a healthcare provider’s credentials to bill insurance companies without the provider’s knowledge or consent. Clinics bill for appointments that never happened. Clinics provide unnecessary services or products to patients in order to maximize billing.
- Clinics put out advertising that is misleading to the public. In some cases the healthcare professionals who work there may not be aware of the misleading advertising, or they are aware but have limited control over it, because it is done by the employer.
- Clinics use products or devices that have not been approved for use in Canada and may be unsafe.
- Clinics sell goods or products on the premises, and patients may think that the products are endorsed by the healthcare professional, which may not be true. In some cases selling products where healthcare professionals work is against the rules, because it is a conflict of interest.
The above problems pointed out by the Working Group are troublesome and I’m sure we will all agree need to be addressed. The question is: Is creating another regulatory body to oversee clinics the best way to address these concerns?
The Working Group feels that regulating clinics would benefit Ontarians by:
- Ensuring that clinics are safe for patients
- Requiring clinics, and thereby their owners, to act in patients’ best interest
- Promoting patient-centred care
- Helping patients make informed choices about where to seek care by providing a list of registered clinic near them that meets provincial standards
- Establishing safeguards against fraud and other inappropriate business practices
- Ensuring that health care services are provided by qualified individuals, and in the case of assistants, ensuring that they have appropriate supervision
- Promoting better ways to manage and protect patient records
As Registered Opticians our Standards Of Practice not only dictate how we practice but they also describe and “regulate” our work environment. So an optician that owns their own store is not only responsible for their actions but also for those in their employ. In this case the “clinic’ is regulated. But what happens in a case where an optician works for a company that is not owned by a registered optician? A complaint lodged against an optician for their actions is processed through the COO’s Complaints and Discipline committees. However, the COO can only deal with complaints against members of the COO in-house. If there has been a complaint lodged against a clinic owned by a non-registered professional it must be handled through the court system with the COO being the complainant. History has shown that this is a very arduous and costly process that seems to drag on. How about the situation where an optician is employed by a non-regulated employer and the employer’s policies don’t fully comply with the COO Regulations, Standards Of Practice and Policies? If the optician is asked to practice outside these rules they are accountable to the COO. What are the choices for an optician in these circumstances? Not many. The optician either goes ahead and breaks the rules or challenges their employer, which may lead to the optician being fired, or quitting.
So how can the public and opticians be safeguarded against non-regulated owners of clinics? The College of Opticians Of Manitoba has in place a system where an Optician of Record is ultimately responsible for what goes on in the clinic. In this model a Licensed Optician “takes the hit” for the owner when things go wrong. I’m not sure that I would want to be the Optician Of Record and take responsibility for actions from co-workers and my employer.
If clinics in our profession were to be regulated a positive outcome would be that the overall responsibility of what goes on in the clinic falls on the shoulders of the owner. This sounds good on the surface but in the end, who pays for this new regulatory agency? In a recent meeting the OOA had with the Ministry of Health & Long Term Care (MOHLTC) we were told that they applauded the Working Group on their initiative but did not endorse it or plan on funding it.
Usually when there is to be a new regulatory college the MOHLTC funds the creation and the members of the new college fund the operation. We were told there are no plans to fund this creation. So where will the money come from? It will have to come from the clinic or storeowner. And where does that money come from? It comes from raising prices or cutting expenses. Raising prices could have the effect of people seeking out cheaper unregulated venues to purchase their eyewear such as the Internet. Cutting expenses usually ends up in reducing staff. Would this result in a reduction of employed opticians? There’s no magic here. Regulation costs money.
Of course there are too many comments submitted for us to read them all but I found that an overriding question is whether the current model could be adjusted to address the concerns brought forward by the Working Group? In the case of insurance fraud wouldn’t the police be a good place to start? We’ve already seen in the past couple of years instances where the College Of Physicians And Surgeons (CPSO) have handled internally sexual abuse complaints when it’s obvious that a complaint of this nature is something that not only the professional body should be handling, but also our legal system. This is now being looked at by the CPSO after the Minister Of Health became aware of the situation.
The OOA submitted comments to the working suggesting that the current regulations could be reviewed and adjusted to deal with the concerns or possibly the Optician Of Record model could be instituted.
It will be interesting to see where the Working Group goes from here. My impression is that the majority of stakeholders don’t see the creation of a new regulatory body as the remedy to these real and perceived problems. At least with the information provided to this point. It will also be interesting to see what the Ministry has to say in response to the Working Group’s proposal. Stay tuned.