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The Health Services Insurance Amendment Act

S.M. 1991-92, c. 8

Bill 4, 2nd Session, 35th Legislature

The Health Services Insurance Amendment Act

(Assented to July 26, 1991)

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

C.C.S.M. c. H35 amended

1           The Health Services Insurance Act is amended by this Act.

Subsection 2(1) amended: definition of "dependant"

2(1)        The definition of "dependant" in subsection 2(1) is amended by striking out "19" wherever it occurs and substituting "18".

Subsection 2(1) amended: definition of "hospital"

2(2)        Subsection 2(1) is amended by repealing the definition of "hospital" and substituting the following:

"hospital", except in sections 57 to 60, means

(a) a hospital in Manitoba that is designated as a hospital by regulation under subsection 113(1), and

(b) a hospital or facility outside Manitoba that

(i) is approved by the commission for the purpose of this Act, and

(ii) is licensed or approved as a hospital by the governmental licensing authority in the jurisdiction in which the hospital is located; («hôpital»)

Subsection 2(1) amended: definition of "participating hospital province"

2(3)        The definition of "participating hospital province" in subsection 2(1) is amended by striking out "Hospital Insurance and Diagnostic Services Act (Canada)" and substituting ""Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act".

Section 6 repealed

3           Section 6 is repealed.

Section 12.1 added

4           The following is added after section 12:

Meetings by telephone

12.1        If the members of the commission agree, a member may participate in a meeting of the commission by telephone or other means of communication that permits all persons participating in the meeting to hear each other, and a member so participating is considered to be present at the meeting.

Section 17 repealed and substituted

5           Section 17 is repealed and the following is substituted:

Duties of chairman

17(1)       The chairman shall preside at meetings of the commission, but if the chairman is unable to act or the office of chairman is vacant, the vice-chairman, or if he or she is unable to act or the office of vice-chairman is vacant, a member of the commission elected by the members, shall act as and have the powers of the chairman.

Chief executive officer

17(2)       The Lieutenant Governor in Council may appoint an executive director who shall be the chief executive officer of the commission.

Section 18.1 added

6           The following is added after section 18:

Power to delegate

18.1        The commission may, by resolution, delegate to any person or body of persons any of the powers, duties and functions conferred or imposed on the commission under this Act or the regulations.

Sections 42 and 43 amended

7           Sections 42 and 43 are amended by striking out "$200." wherever it appears and substituting "$5,000."

Clause 47(b) amended

8           Clause 47(b) is amended by striking out "Hospital Insurance and Diagnostic Services Act (Canada)" and substituting "Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act".

Subsection 50(1) repealed and substituted

9           Subsection 50(1) is repealed and the following is substituted:

Agreements with Canada

50(1)       With the approval of the Lieutenant Governor in Council, the Government of Manitoba, represented by the minister, may enter into agreements with the Government of Canada under the Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act to provide for contributions under those Acts by the Government of Canada towards the cost of providing hospital services to insured persons.

Section 56 amended

10          Section 56 is amended by striking out "one of its senior officers or employees as the chief budget officer" and substituting "a chief budget officer".

Subsection 57(1) renumbered and new subsection added

11          Subsection 57(1) is renumbered as subsection 57(1.1) and the following is added as subsection 57(1):

Definition of "hospital"

57(1)       In this section and in sections 58 to 60, "hospital" means

(a) a hospital in Manitoba that is designated as a hospital by regulation under subsection 113(1); and

(b) an institution that is not a hospital but that provides facilities in Manitoba for the treatment of disease, illness or injury and that is designated in the regulations as an institution to which this section applies.

Clause 57(1.1)(a) repealed and substituted

12          Clause 57(1.1)(a) is repealed and the following is substituted:

(a) examine the budget of each hospital;

Subsection 57(2) amended

13          Subsection 57(2) is amended by striking out "subsection (1)" and substituting "subsection (1.1)".

Subsection 60(2) amended

14          Subsection 60(2) is amended by striking out "sub-clause 57(1)(c)(ii)" wherever it occurs and substituting "subclause 57(1.1)(c)(ii)".

Section 64 amended

15          Section 64 is amended by striking out "subsection 57(1)" and substituting "subsection 57(1.1)".

Section 75 repealed and substituted

16          Section 75 is repealed and the following is substituted:

Interpretation

75(1)       In this section and in sections 75.1 and 75.2, "practitioner" means a medical practitioner and any other health practitioner who provides services for which payment is made under this Act.

