12/02/2010

Amendments to the Health Promotion and Protection Act expand the powers of the Chief Medical Officer of Health.
On November 30, 2010, the Minister of Health and Long Term Care, Deb Matthews, introduced legislation that strengthens the role of the Chief Medical Office of Health in some areas of local decision making.

In June 2010, the Chief Medical Officer of Health (CMOH), Dr. Arlene King, released her report The H1N1 Pandemic - How Ontario Fared. The focus of this report is to provide a process review of the development of the pandemic, the efficacy of response and coordination and to provide an overview of “what went right” and “what went wrong”.

Acknowledging that the pandemic may not yet have run its course, and that the provincial government is waiting to see if there will be another upsurge, in an effort to assess processes to date, the CMOH, in the report, provides an overview of how things went during the first pandemic.

In reviewing Ontario’s response to the H1N1, the CMOH determined that strong centralized oversight should be in place to ensure a coordinated and effective response in the event of a public health emergency, such as a pandemic.

The changes the Minister of Health and Long Term Care is proposing build on Dr. King’s impressions of the response and coordination to the H1N1 and in anticipation of better preparation for future and potentially more devastating pandemics.

In response to the findings, the government has proposed the following amendments:

  • To require the approval of the Minister and the Chief Medical Officer of Health in order to appoint an acting medical officer of health for a term of six months or more.
  • The Act currently provides for the Minister, on the advice of the Chief Medical Officer of Health, to make an order for the possession of premises or part of premises to be used as a temporary isolation facility if there exists or is an immediate risk of an outbreak of communicable disease in Ontario.
  • The Act is amended to provide for the Minister to make an order for the possession of publicly owned premises or part of publicly owned premises for public health purposes if the Chief Medical Officer of Health is of the opinion that there exists or is an immediate risk of an outbreak of a communicable disease or there is an immediate risk to the health of persons in Ontario.
  • The Act is amended to provide for the Chief Medical Officer of Health to issue a directive to any board of health or medical officer of health requiring the adoption or implementation of certain policies or measures if there exists or there is an immediate risk of a provincial, national or international public health event, a pandemic or an emergency with health impacts in Ontario and the policies or measures are necessary to support a co-ordinated response or otherwise protect the health of persons. The directives may relate to infectious diseases, environmental health, public health emergency preparedness or a matter prescribed in regulations made by the Minister. The directive will not be in force for more than six months unless the Chief Medical Officer of Health consults with every affected board of health and medical officer of health.
Providing a government senior official with some of the authority of a Minister is not uncommon and also typical of emergency management planning. In the event of a pandemic, this may be beneficial by providing a streamlined and coordinated centre of control that is closer to the ground.

The amendment that extends provincial authority for MOH and MOH acting appointments does intrude upon the governance and administrative roles of Boards of Health. It is unclear to AMO what the impetus for this amendment is and its relation to the pandemic experience and report.

As partners in public health, AMO and municipalities certainly understand the desire for a prepared, well-organized and well-coordinated system.

However, the government must consider the impact of greater provincial oversight on local governance and accountability including local relationships and public confidence. Issues of funding responsibility, liability and indemnification must be clarified prior to these new CMOH powers being enacted.

AMO is hopeful that challenges experienced during the H1N1 can be improved upon in a collaborative manner with the goal of strengthening local planning and coordinated provincial- municipal responses in mind.