A A A

Third Session, Thirty-Eighth Legislature

This version is based on the printed bill that was distributed in the Legislature after First Reading.   It is not the official version.   If accuracy is critical, you can obtain a copy of the printed bill from Statutory Publications.

Bill 17

THE REGIONAL HEALTH AUTHORITIES AMENDMENT AND MANITOBA EVIDENCE AMENDMENT ACT


Explanatory Note

(Assented to                                         )

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:

PART 1

THE REGIONAL HEALTH

AUTHORITIES ACT

C.C.S.M. c. R34 amended

1           The Regional Health Authorities Act is amended by this Part.

2           The following is added after section 53:

PART 4.1

PATIENT SAFETY

Definitions

53.1        The following definitions apply in this Part.

"critical incident" means an unintended event that occurs when health services are provided to an individual and results in a consequence to him or her that

(a) is serious and undesired, such as death, disability, injury or harm, unplanned admission to hospital or unusual extension of a hospital stay, and

(b) does not result from the individual's underlying health condition or from a risk inherent in providing the health services. (« incident critique »)

"critical incident review committee" means a committee of one or more individuals established under subsection 53.3(1) or 53.4(1). (« comité d'examen des incidents critiques »)

"personal health information" means personal health information as defined in The Personal Health Information Act. (« renseignements médicaux personnels »)

"personal information" means personal information as defined in The Freedom of Information and Protection of Privacy Act. (« renseignements personnels »)

Critical incident: disclosure and recording

53.2(1)     Regional health authorities, health corporations and prescribed health care organizations must establish written procedures respecting providing information about and recording critical incidents as required in subsection (2), in accordance with guidelines approved by the minister.

Duty to inform individual re critical incident

53.2(2)     If a critical incident occurs when a regional health authority, health corporation or prescribed health care organization is providing health services to an individual, the authority, corporation or organization must ensure that

(a) appropriate steps are taken to fully inform the individual, as soon as possible, about

(i) the facts of what actually occurred with respect to the critical incident,

(ii) its consequences for the individual as they become known, and

(iii) the actions taken and to be taken to address the consequences of the critical incident, including any health services, care or treatment that are advisable;

(b) a complete record is promptly made about the critical incident, which includes

(i) the facts of what actually occurred with respect to the critical incident,

(ii) its consequences for the individual as they become known, and

(iii) the actions taken and to be taken to address the consequences of the critical incident, including any health services, care or treatment that are advisable; and

(c) the record described in clause (b) is available to be examined and copied by the individual at no cost.

If individual lacks capacity or is deceased

53.2(3)     If an individual lacks the capacity to understand the nature and consequences of a critical incident, or is deceased, the information required to be provided and the record to be made available under subsection (2) must be provided or made available to a person authorized by the regulations to receive information and records on the individual's behalf.

Critical incident: health corporation or organization

53.3(1)     Except as provided in subsection (6), if a critical incident occurs when health services are provided to an individual by a health corporation or a prescribed health care organization, the corporation or organization must promptly

(a) notify the regional health authority for the health region in which the critical incident took place about the critical incident, in accordance with guidelines established by the regional health authority; and

(b) in consultation with the regional health authority, establish a critical incident review committee, consisting of one or more individuals satisfactory to the regional health authority, to investigate and report respecting the critical incident.

Regional health authority to notify minister

53.3(2)     Promptly upon being notified about a critical incident under subsection (1), the regional health authority must notify the minister about the critical incident.

Investigation and reports of review committee

53.3(3)     A critical incident review committee established under subsection (1) must, in accordance with the health corporation's or prescribed health care organization's directions,

(a) investigate the critical incident and, during the investigation, provide information and reports to the corporation or organization as requested; and

(b) upon completing the investigation, report its findings and recommendations to the corporation or organization in writing.

Reports to regional health authority

53.3(4)     In accordance with guidelines established by the regional health authority, the health corporation or prescribed health care organization must provide information and reports to the authority about the critical incident and the critical incident review committee's investigation, including a written report upon completion of the investigation.

Reports by regional health authority to minister

53.3(5)     The regional health authority must provide information and reports to the minister about the critical incident and the critical incident review committee's investigation, including a written report upon completion of the investigation.

Exception: designated organizations

53.3(6)     Subsections (1) to (5) do not apply to a prescribed health care organization that is designated by regulation.  Instead, an organization that is designated must

(a) notify and report to the minister, rather than the regional health authority, if a critical incident occurs; and

(b) comply with the duties imposed on a regional health authority in section 53.4, with the necessary changes.

Critical incident: regional health authority

53.4(1)     If a critical incident occurs when health services are provided to an individual by a regional health authority, the authority must promptly

(a) notify the minister about the critical incident; and

(b) establish a critical incident review committee to investigate and report respecting the critical incident.