Special arrangements for remuneration

75(2)       The commission may pay remuneration, either directly or through another person, to practitioners who provide services to residents on a basis other than a fee for services rendered.

Amount of remuneration

75(3)       Payments under subsection (2) shall be made at a rate prescribed in the regulations.

Sections 75.1 and 75.2 added

17          The following is added after section 75:

Particulars of claims

75.1        Every practitioner shall, for the purpose of assessment, payment and audit of claims, provide the commission with the particulars of the services and claims that are required by this Act and the regulations.

Inspection of records

75.2        The commission may, in writing, appoint inspectors who may, at any reasonable time and upon presentation of identification,

(a) enter the office of a practitioner or group of practitioners; and

(b) examine, audit and make copies of the books, records and accounts maintained by or on behalf of the practitioner or group of practitioners with respect to claims for benefits relating to services provided by that practitioner or members of that group of practitioners.

Sections 76 to 85 repealed and substituted

18          Sections 76 to 85 are repealed and the following substituted:

Agreement re medical review committee

76(1)       With the approval of the Lieutenant Governor in Council, the commission may enter into an agreement with the Manitoba Medical Association or the College of Physicians and Surgeons of Manitoba, or both, respecting

(a) the establishment of a medical review committee;

(b) the number of members that constitute the committee and their terms of office;

(c) the remuneration and expenses to be paid to the members;

(d) the conduct of the affairs of the committee;

(e) the administrative support to be provided to the committee by the commission; and

(f) the duties of the committee in addition to those described in section 76.1.

Agreement with M.M.A.

76(2)       Notwithstanding that it is not an incorporated association, the Manitoba Medical Association may, through its officers, enter into an agreement under subsection (1).

Where no agreement concluded

76(3)       If no agreement is concluded under subsection (1), the commission, with the approval of the Lieutenant Governor in Council, may appoint a medical review committee of not less than 3 members, and may pay such remuneration to the members as the Lieutenant Governor in Council determines.

Duties of medical review committee

76.1        The medical review committee shall review the past and present patterns of medical practice of medical practitioners.

Investigation

77(1)       When it appears to the medical review committee that the past or present pattern of practice of a medical practitioner departs from the average pattern of practice of medical practitioners who, in the opinion of the committee, practice in comparable circumstances, the committee may conduct an investigation of the pattern of practice of that medical practitioner.

Records and information

77(2)       In the conduct of an investigation, the medical review committee may require the investigated medical practitioner

(a) to produce to the committee any records in his or her possession or under his or her control;

(b) to produce in a form acceptable to the committee information that the committee requests in respect of the care of patients by the medical practitioner; and

(c) to attend at the investigation.

Failure to produce records

77(3)       The medical review committee may summarily apply ex parte to the Court of Queen's Bench for an order

(a) directing the investigated medical practitioner to produce to the medical review committee any records in his or her possession or under his or her control, if it is shown that the medical practitioner failed to produce them when required to do so by the committee; or

(b) directing any person to produce to the medical review committee any records that are or may be relevant to the matter being investigated.

Confidential information

77.1        Every insured person is deemed to have authorized his or her medical practitioner who performed services to which the insured person is entitled as a benefit under this Act to provide the medical review committee, or the formal inquiry committee established under subsection 79(1), with such information as it requires, and no action lies against a medical practitioner because that information is provided.

Decision of medical review committee

78(1)       At the conclusion of an investigation, the medical review committee shall direct that no further action be taken if

(a) in the opinion of the committee, the pattern of practice of the investigated medical practitioner does not depart unjustifiably from the average pattern of practice to which that medical practitioner's pattern has been compared; or

(b) the investigated medical practitioner has entered into an agreement with the commission to pay to the commission an amount of money that the commission considers reasonable because the pattern of practice of the investigated medical practitioner has departed unjustifiably from the average pattern of practice to which that medical practitioner's pattern has been compared.

Referral to formal inquiry committee

78(2)       If it does not make a direction under subsection (1), the medical review committee shall, at the conclusion of an investigation, refer the matter under investigation to the formal inquiry committee.

Decision to be served on physician

78(3)       The medical review committee shall notify the investigated medical practitioner and the commission, in writing, of any decision it makes under subsection (1) or (2), and the reasons for its decision.

