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To Zero: Independent Report of the Minister's Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991

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To Zero: Independent Report of the Minister's Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991 To Zero: Independent Report of the Minister's Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991 I am extremely proud of the dedication, expertise and calibre of the professionals who work within Ontario's health care system. But my top priority as Minister is to protect the safety and well-being of Ontarians, which is why we have asked the task force to take a look at the existing legislation to help prevent and deal with cases of sexual abuse of patients by regulated health professionals. - The Honourable Dr. Eric Hoskins, Minister of Health and Long-Term Care In each of these agencies, I am vulnerable. I may be asked questions about my medical history; I may be asked to remove some or all of my clothing; I may be touched in ways that feel personal. The system breaks down if I cannot trust that each and every person working within the walls of that agency will treat me professionally. -Patient The re-victimization occurs when they seek redress or justice and here it's the imbalance that is really striking in terms of access to resources ... Why should taxpayers support only the doctors - how is this patient-centred? How is this just? - Michael B. Deeter, chair of the board, Patients Canada; former Deputy Minister of Health Table of Contents Letter of Transmittal .....................................................................................................i Acknowledgments .......................................................................................................v Mandate .........................................................................................................................vii Executive Summary ....................................................................................................ix Chapter 1: Introduction and Recommendations ...........................................1 Chapter 2: Context for this Report..................................................................... 45 Chapter 3: A Systemic Betrayal of Trust: Survivors Speak ....................... 51 Chapter 4: The Why and How of Ontario’s Zero Tolerance Standard .......69 Chapter 5: Modernization of the Regulated Health Professions Act, 1991, for Health and Dignity......................................................................103 Chapter 6: Research and Education Priorities .............................................139 Chapter 7: Sustainable Transparency and Accountability .....................151 Contributors ..............................................................................................................161 Appendices.................................................................................................................169 A: Terms of Reference .....................................................................................171 B: Recommendations......................................................................................179 C: Correspondence .........................................................................................199 D: Summary of Questions to Health Regulatory Colleges, February 6, 2015 to July 22, 2015 ...............................................................215 E: Consultation Summary .............................................................................223 F: Relevant Sections of the Regulated Health Professions Act, 1991, and the Health Professions Procedural Code ............................237 G: Re-Vision: Zero Tolerance Applied ..........................................................275 H: Samples of Media Coverage, December 2014 to December 2015 ...........................................................................................289 I. Acronyms .........................................................................................................295 J. Table of Cases.................................................................................................297 Letter of Transmittal December 15, 2015 The Honourable Dr. Eric Hoskins Minister of Health and Long-Term Care Government of Ontario Since your appointment of this independent task force, which commenced on January 5, 2015, we have taken a patient-centred approach to reviewing the Regulated Health Professions Act, 1991 (RHPA) to assess whether it and related laws, policies and programs in Ontario uphold the standard of zero tolerance of sexual abuse of patients — as you requested. Soon after we began, the Honourable Roy McMurtry, regretfully, resigned for health reasons, reducing this expert panel from three to two. We appreciated the benefit of his contributions to developing our work plan, and we have been determined to deliver on the task you entrusted to us. We also wish to express our appreciation for the resources provided by your ministry to ameliorate some of the pressure on this task force. In the first six months of 2015, we heard from over 100 patients and presenters at public and private hearings, roundtables with experts in law, health policy and advocacy, faculty and students at five universities in Toronto, Hamilton, Ottawa and Thunder Bay. As well, we engaged with: • health regulatory colleges and professional associations representing regulated health care professionals, as well as individual professionals; • patients who have experienced sexual abuse by regulated health professionals; • organizations representing individuals who have experienced sexual abuse, sexual assault or other types of sexual violation; • institutions in which regulated health professionals are employed or hold privileges to practise. The sexual abuse of patients is a complex problem, and complex problems require complex solutions. Our recommendations to you are interlocking and multi-sectoral in nature, situated within an ecological human rights framework. Access to justice for all is a strong theme in this report. Letter of Transmittal i This task force was given the mandate to “examine the existing legislative scheme under the RHPA and provide advice and recommendations with respect to modernizing and reinforcing the province’s ongoing commitment to a zero tolerance policy for the sexual abuse of patients by regulated health professionals.” As well, the task force was asked to “undertake its work bearing in mind that patient experience is its primary focus, while also respecting the fundamental guiding principle set out in the RHPA regarding the self-regulatory model for all health regulatory colleges in the province.” In conveying our findings to you on “patient experience,” we are of the opinion that those from whom we did not hear from is also an important consideration. For example, although we consulted experts based in both urban and northern Aboriginal communities, we did not hear directly from any patients of Aboriginal origin. As well, we heard from very few patients who moved to Ontario from other countries, or patients living with disabilities. Nor did we hear from patients who self-identified as lesbian/gay/ bisexual/transgender/queer. Reform of the self-regulatory model as it pertains to the sexual abuse of patients is central to the substantive changes that this task force recommends as crucial for modernizing and reinforcing Ontario’s ongoing commitment to the zero tolerance of sexual abuse of patients by regulated health professionals. Upholding the standard of zero tolerance requires ongoing, courageous ministerial oversight with sustained silo-crossing within government and across various sectors of Ontario society. We believe that this government, under Premier Kathleen Wynne, with you as the Minister of Health and Long-Term Care and in cooperation with key Cabinet colleagues, can achieve what no other government has for patient safety and protection. The media’s freedom to question access to justice for sexually abused patients has alerted the public’s perception of the issue repeatedly in the 25 years since it was first raised in Ontario and the first task force was formed. While this is a cherished freedom in our democracy, government must do much more than rely on the media as the primary mechanism for transparency and accountability in patient safety. ii To Zero: Independent Report of the Minister’s Task Force on the Prevention of Sexual Abuse of Patients and the RHPA In this independent report, entitled To Zero: Independent Report of the Minister's Task Force on the Prevention of Sexual Abuse ofPatients and the Regulated Health Professions Act, 1991, recommendations are predicated on transparency and accountability in responding to the pressing need for immediate substantive changes and in sustaining the multi-sectoral reform necessary to achieve zero tolerance of sexual abuse of patients in Ontario. We are all patients. Patient safety is key to public safety. We thank you for this opportunity to serve the interests of public safety and trust. Sincerely, Marilou McPhedran, Sheila Macdonald, Task Force Chair Task Force Member Task Force Chair Marilou McPhedran; Minister of Health and Long -Term Care Dr. Eric Hoskins; and Task Force Member Sheila Macdonald. This page has been intentionally left blank Acknowledgments To the patients who came to the task force public hearings, or who wrote and called the task force, many of whom — having entrusted us with your reports of experiencing sexual abuse by a regulated health professional — chose not to be identified in this report: your voices can be heard throughout it. This minister’s task force operated entirely independently from the Ministry
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