Investigation and reports of review committee

53.4(2)     A critical incident review committee established under subsection (1) must, in accordance with the regional health authority's directions,

(a) investigate the critical incident and, during the investigation, provide information and reports to the regional health authority as requested; and

(b) upon completing the investigation, report its findings and recommendations to the regional health authority in writing.

Reports to minister

53.4(3)     The regional health authority must provide information and reports to the minister about the critical incident and the critical incident review committee's investigation, including a written report upon completion of the investigation.

Minister's guidelines

53.5        The minister may establish guidelines respecting investigations to be carried out, and notices and reports to be provided, under this Part.

Review committee may require information

53.6(1)     For the purpose of carrying out its duties under this Part, a critical incident review committee may require a health corporation, prescribed health care organization, regional health authority, health care provider or other person providing health services that has information or custody or control of a document or record — including a record containing personal health information or personal information — relating to the critical incident being investigated to provide the information, document or record to the review committee.

Limit re personal health information and personal information

53.6(2)     A critical incident review committee must limit personal health information and personal information to be provided under subsection (1) to the minimum amount necessary to properly carry out its duties under this Part.

Sharing of information between review committees

53.6(3)     If a critical incident involves more than one health corporation, prescribed health care organization or regional health authority, the members of the critical incident review committees established to investigate it may share information, documents and records — including records containing personal health information or personal information — with each other to the extent necessary to properly carry out their duties under this Part.

Limit re personal health information and personal information in notices and reports

53.7        A notice, report or information provided under this Part may include personal health information and personal information.  But personal health information and personal information must be limited to the minimum amount necessary to accomplish the purposes of this Part.

Discovery of information to be provided to individual

53.8        If, in the course of investigating a critical incident, a critical incident review committee becomes aware of information that should be, or should have been, provided to an individual or included in a record under subsection 53.2(2),

(a) the review committee must notify the health corporation, prescribed health care organization or regional health authority responsible for providing or recording the information; and

(b) the corporation, organization or authority must ensure that the information is promptly provided or recorded as required under subsection 53.2(2).

Retaliation prohibited

53.9        No person shall dismiss, suspend, demote, discipline, harass or otherwise disadvantage another person because that other person has complied with a requirement to provide information, documents or records under this Part.

Limit on access to records re critical incident

53.10(1)    No person, including an individual information is about, has a right of access under any Act or regulation — including under Part 2 of The Freedom of Information and Protection of Privacy Act or Part 2 of The Personal Health Information Act — to any of the following:

(a) a notice provided under section 53.3 or 53.4;

(b) a record or information — including an opinion or advice — prepared solely for the use of a critical incident review committee, or collected, compiled or prepared by a critical incident review committee for the sole purpose of carrying out its duties under this Part;

(c) a report, record or information that is required to be prepared or provided by a health corporation, prescribed health care organization or regional health authority under section 53.3 or 53.4.

Exception

53.10(2)    The limit on the right of access in subsection (1) does not apply to

(a) the information in a record referred to in clause 53.2(2)(b), or to an individual's right to examine and copy a record under clause 53.2(2)(c);

(b) information in a record created or maintained for the purpose of providing health services, including health care or treatment, to an individual; or

(c) information in a record required by law to be created or maintained by the owner, operator or person in charge of a facility or by a health care provider.

3           The following is added after clause 59(p.1):

(p.2) respecting critical incidents for the purpose of Part 4.1, including

(i) prescribing health care organizations for the purpose of the Part,

(ii) respecting the persons who are to receive information and records under subsection 53.2(3) on behalf of an individual who lacks capacity or is deceased, and

(iii) designating prescribed health care organizations for the purpose of subsection 53.3(6);

PART 2

THE MANITOBA EVIDENCE ACT

C.C.S.M. c. E150 amended

4           The Manitoba Evidence Act is amended by this Part.

5           Sections 9 and 10 are replaced with the following:

Definitions

9(1)        The following definitions apply in this section and in section 10.