Examination of documentary evidence

78(4)       The investigated medical practitioner and the commission may examine any documentary evidence that the medical review committee has considered in making a decision under this section.

Formal inquiry committee

79(1)       A formal inquiry committee of 3 medical practitioners entitled to practise in Manitoba is hereby established consisting of

(a) a medical practitioner appointed by the commission;

(b) a medical practitioner appointed by the College of Physicians and Surgeons of Manitoba; and

(c) a medical practitioner appointed by the Manitoba Medical Association.

Where College or M.M.A. does not appoint

79(2)       If no appointment is made to the formal inquiry committee by the College of Physicians and Surgeons of Manitoba or the Manitoba Medical Association, the commission shall appoint a member for the College or the Manitoba Medical Association, or both, as the case may be.

Term of appointment

79(3)       An appointment of a member to the formal inquiry committee shall be for a term of 3 years and may be renewed once, and where a term has expired, the member shall continue to act until a successor is appointed.

Chairperson

79(4)       The medical practitioner appointed by the College of Physicians and Surgeons of Manitoba shall be the chairperson of the formal inquiry committee.

Appointment of alternate members

79(5)       When a member is absent or unable to act for any reason, an alternate may be appointed in accordance with this section to act in that person's place for such period as the appointment may specify.

Disqualification

79(6)       No person who is or has been a member of the medical review committee shall subsequently be appointed as a member of the formal inquiry committee.

Quorum

79(7)       A quorum at a hearing of the formal inquiry committee is 3.

Remuneration

80(1)       The commission shall pay the members of the formal inquiry committee such remuneration and expenses as the commission determines.

Administrative support

80(2)       The formal inquiry committee shall be provided with such clerical and other administrative support, including the engaging of assistance for the committee, as the commission determines.

Procedure

80.1        The formal inquiry committee may determine its own practice and procedure.

Hearing by formal inquiry committee

81(1)       On referral of a matter to the formal inquiry committee under subsection 78(2), the formal inquiry committee shall hold a hearing.

Notice of hearing

81(2)       At least 30 days before the date of the hearing, the formal inquiry committee shall provide a notice of hearing to the commission, the medical review committee and the investigated medical practitioner, and the copy provided to the medical practitioner shall either be served personally or sent by registered mail to the last address of the medical practitioner shown in the records of the commission.

Contents of notice

81(3)       The notice of hearing under subsection (2) shall state the date, time and place at which the formal inquiry committee will hold a hearing and shall identify the specific matters in respect of which the hearing will be held.

Appearances at hearing

81(4)       The commission, the medical review committee and the investigated medical practitioner may appear and be represented by counsel or an agent at a hearing of the formal inquiry committee.

Hearing to be private

81(5)       A hearing of the formal inquiry committee shall be held in private.

Medical review committee to forward material

81.1        The medical review committee shall forward to the formal inquiry committee any information or material in its possession that the formal inquiry committee requests, and the formal inquiry committee shall give the commission and the investigated medical practitioner an opportunity to examine any information and material that it receives.

Power to administer oaths

82(1)       A member of the formal inquiry committee has power to administer oaths and affirmations for the purpose of a hearing of the committee.

Witnesses and records

82(2)       The formal inquiry committee may at a hearing

(a) examine witnesses under oath or affirmation;

(b) require the attendance of the investigated medical practitioner and any other witnesses; and

(c) require the production of any records relevant to the proceedings.

Notice to attend and produce records

82(3)       The attendance of witnesses before the formal inquiry committee and the production of records may be enforced by a notice issued by the committee requiring the witness to attend and stating the date, time and place at which the witness is to attend and the records, if any, that the witness is required to produce.

Exception for patients

82(4)       A patient who is given a notice under subsection (3) is excused from testifying before the formal inquiry committee if he or she provides a certificate of a medical practitioner certifying that testifying would likely jeopardize the patient's health.

Failure to attend or give evidence

82(5)       Proceedings for civil contempt of court may be brought against a witness

(a) who fails to attend before the formal inquiry committee in compliance with a notice to attend;

(b) who fails to produce any records in compliance with a notice to produce them; or

(c) who refuses to be sworn or to answer any question he or she is asked by the formal inquiry committee.

