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The Sars Commission Second Interim Report Sars And THE SARS COMMISSION SECOND INTERIM REPORT SARS AND PUBLIC HEALTH LEGISLATION The Honourable Mr. Justice Archie Campbell Commissioner April 5, 2005 SECOND INTERIM REPORT ♦ SARS AND PUBLIC HEALTH LEGISLATION Table of Contents Table of Contents Dedication Letter of Transmittal INTRODUCTION AND EXECUTIVE SUMMARY ................................................. 1 1. Medical Independence and Leadership ............................................................. 15 The Commission’s Earlier Findings and Recommendations..................................17 Chief Medical Officer of Health: What the Government Did ...............................22 Independence of the Chief Medical Officer of Health: Finishing the Task .........27 Power Over Assessors ..................................................................................................27 Public Health Laboratories...........................................................................................30 Enforcement Powers ....................................................................................................33 Powers over Inspectors ................................................................................................34 Powers to Remain with the Minister of Health and Long-Term Care..................35 Parallel Independence of Local Medical Officers of Health...................................38 A Continued Need for Greater Central Control over Health Protection.............41 Public Health Emergency Preparedness and Response...........................................46 Protection from Personal Liability..............................................................................55 Conclusion......................................................................................................................56 Recommendations.........................................................................................................56 2. Local Governance ............................................................................................... 59 Introduction ...................................................................................................................59 Fundamental Governance Problems..........................................................................62 Should Municipalities Get out of Public Health? .....................................................69 Give the Present System Another Try – Increased Pay for Increased Say ...........70 The Argument for Local Control................................................................................73 Upload Public Health Funding and Control 100 Per cent to the Province..........76 Association Of Municipalities’ Position.....................................................................80 Local Health Integrated Networks..............................................................................80 Conclusion on Uploading.............................................................................................83 Municipal Bureaucracies...............................................................................................86 Strengthening Accountability.......................................................................................91 Monitoring, Auditing and Enforcement ....................................................................95 Composition & Qualification of Boards of Health................................................102 Good Governance Best Practices .............................................................................108 Conclusion....................................................................................................................110 Recommendations.......................................................................................................111 3. HPPA Tuneup ...................................................................................................114 Overview of the Act....................................................................................................116 Simplify Disease Categories .......................................................................................118 Two Streams of Power ...............................................................................................120 Clarify Standards for Intervention ............................................................................124 i SECOND INTERIM REPORT ♦ SARS AND PUBLIC HEALTH LEGISLATION Table of Contents Strengthen Section 22 .................................................................................................126 Conclusion....................................................................................................................127 Recommendations.......................................................................................................128 4. Stronger Health Protection Powers ...................................................................129 The Relationship Between Public Health and Hospitals.......................................131 Information ..................................................................................................................134 Investigation.................................................................................................................139 Case Classification .......................................................................................................147 Directives......................................................................................................................152 Power to Detain...........................................................................................................157 Power to Enter A Dwelling-House ..........................................................................164 Conclusion....................................................................................................................171 Recommendations.......................................................................................................172 5. Reporting Infectious Disease ............................................................................175 Current Reporting Requirements..............................................................................176 In Hospital or Out of Hospital..................................................................................178 Expanding the Categories of those who must Report...........................................181 Broad Powers to Obtain Information......................................................................187 Timing ...........................................................................................................................192 Content of the Report.................................................................................................194 Reporting Contacts of Cases......................................................................................198 Standardizing Reporting .............................................................................................199 Reporting – Education and Awareness....................................................................201 Reciprocal Reporting Obligations.............................................................................205 Conclusion....................................................................................................................208 Recommendations.......................................................................................................209 6. Privacy and Disclosure.......................................................................................213 Ontario’s Privacy Legislation .....................................................................................213 Disclosures by a Medical Officer of Health or the Chief Medical Officer of Health..................................................................................................................218 The Need for Clarity ...................................................................................................221 Disclosure for Research..............................................................................................226 Privacy Safeguards.......................................................................................................227 Conclusion....................................................................................................................228 Recommendations.......................................................................................................229 7. Whistleblower Protection...................................................................................231 The Case for Whistleblower Protection...................................................................231 Principles of Whistleblower Protection....................................................................240 Conclusion....................................................................................................................248 Recommendation.........................................................................................................248 8. Quarantine ........................................................................................................ 250 Introduction .................................................................................................................250 Public Cooperation......................................................................................................250
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