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