Hearing in absence of investigated medical practitioner

82.1        The formal inquiry committee, on proof of service on the investigated medical practitioner of the notice of hearing, may

(a) proceed with the hearing in the absence of the medical practitioner or his or her agent; and

(b) determine the matter being heard in the same way as if the medical practitioner were in attendance.

Recording of evidence

83          The oral evidence given at a hearing of the formal inquiry committee shall be recorded.

Finding of formal inquiry committee

83.1        The formal inquiry committee may find that the pattern of practice of an investigated medical practitioner

(a) departs unjustifiably; or

(b) does not depart unjustifiably;

from the average pattern of practice to which the medical practitioner's pattern has been compared.

Order of formal inquiry committee

84(1)       Where the formal inquiry committee determines that, by reason of an unjustifiable departure by the medical practitioner from the average pattern of practice to which that medical practitioner's pattern has been compared, the commission has paid amounts to the medical practitioner or any other person, or both, the formal inquiry committee may by written order require the practitioner to pay to the commission a sum of money that the committee specifies.

Costs

84(2)       An order made under subsection (1) may include a requirement to pay all or part of the costs of the investigation and of the hearing.

Service of order

84(3)       The formal inquiry committee shall provide a copy of an order made under subsection (1) to the commission and to the medical practitioner affected by it, and the copy provided to the medical practitioner shall either be served personally or sent by registered mail to the last address of the medical practitioner shown in the records of the commission.

Record of hearing

84.1(1)     The formal inquiry committee shall, at the request of the commission or an investigated medical practitioner who intends to appeal the order of the committee under section 84.4, compile a record of the hearing it has held which shall include

(a) the notice of hearing;

(b) all documentary evidence;

(c) the transcript of any oral evidence given at the hearing; and

(d) the order of the committee and the reasons for the order.

Identifying information

84.1(2)     When compiling the record under subsection (1), the formal inquiry committee shall strike out or delete information that might identify individual patients.

Examination of record

84.1(3)     The commission and the investigated medical practitioner may examine the record described in subsection (1).

Copies of the record

84.1(4)     An investigated medical practitioner is entitled to a copy of the record referred to in subsection (1),

(a) at no cost, if the commission or the medical practitioner appeals the order of the formal inquiry committee under section 84.4; and

(b) on payment of the reasonable costs of providing the record as determined by the committee, if no appeal is taken from the order of the committee under section 84.4.

Recovery of amount owing

84.2(1)     The commission may withhold from money owing or money that becomes owing to a medical practitioner any amount that the medical practitioner is, by order of the formal inquiry committee made under subsection 84(1), required to pay to the commission.

Filing of order

84.2(2)     The commission may file a copy of an order made under subsection 84(1) in the Court of Queen's Bench, and on the order being filed it may be enforced in the same manner as a judgment of the court.

Interest on unpaid amount

84.3(1)     If a medical practitioner is served with an order under subsection 84(3) and does not pay the amount specified in the order within 30 days of receiving a demand for payment from the commission, the commission is entitled to be paid interest on the amount not paid, and the rate of interest per annum shall

(a) for the period January 1 to June 30 in each year, be the prime lending rate of the commission's principal banker as that rate stood on January 1 of that year, plus 1%; and

(b) for the period July 1 to December 31 in each year, be the prime lending rate of the commission's principal banker as that rate stood on July 1 of that year, plus 1%;

compounded annually.

Interest may be recovered

84.3(2)     Interest payable under subsection (1) is a debt owing to the commission and the commission may recover the amount of the interest by action or by withholding it from money owing or against money that becomes owing by the commission to the medical practitioner.

Appeal to Court of Appeal

84.4(1)     An investigated medical practitioner or the commission may appeal to the Court of Appeal a finding or an order, or both, made by the formal inquiry committee.

Notice of appeal

84.4(2)     An appeal under this section shall be commenced by filing a notice of appeal with the Registrar of the Court of Appeal within 30 days from the date on which the order of the formal inquiry committee is served under subsection 84(3).

Appeal on the record

84.4(3)     An appeal to the Court of Appeal shall be founded on the record of the hearing before the formal inquiry committee.

Powers of Court on appeal

84.4(4)     The Court of Appeal on hearing an appeal may

(a) make any decision or order that in its opinion should have been made;

(b) quash, vary or confirm the order of the formal inquiry committee or any part of it; or

(c) refer the matter back to the formal inquiry committee for further consideration in accordance with any direction of the Court.

