Scope of Practice Review: Medical Laboratory Technology

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Interprofessional Collaboration

Jurisdictional Review

October 2008 INDEX

Executive Summary ...... i

Ontario ...... 1

British Columbia ...... 23

Alberta ...... 24

Saskatchewan...... 30

Manitoba ...... 41

Quebec ...... 47

New Brunswick...... 51

Newfoundland/Labrador ...... 56

Northwest Territories ...... 57

Nova Scotia...... 58

Nunavut...... 62

Prince Edward Island ...... 62

Yukon...... 62

Canadian Society for Medical Laboratory Science...... 63

Australia (Queensland and South Australia)………………………………….. 67

New Zealand…………………………………………………………………....70

United Kingdom………………………………………………………………...82

EXECUTIVE SUMMARY

This jurisdictional review provides an overview of regulations concerning medical laboratory technologists (MLTs) across Canada and selected foreign jurisdictions.

Ontario, Alberta, Saskatchewan, Manitoba, Quebec, New Brunswick, and Nova Scotia have self- regulated bodies that govern the MLT profession. Several of these bodies advised that their provinces are currently reviewing proposals to determine how MLTs should continue to be regulated. The stage of these discussions varies across the provinces.

The scope of practice of MLTs varies little across Canadian jurisdictions. Provinces either define this term in the legislation or adopt it from the Canadian Society of Medical Laboratory Sciences (CSMLS) competency profile. Most often, it involves the “performance of laboratory investigations” and the “collection and handling of laboratory specimens.” Additionally, the affected provinces reserve the title of “medical laboratory technologist” for licensed professionals.

Of all the provinces, Ontario and Quebec have the most comprehensive regulatory regimes. Both provinces set out the scope of practice and provide for restricted activities/authorized acts for MLTs in provincial legislation.1 Moreover, Quebec gives MLTs the broadest scope of practice. It is the only province in which MLTs are permitted to perform PAP tests and allergy testing.

A minority of jurisdictions permit MLTs to decide on their own whether or not to perform follow-up procedures previously ordered on the basis that these are unnecessary. However, none of the jurisdictions permit MLTs to initiate testing on their own, unless the hospital or laboratory have policies in place that give prior permission for follow-up testing where certain test results are present.

Almost every province requires CSMLS certification for provincial licensure. One provincial regulatory body also requires CSMLS membership. In addition to providing a competency profile, the CSMLS also provides national standards of practice. These are the minimum standards across Canada. Provincial regulatory bodies also have their own standards of practice or code of ethics documents. These provincial standards govern in disciplinary matters within the mandate of the regulatory body.

In contrast to MLTs, Medical Laboratory Assistants/Technicians (MLA/Ts) are unregulated in all provinces. Several provinces have proposals to regulate MLA/Ts, but no province has completed this process. Selected Foreign Jurisdictions

The foreign jurisdictions surveyed take a different approach to Ontario’s regulation of MLTs. The first marked difference can be noted from the titles used. In Australia, MLTs are called Medical Laboratory Scientists. In New Zealand, the regulatory body governs both MLTs and MLA/Ts; they are called, respectively, Medical Laboratory Scientists and Medical Laboratory Technicians. In the United Kingdom, MLTs are referred to as Biomedical Scientists. These were formerly referred to as Medical Laboratory Technicians, but correspond to Ontario’s MLTs.

The next contrast to Ontario’s regulatory regime stems from the absence of specific authorized or restricted activities. No such acts are set out in the Queensland or South Australia jurisdictions. In New Zealand, restricted activities exist but none pertain to MLTs. Likewise, no restricted activities have been set out for MLTs in the United Kingdom.

The level of regulation also differs in these jurisdictions. There is no statutory registration for Medical Laboratory Scientists in any jurisdiction in Australia. However, some employers do require eligibility for professional membership of the Australian Institute for Medical Scientists (AIMS) for employment.

1 Ontario’s Medical Laboratory Technology Act, 1991, S.O. 1991, c.28 and Quebec’s Professional Code, R.S.Q. c. C-26.

AIMS is also the body gazetted by the Australian Government to assess the skills and qualifications of people wishing to migrate to Australia as medical scientists and medical laboratory technical officers.

In New Zealand, the Medical Laboratory Science Board (MLSB) regulates the equivalent of Ontario’s MLTs and MLA/Ts. It establishes the educational requirements and scope of practice for Medical Laboratory Scientists and Medical Laboratory Technicians. The MLSB also establishes a Code of Competencies and Standards for both professions. Of all four jurisdictions surveyed, New Zealand’s regulatory regime most closely resembles Ontario’s.

In the United Kingdom, health professionals are self-regulated. Biomedical scientists fall under the regulatory powers of the Health Professions Council (HPC). To use the title Biomedical Scientist, a candidate must register with the HPC. The HPC establishes standards of education, training, conduct and performance for members of the relevant professions. It also ensures the maintenance of those standards. The HPC requires candidates to hold a Certificate of Competence by the Institute of Biomedical Science.