"committee" means

(a) a critical incident review committee established under Part 4.1 of The Regional Health Authorities Act;

(b) a standards committee appointed under section 24 of The Hospitals Act;

(c) a medical staff committee established for the purpose of studying or evaluating medical practice in a hospital;

(d) a research committee of a hospital; and

(e) a medical research committee designated in a regulation made by the Minister of Health for the purpose of sections 9 and 10. (« comité »)

"committee proceeding" means a proceeding of, or an investigation, study, evaluation, analysis, program or research carried out by, a committee. (« travaux de comité »)

"critical incident" has the same meaning as in The Regional Health Authorities Act. (« incident critique »)

"facility" has the same meaning as in The Regional Health Authorities Act. (« établissement »)

"health care provider" has the same meaning as in The Regional Health Authorities Act. (« fournisseur de soins de santé »)

"health services" has the same meaning as in The Regional Health Authorities Act. (« services de santé »)

"hospital" has the same meaning as in The Hospitals Act. (« hôpital »)

"legal proceeding", in addition to having the meaning set out in section 1, includes

(a) an action or proceeding for the imposition of punishment by fine, penalty or imprisonment to enforce any regulation made under an Act of the Legislature; and

(b) a proceeding before a tribunal, board or commission. (« poursuite judiciaire »)

"record" means a record of information in any form, and includes any information that is written, photographed, recorded or stored in any manner, on any storage medium or by any means, including by graphic, electronic or mechanical means. (« document »)

"witness" in addition to its ordinary meaning, includes a person who, in the course of a legal proceeding,

(a) is examined for discovery;

(b)  is cross-examined on an affidavit made by him or her;

(c)  answers interrogatories;

(d)  makes an affidavit as to documents; or

(e) is called upon to answer any question or produce any record, whether under oath or not. (« témoin »)

Privilege re committee proceedings

9(2)        Subject to subsection (4), a witness in a legal proceeding, whether a party to it or not,

(a) is not liable to be asked and is not permitted to answer any question or to make any statement with respect to a committee proceeding; and

(b) is not liable to be asked to produce, and is not permitted to produce,

(i) any record or information — including, without limitation, an opinion or advice — that is prepared solely for the use of, or collected, compiled or prepared by, a committee for the purpose of carrying out its duties,

(ii) any record or information — including, without limitation, an opinion or advice — that is used solely in the course of, or arising out of, a committee proceeding, or

(iii) a notice, report or other record or information respecting a critical incident that is required to be provided by a health corporation, prescribed health care organization or regional health authority under section 53.3 or 53.4 of The Regional Health Authorities Act (patient safety).

Records not admissible

9(3)        Subject to subsection (4), a record and information referred to in clause (2)(b) are not admissible as evidence in a legal proceeding.

Exception

9(4)        The privileges in subsections (2) and (3) do not apply

(a) to information in a record created or maintained for the purpose of providing health services, including health care or treatment, to an individual;

(b) to the facts of what actually occurred with respect to a critical incident that are contained in a record, unless those facts are also fully recorded in a record described in clause (a), or another record, that is available to the individual affected by the critical incident; or

(c) to information in a record required by law to be created or maintained by the owner, operator or person in charge of a facility or by a health care provider.

Members of committees, etc. not excused generally

9(5)        Except as provided in subsection (2), a witness in a legal proceeding who

(a) is or has been a member of, or has participated in the activities of, a committee; or

(b) has provided a record or information to a committee;

is not excused from answering any question or producing any record that the witness is otherwise required to answer or produce.

Protection from liability

10(1)       The disclosure of

(a) a record or information to a committee for use in committee proceedings; or

(b) a record or information that arises out of committee proceedings;

does not raise or create any liability on the part of the person making the disclosure, unless the person was acting in bad faith.

Committee member's protection from liability

10(2)       No action lies against a member of a committee for actions taken, or for disclosing or providing any record or information — including a report of findings or recommendations — in the course of a committee proceeding, unless the member was acting in bad faith.

PART 3

CONSEQUENTIAL AMENDMENTS AND COMING INTO FORCE

Consequential amendment, C.C.S.M. c. M110

6(1)        The Mental Health Act is amended by this section.

6(2)        Subsection 36(2) is amended by adding the following after clause (k):

(k.1) required by a critical incident review committee established under Part 4.1 of The Regional Health Authorities Act;

Coming into force

7           This Act comes into force on a day to be fixed by proclamation.

Explanatory Note

This Bill enhances the safety of hospital patients, residents of personal care homes and other people receiving health services.

The Regional Health Authorities Act is amended to deal with critical incidents.  A critical incident is an unintended event that harms a person while he or she is receiving health services.  The Bill requires regional health authorities, health corporations and certain health care organizations to report and investigate critical incidents, to keep records about them, and to keep the people affected fully informed.

Amendments are made to The Manitoba Evidence Act concerning committees that deal with critical incidents, hospital standards, medical staff and research.  What happens at those committees cannot be disclosed in legal proceedings, as long as certain information, such as patient records or the facts of a critical incident, is otherwise available to the patient or person affected.  Also, committee members and persons who provide information to committees are protected from liability.

The Bill includes a consequential amendment to The Mental Health Act to permit information to be disclosed to a committee formed to look into a critical incident.