Appeal does not operate as stay

85          An appeal taken under section 84.4 does not operate as a stay of an order appealed against.

Disclosure of information

85.1(1)     Except for the purpose of enforcement of this Act or the regulations, information obtained by or provided to the commission, the medical review committee or the formal inquiry committee, and relating to

(a) the relationship of a medical practitioner to a patient; or

(b) the medical services rendered by a medical practitioner to a patient;

is confidential and shall not be communicated to any person not entitled by law to that information.

Right of M.M.A. and College of Physicians and Surgeons to information

85.1(2)     Despite subsection (1), the commission, the medical review committee and the formal inquiry committee may communicate any information referred to in subsection (1) to the Manitoba Medical Association and the College of Physicians and Surgeons of Manitoba.

Section 95.1 added

19          The following is added after section 95:

Interpretation

95.1(1)     In this section, "practitioner" means a medical practitioner and any other health practitioner who provides services for which payment is made under this Act.

Recovery of money from persons

95.1(2)     If the commission pays an amount under the plan to or on behalf of a person for a service rendered and

(a) the person was not an insured person when the service was rendered;

(b) the service rendered was not a service to which the person is entitled as a benefit under this Act; or

(c) the person misrepresented to the commission the nature or extent of the services;

the amount so paid is a debt owed by the person to the commission.

Recovery of money from practitioners

95.1(3)     If the commission pays an amount under the plan to or on behalf of a practitioner in respect of a service and

(a) the amount was claimed by the practitioner in respect of a service that was not rendered; or

(b) the practitioner misrepresented to the commission the nature or extent of the service rendered;

the amount so paid is a debt owed by the practitioner to the commission.

Commission may recover money by action

95.1(4)     The commission may recover a debt referred to in this section by action or by set-off against money owing or that becomes owing by the commission to the person or to the practitioner.

Section 97 repealed and substituted

20          Section 97 is repealed and the following is substituted:

Definition of past and future insured services

97(1)       In this section,

"future cost of insured services" means the estimated total cost of the future insured hospital, medical or other health services made necessary as the result of a bodily injury that will probably be required by an insured person after the date of settlement or, where there is no settlement, the first day of trial; («coût futur des services assurés»)

"past cost of insured services" means the total cost of the insured hospital, medical or other health services made necessary as the result of a bodily injury and provided to an insured person up to and including the date of settlement or, where there is no settlement, the first day of trial. («coût antérieur des services assurés»)

Action by insured person for cost of insured services

97(2)       When, as a result of the negligence or other wrongful act or omission of another person, an insured person suffers bodily injuries for which he or she receives insured hospital, medical or other health services under this Act, the person may, subject to section 101, bring an action against and recover from that other person

(a) the past cost of the insured services; and

(b) the future cost of insured services;

for which the person, if he or she were not an insured person, would be legally liable to pay.

Cost of hospital services

97(3)       For the purpose of this section, the cost of insured hospital services shall be the per diem rate of payment established by the commission by regulation under section 59.

Subsection 98(1) amended

21          Subsection 98(1) is amended by striking out "seven days" and substituting "60 days".

Sections 99.1 and 99.2 added

22          The following is added after section 99:

Judge to divide award

99.1        The judge at trial shall, if the evidence permits, apportion the elements of the insured person's loss and damages so as to clearly designate the amount of the commission's recovery for the past cost of insured services and separate it from the amount of the commission's recovery of future cost of insured services, if any.

Insufficient amount of recovery

99.2(1)     Where the amount of money recovered by an insured person to whom section 97 applies, whether by action or on settlement, is, after deduction of the costs of the recovery, not sufficient to provide complete indemnity for the loss or damage suffered, the amount remaining after deduction of the costs of recovery shall be divided between the insured person and the commission in the proportion in which the loss or damage has been borne by them.

Exception for undue hardship

99.2(2)     Subsection (1) does not apply where a division between the commission and the insured person of money recovered would result in undue hardship to the insured person.

Commission may waive rights

99.2(3)     The commission may waive its right to recovery under subsection (1) on such terms and conditions as it considers appropriate.