ONTARIO

Regulatory Body College of Medical Laboratory Technologists of Ontario Pertinent Legislation Health Care Consent Act, 1996, S.O. 1996, c. 2, Sch. A Health Protection and Promotion Act, R.S.O. 1990, Chapter H.7 Independent Health Facilities Act, R.S.O. 1990, Chapter 1.3 Laboratory and Specimen Collection Centre Licensing Act, R.S.O. 1990, c.L.1 Laboratories, R.R.O. 1990, Reg. 682 Specimen Collection Centres, R.R.O. 1990, Reg. 683 Medical Laboratory Technology Act, 1991, S.O. 1991, c.28 General, O. Reg. 207/94 Professional Misconduct, O.Reg. 752/93 Occupational Health and Safety Act, R.S.O. 1990 Control of Exposure to Biological or Chemical Agents, R.R.O. 1990, Reg. 833 Health Care and Residential Facilities, O. Reg. 67/93 Needle Safety, O.Reg. 474/07 Private Hospitals Act, R.S.O. 1990, c.P.24 General, R.R.O. 1990, Reg. 937 Public Hospitals Act, R.S.O. 1990, c.P40 Regulated Health Professions Act, 1991, S.O. c.18 Controlled Acts, O-Reg. 107/96 By-Laws, Codes and Guidelines College of Medical Laboratory Technologists of Ontario: Consolidated Bylaws (May 8, 2008) Code of Ethics (May 2007) Standard of Practice for Medical Laboratory Technologists

1. SCOPE OF PRACTICE

Medical Laboratory Technology Act, 1991, S.O. 1991, c.28

3. The practice of medical laboratory technology is the performance of laboratory investigations on the human body or on specimens taken from the human body and the evaluation of the technical sufficiency of the investigations and their results.

2. AUTHORIZED ACTS

Medical Laboratory Technology Act, 1991, S.O. 1991, c.28

4. In the course of engaging in the practice of medical laboratory technology, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to take blood samples from veins or by skin pricking.

5.(1) A member shall not perform a procedure under the authority of section 4 unless the procedure is ordered by a member of the College of Physicians and Surgeons of Ontario or the Royal College of Dental Surgeons of Ontario or by a prescribed person.

General, O. Reg. 207/94 under the Medical Laboratory Technology Act, 1991, S.O. 1991, c.28

12. For the purposes of subsection 5 (1) of the [Medical Laboratory Technology] Act, the following are prescribed persons:

1. A member of the College of Midwives of Ontario.

2. A member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991.

3. CONDITIONS AND LIMITATIONS ON AUTHORIZED ACTS

(i) Restrictions on Controlled Acts

Regulated Health Professions Act, 1991, S.O. c.18

CONTROLLED ACTS RESTRICTED

27.(1) No person shall perform a controlled act set out in subsection (2) in the course of providing health care services to an individual unless,

(a) the person is a member authorized by a health profession Act to perform the controlled act; or

(b) the performance of the controlled act has been delegated to the person by a member described in clause (a).

Controlled Acts, O-Reg. 107/96 under the Regulated Health Professions Act, 1991, S.O. c.18

11. The taking of a blood sample from a vein or by skin pricking is an activity that is exempt from subsection 27(1) of the Act if the person taking the blood sample is employed by a laboratory or specimen collection centre licensed under the Laboratory and Specimen Collection Centre Licensing Act.

(ii) Restrictions on Testing and Specimen Collection

Laboratory and Specimen Collection Centre Licensing Act, R.S.O. 1990, c.L.1

TESTS PERMITTED

14.(1) Every owner and operator of a laboratory shall ensure that no tests are performed in the laboratory other than tests authorized by the licence, and no person employed in the laboratory shall knowingly participate in such tests.

SPECIMEN TAKING OR COLLECTING PERMITTED

(2) Every owner and operator of a specimen collection centre shall ensure that no specimen taking or collecting is carried out in the specimen collection centre other than specimen taking or collecting authorized by the licence, and no person employed in the specimen collection centre shall knowingly participate in such specimen taking or collecting.

(iii) Laboratory Requirements

Laboratories, R.R.O. 1990, Reg. 682 under the Laboratory and Specimen Collection Centre Licensing Act, R.S.O. 1990, c. L.1

9.(1) The owner and the operator of a laboratory shall ensure that the staff of the laboratory,

(a) examine specimens from humans only, (i) at the request of a legally qualified medical practitioner or a dentist, (ii) at the request of a midwife, in respect of a test specified in Appendix B, (ii.1) at the request of a person who lawfully practises a health profession in a jurisdiction outside Ontario, if in that jurisdiction a laboratory may lawfully examine specimens at the request of that person, (iii) at the request of an insurer or an agent within the meaning of the Insurance Act, in respect of HIV Antibody testing, (iv) at the request of a registered nurse who holds an extended certificate of registration under the Nursing Act, 1991, in respect of a test specified in Appendix C, or (v) at the request of a person who is a participant in the provincial colorectal cancer screening program, in respect of a test or tests for the purposes of the program; (a.1) report the results of tests performed as part of the provincial colorectal cancer screening program to Cancer Care Ontario for the purposes of the Colorectal Cancer Screening Registry;

(b) except in the case of a person described under subclause (a) (v), report the results of a test directly to the person who requested it and include in the report the name of the laboratory that received the specimen and the name and address of the laboratory in which the test was performed;

(b.1