B.C.’s health minister has introduced a long-awaited piece of legislation that will overhaul the province’s system for regulating everyone from doctors to dental hygienists, promising increased accountability for health professionals and improved transparency for the public.

Adrian Dix tabled the Health Professions and Occupations Act on Wednesday afternoon, saying it will replace the Health Professions Act. The expected results will include routine audits of all the health colleges, funding for victims of sexual misconduct and the publication of all disciplinary measures, according to the province.

“Our government is making the most significant changes to oversight of regulated health professions in British Columbia’s history,” Dix said in a news release. 

“These changes will streamline the process to regulate new health professions, provide stronger oversight, provide more consistent discipline across the professions, acting in the public interest and protecting patient care in the province while also laying the groundwork to further reduce the total number of regulatory colleges.”

The new legislation follows a 2019 report from an international expert who charged that B.C.’s professional health colleges had demonstrated “a lack of relentless focus on the safety of patients” and recommended the current system be scrapped and replaced entirely.

The proposed new act would create a new oversight body and an independent discipline tribunal for professionals accused of wrongdoing.

The province says it will also streamline the process of reducing the number of professional colleges to six, down from the original 24. A number of amalgamations over the last few years have reduced the current number to 15.

Dix said the province will now prioritize the regulation of counsellors and psychotherapists, something many members of those professions have been pleading for over the past three decades. After that, the priority will be diagnostic and therapeutic professionals.

New anti-discrimination measures, funding for victims

According to a backgrounder from the province, a new oversight body will do routine audits of the colleges and have the power to investigate them if necessary. This body will also set standards for policies and practices.

The legislation will also create a separate discipline process for professionals, in which the oversight body will provide support.

Unlike now, all disciplinary agreements concerning health professionals will be made public. Currently, only those deemed to be “serious matters” are published.

The colleges will have to fund counselling for victims of sexual abuse and sexual misconduct, and victims will be able to cover costs from the professionals who’ve harmed them.

College board members will no longer be elected, but instead will be appointed through what the ministry describes as a “competency-based process” to ensure that they prioritize public safety over the interests of the professionals who voted for them.

Dix said the legislation also addresses the findings of the “In Plain Sight” report on anti-Indigenous racism within B.C.’s health-care system. Discrimination will be considered a form of professional misconduct, and all colleges will have to implement anti-discrimination measures.

Lack of ‘clear accountability to the public’ in system

The health ministry’s news release on the act says it was written “partly in response” to a report from British regulation expert Harry Cayton, who was brought in to examine dysfunction at the College of Dental Surgeons of B.C.

When he looked beyond the dentists’ college to the entire system, Cayton wrote that he discovered “a lack of relentless focus on the safety of patients in many but not all of the current colleges. Their governance is insufficiently independent, lacking a competency framework, a way of managing skill mix or clear accountability to the public they serve.”

His concerns were not new.

B.C.’s ombudsperson expressed some distress about the state of regulation 19 years ago, writing “the professions do not appear to have fully accepted or understood what it means to act in the public interest.”

Cayton’s report pointed to a number of troubling examples from recent history, including the case of Anke Zimmermann, the former Victoria naturopath who drew global attention after treating a small boy with a homeopathic remedy derived from rabid dog saliva.

Cayton said the story demonstrates “an example of the weakness in public protection of fragmented self-regulation.”

It was the B.C. Naturopathic Association that stepped up and filed a complaint against Zimmermann. Cayton writes that this turn of events made it look like the college, which is legally mandated to protect the public, was less dedicated to that mission than a professional association, whose mandate is to act on behalf of its members.

The report also slammed the “secrecy” built into the complaint system in B.C.

“Only a small number of outcomes from complaints are published,” Cayton wrote.

“It should be recognized as a fundamental right of a patient to know about their health-care provider’s competence and conduct.”

Cayton’s report led to the formation of a cross-party committee consisting of Dix and then health critics Norm Letnick of the Liberals and Sonia Furstenau of the Green Party, who developed the framework for the legislation introduced on Wednesday.