Section 103 repealed and substituted

23          Section 103 is repealed and the following is substituted:

Action under M.P.I.C. Act

103         An insured person who may bring an action against another person under section 97 may also, in respect of bodily injuries arising out of the operation of a motor vehicle in Manitoba by a person whose identity or whereabouts cannot be ascertained, bring an action under The Manitoba Public Insurance Corporation Act or the regulations under that Act for the amount for which an action may be brought under section 97.

Section 106 repealed and substituted

24          Section 106 is repealed and the following is substituted:

Right of commission to bring action

106(1)      Subject to sections 109 and 110, where a person who may claim and recover an amount under section 97,

(a) does not bring an action;

(b) brings an action that does not include or that in the opinion of the commission is insufficient to adequately recover the past cost of insured services and the future cost of insured services; or

(c) does not effect a settlement of the claim in an amount and subject to terms and conditions that are acceptable to the commission;

the commission may, upon notice to the insured person, bring an action in its own name under section 97.

Action under M.P.I.C. Act

106(2)      The commission may, under The Manitoba Public Insurance Corporation Act or the regulations made under that Act, bring an action to recover past and future costs of insured services where the costs are incurred in respect of bodily injuries arising out of the operation of a motor vehicle in Manitoba by a person whose identity or whereabouts cannot be ascertained.

Sections 109 and 110 repealed and substituted

25          Sections 109 and 110 are repealed and the following is substituted:

Limitation on commission's right to bring action

109         Except as provided in section 110, the commission may only bring an action under section 106 within 2 years from the date the bodily injuries are suffered, unless a justice is satisfied, on application by the commission, that the commission did not know that a cause of action had arisen under section 97 and the justice permits the commission to bring an action after the 2 years has elapsed.

Extension of time: abandonment or discontinuance

110(1)      If an insured person

(a) brings an action under section 97; and

(b) abandons or discontinues the action insofar as the claim for the amounts described in clauses 97(2)(a) and (b) are concerned;

the commission may bring an action in its own name within 3 months from the date it receives notice of the abandonment or discontinuance.

Extension of time: failure to give notice

110(2)      If an insured person

(a) brings an action under section 97 without including in the claim the amounts described in clauses 97(2)(a) and (b); and

(b) fails to give notice of the action to the commission under subsection 98(1);

the commission may bring an action in its own name within 3 months from the date it receives notice that the insured person has brought an action, or within the 2 year period set out in section 109, whichever comes later.

Subsection 113(1) amended

26(1)       Subsection 113(1) is amended by repealing clause (k) and substituting the following:

(k) prescribing the services in respect of which an insured person is not entitled to receive benefits;

(k.1) designating hospitals for the purpose of this Act;

Subsection 113(1) amended

26(2)       Subsection 113(1) is amended by adding the following after clause (t):

(t.1) respecting, for the purpose of section 75, the remuneration to be paid to medical practitioners and other health practitioners who provide services to residents under this Act on a basis other than a fee for services rendered;

(t.2) prescribing information that medical practitioners and other health practitioners who provide services to insured persons under this Act are required to file with the commission for the purpose of facilitating the assessment, payment and audit of claims;

(t.3) prescribing the times by which and the circumstances under which practitioners referred to in clause (t.2) are required to file information under the regulations made under that clause;

(t.4) authorizing the commission to withhold the payment of claims to practitioners referred to in clause (t.2) until the regulations made under clauses (t.2) and (t.3) are complied with;

(t.5) requiring practitioners referred to in clause (t.2) to keep and maintain for a prescribed period such books and records as are prescribed;

Subsection 113(2) amended

27          Subsection 113(2) is amended by striking out "or (t)" and substituting ", (t) or (t.1)".

Subsection 116(1) amended

28          Subsection 116(1) is amended by adding the following after clause (a):

(a.1) designating hospitals or institutions for the purposes of section 54;

(a.2) designating institutions for the purpose of section 57;

Section 118 amended

29          Section 118 is amended by striking out "section 120" wherever it occurs and substituting "section 129".

Sections 119 to 121 repealed and substituted

30          Sections 119 to 121 are repealed and the following is substituted:

Definitions

119         In sections 120 to 130,

"laboratory" means a place where

(a) the diagnostic examination or treatment of patients is performed by means of radiation emitting or non-radiation emitting medical imaging devices, or

(b) operations and procedures, including the collection of specimens from the human body, are performed for the purpose of obtaining information for diagnosis, prophylaxis or treatment,

but does not include

(c) the office of a medical practitioner where diagnostic laboratory procedures prescribed by regulation are performed by the medical practitioner or an employee under his or her supervision solely for the diagnosis of patients of the medical practitioner,

(d) the office of a dentist, as defined in The Dental Association Act, where diagnostic laboratory procedures are performed solely for the diagnosis of patients, or

(e) the office of a chiropractor, as defined in The Chiropractic Act, where diagnostic laboratory procedures are performed solely for the diagnosis of patients; («laboratoire»)

"officer" means the person appointed as an approving officer under section 120; («agent»)

"specimen collection centre" means a place where specimens are taken or collected from the human body for examination to obtain information for diagnosis, prophylaxis or treatment, but does not include

(a) the office of a medical practitioner where specimens are taken or collected by the medical practitioner or an employee under his or her supervision solely for the diagnosis of patients of the medical practitioner, or

(b) a laboratory that is established, operated or maintained under an approval under this Act. («centre de prélèvements»)

Appointment of approving officer

120         The commission shall appoint an approving officer for the purpose of sections 119 to 130.

Approval required for laboratory

121(1)      No person shall

(a) establish, operate or maintain a laboratory or a specimen collection centre; or

(b) enlarge, relocate, or establish a branch of a laboratory or specimen collection centre;

except under the authority of an approval granted by the officer under this Act.

Granting of approval

121(2)      The officer may grant an approval,

(a) in the case of a laboratory, to perform such tests or classes of tests and collect such specimens as the officer may specify in the approval; and

(b) in the case of a specimen collection centre, to take or collect such specimens or classes of specimens as the officer may specify in the approval.

Conditions of approval

121(3)      The officer, when granting an approval or by written notice at any time, may impose on the approval such conditions as the officer considers necessary.

Entitlement to approval

121(4)      A person who applies in accordance with this Act and the regulations for an approval

(a) to establish, operate or maintain a laboratory or a specimen collection centre; or

(b) to enlarge, relocate, or establish a branch of a laboratory or specimen collection centre;

and who meets the requirements of this Act and the regulations is entitled to be granted the approval.

Grounds for refusal - location

122(1)      Despite subsection 121(4), the officer shall not grant an approval if in the officer's opinion it is not in the public interest to grant an approval in the area where the applicant proposes

(a) to establish, operate or maintain a laboratory or specimen collection centre; or

(b) to enlarge, relocate, or establish a branch of a laboratory or specimen collection centre.

Grounds for refusal - tests and specimens

122(2)      Despite subsection 121(4), if the officer is of the opinion that it is not in the public interest to grant an approval,

(a) in the case of a laboratory, for any of the tests or classes of tests, diagnostic examinations or treatments in respect of which the application is made; or

(b) in the case of a specimen collection centre, to take or collect such specimens or classes of specimens in respect of which the application is made;

the officer shall not grant the approval for those tests or classes of tests or for taking or collecting those specimens or classes of specimens.

Matters to be considered

123         In considering, under section 122, whether it is in the public interest to grant an approval, the officer shall take into account the following:

(a) the number of laboratories or specimen collection centres that operate under the authority of approvals granted under this Act in the area for which the approval is sought or in any other area;

(b) the number of laboratories or specimen collection centres operated by the government in the area for which the approval is sought or in any other area;

(c) the tests and classes of tests performed in the laboratories or the specimens or classes of specimens taken or collected in the specimen collection centres in the area for which the approval is sought or in any other area;

(d) the utilization of existing laboratories or specimen collection centres and their capacity to handle increased volume;

(e) the availability of facilities for the transportation of persons and specimens to laboratories or for the transportation of persons to specimen collection centres, in the area for which the approval is sought or in any other area; and

(f) the funds available to provide payment for laboratory tests that are insured under this Act.

Further grounds for refusal of approval

124         In addition to the grounds for refusal set out in section 122, the officer may refuse to grant an approval if in the officer's opinion,

(a) the past conduct of the applicant or, where the applicant is a corporation, of its officers or directors affords reasonable grounds for belief that the laboratory or specimen collection centre will not be operated in accordance with the law and with honesty and integrity;

(b) the proposed laboratory or specimen collection centre or its operation would contravene this Act or the regulations or any other Act or regulation;

(c) the applicant is not competent to operate a laboratory or specimen collection centre in accordance with this Act and the regulations; or

(d) the equipment or premises are not suitable for the performance of the tests or the taking or collecting of the specimens for which the approval is sought.

Operator to be named in approval

125(1)      It is a condition of an approval that the operation of the laboratory or specimen collection centre be under the charge and control of the operator named in the approval as operator and that the ownership of the laboratory or specimen collection centre be only in the person named in the approval as owner.

Notice of changes

125(2)      If the operator or the owner named in the approval is a corporation, the corporation shall notify the commission in writing within 15 days of any change in the officers or directors of the corporation.

Revocation of approval

126         The officer may revoke an approval if

(a) a person has made a false statement in the application for the approval or in any report, document or other information required by this Act or the regulations;

(b) a test or specimen taking or collecting authorized by the approval is carried out incompetently;

(c) there is a breach of a condition of the approval;

(d) the owner or operator does not comply with this Act or the regulations;

(e) the services that can be provided by the laboratory or specimen collection centre are misrepresented; or

(f) a change in the officers or directors of a corporation which is an operator or an owner of a laboratory or specimen collection centre named in the approval would afford grounds for refusing to grant an approval under clause 124(a).

Right to appeal

127(1)      Where the officer,

(a) refuses to grant an approval;

(b) grants an approval subject to conditions or imposes new conditions on an approval; or

(c) revokes an approval;

the officer shall by written notification inform the applicant or the owner and operator that the officer's decision may be appealed to the commission by mailing or delivering to the commission, within 30 days of receipt of the written notification, a request for an appeal.

Powers of commission on appeal

127(2)      On hearing an appeal, the commission may set aside, vary or confirm the decision of the officer or may refer the matter back to the officer for further consideration in accordance with the commission's instructions.

Appeal considered by panel

127(3)      The commission may appoint a panel of 3 of its members for the purpose of considering an appeal under this section, and a decision of a majority of the members of the panel is the decision of the commission.

Appointment of inspectors

128(1)      The commission may appoint 1 or more persons as inspectors for the purpose of sections 119 to 130.

Powers of inspectors

128(2)      When claims have been submitted to the commission for services rendered in a laboratory or a specimen collection centre, an inspector may, without a warrant, during ordinary business hours enter the premises of the laboratory or the specimen collection centre and may inspect and examine

(a) the premises;

(b) any records, facilities and equipment located on the premises that are relevant to the submission of claims and the payment of benefits under the plan for services rendered by the laboratory or specimen collection centre; and

(c) any records, facilities and equipment located on the premises that will aid the commission in determining whether the standards of testing and analysis, the qualifications and number of skilled personnel, and the range and availability of services and equipment provided are appropriate to the operation of the laboratory or specimen collection centre and the functions performed under the approval granted in respect of it.

Entry to be permitted

128(3)      A person who operates a laboratory or a specimen collection centre approved under this Act shall, on the request of an inspector and on presentation of identification, permit entry onto the premises of the laboratory or the specimen collection centre and permit the inspector to inspect or examine, in accordance with subsection (2), the premises and the records, facilities and equipment located on the premises.

Records to be produced

128(4)      When records of a kind referred to in subsection (2) are not located on the premises of a laboratory or a specimen collection centre approved under this Act, a person who has possession of the records shall, on the request of an inspector, produce the records and permit inspection of them by the inspector.

Regulations

129         For the purpose of carrying out the provisions of sections 118 to 128, the commission may make regulations

(a) respecting standards and other requirements for premises operated as personal care homes and respecting the personal care to be provided in personal care homes;

(b) respecting standards and other requirements for the operation of laboratories and specimen collection centres;

(c) prescribing procedures that medical practitioners may perform in their offices without requiring an approval under section 121.

Offence and penalty

130         A person who contravenes or fails to observe a provision of

(a) section 118 or subsection 121(1);

(b) a condition of an approval granted under section 118 or 121; or

(c) a regulation made under section 129;

is guilty of an offence and is liable on summary conviction to a fine of not more than $1000. for each day that the offence occurs or continues.

Section 122 renumbered and amended

31          Section 122 is renumbered as section 131 and is amended by striking out "clause 120(a)" and substituting "clause 129(a)".

Coming into force

32(1)       This Act, except section 18, comes into force on September 30, 1991.

Coming into force of section 18

32(2)       Section 18 comes into force on a day fixed by proclamation.