Health Protection and Promotion Act (HPPA)

Overview

• The presentation covers HPPA (Health Protection and Promotion Act) Parts 1-4, along with municipal statutes and boards.
• It will cover HPPA Parts 1-2, Part 3, and Part 4, while also delving into municipal statutes and boards.

Health Protection and Promotion Act

• The Health Protection and Promotion Act, R.S.O. 1990, Chapter H.7 initially covers Parts 1-2 but has been revised as of January 2023.

HPPA Purpose

• It addresses public health concerns affecting a substantial portion of the population in Ontario and not individual health issues.
• Public health concerns are exemplified by issues impacting a relatively significant portion of the public or those potentially affected in Ontario.
• An individual's allergy complaint about air quality in their apartment doesn't fall under "public health".

HPPA Jurisdiction

• Public health is an "amorphous topic" constitutionally, involving both federal and provincial jurisdictions.
• Food safety, water quality, and quarantine are subject to both federal and provincial laws.
• The “Paramountcy doctrine" dictates federal law precedence if both levels pass conflicting laws.

Provincial Jurisdiction

• The Constitution Act, section 92 sets out municipal institutions, shop/saloon/tavern licenses, local works/undertakings, property/civil rights, and matters merely local/private for provincial jurisdiction.

Administrative Jurisdiction

• The Ministry of Health is accountable for the HPPA.
• The Ministry of Labour oversees the OHSA (Occupational Health and Safety Act).
• The Ministry of Environment and Climate Change is in charge of EPA (Environmental Protection Act).

General Rule

• The HPPA generally applies to public places and/or when a portion of the public is affected.
• Overlap exists with the MOL (Ministry of Labour) when workers are intermingling with the public.
• Overlap with MOE arises when hazards are present outside of built structures.

Peculiarity

• OHSA Inspectors are under the MOL, while EPA Inspectors are employees of the MOE.
• PHI's (Public Health Inspectors), Local Medical Officers of Health, and PHN's (Public Health Nurses) are employed by the Local Board of Health.
• The Chief Medical Officer of Health is an employee of the MOH (Ministry of Health).

Part I - Interpretation (Section 1: Key Terms)

• "Board" means the Health Services Appeal and Review Board under the Ministry of Health and Long-Term Care Appeal and Review Boards Act,1998
• "board of health" includes regional municipalities, single-tier municipalities, agencies/boards/organizations. The Durham, Halton, Niagara, Peel, Waterloo and York are examples of regional municipalities.
• "Chief Medical Officer of Health" is the Chief Medical Officer of Health under this Act.
• "communicable disease" is designated by the Minister.
• "disease of public health significance" is designated by the Minister.
• "dwelling unit" is real property used as a home.
• "food" is food or drink for human consumption, including ingredients.
• "food premise" is premises where food or milk is manufactured/processed, excluding rooms in private residences.
• "Health” can have a broad meaning that includes "safety".
• A student or patient with the disease is not a “health hazard", but the microorganism is.
• Forms of matter such as solid, liquid and gas are covered.
• "health unit" is an area under the jurisdiction of a board of health.
• "mandatory" refers to a health program or service mentioned in section 5.
• "medical officer of health" is a medical officer under a board of health.
• "milk" includes milk from cows, goats, or sheep.
• "Minister" is the Minister of Health and Long-Term Care.
• "Ministry" is the Ministry of Health and Long-Term Care.
• "municipal member" is a person appointed to a board of health by a municipality council.
• "obligated municipality" means an upper-tier or single-tier municipality within the health unit's area.
• "occupier" includes individuals in physical possession of premises, those controlling premises conditions or activities, and those receiving rent or paying municipal taxes, even if multiple occupiers exist.
• "operator” is a person who has responsibility for and control over an activity carried on at the food premise.
• "person" includes a board, a municipality or any other corporation.
• "personal service setting" is a premises at which personal services are offered where there is a risk of exposure to blood or body fluids and includes premises at which hairdressing and barbering, tattooing, body piercing, nail services, electrolysis and other aesthetic services are offered.
• "physician" is a legally qualified medical practitioner.
• "premises" include lands, structures, water, ships, vessels, trailers, portable structures, trains, railway cars, vehicles, and aircraft.
• "public health inspector" is a public health inspector of a board of health.
• "public health nurse" is a public health nurse of a board of health.
• "public health standard" is a standard published by the Minister under section 7.
• "public pool" means a structure, basin, chamber or tank containing or intended to contain an artificial body of water for swimming, water sport, water recreation or entertainment. It does not include those that are located on a private residential property under the control of the owner and used solely for commercial display and demonstration purposes
• "registered nurse in the extended class" is a College of Nurses of Ontario member with an extended certificate of registration under the Nursing Act, 1991.
• "regulations" are regulations made under this Act.
• "reportable disease" is designated by the Minister. "residential building" has one or more dwelling units.
• "sanitary facilities" has toilets and washbasins.
• "school" is defined in the Education Act.
• "school board” means a board as defined in the Education Act.
• “sexually transmitted disease” means a disease caused by an infectious agent usually transmitted during sexual contact.
• “small drinking water system” means a small drinking water system as specified by regulation (“petit réseau d'eau potable").
• "virulent disease” is designated by the Minister.

Key Facts About HPPA

• An order to close premises must prevent entrance/access and suspend operations, unless otherwise specified (R.S.O. 1990, c. H.7, s. 1 (2)).
• The HPPA aims to organize/deliver public health programs/services, prevent disease spread, and protect Ontarians' health (section 2).
• The Act is binding on the Crown, thus applying to the Ontario government and its agencies (R.S.O. 1990, c. H.7, s. 3).

Part II - Duty of board of health

• Each board of health should superintend, provide or ensure the provision of health programs and services, required by this Act. R.S.O. 1990, c. H.7, s. 4.
• Boards of Health consist of municipal members along with members appointed by the MOH. Local band council members for native serves may be on the board. They differ in emphasis given local control but must deliver the mandatory health programs required by the MOH.

Mandatory health programs and services

• Community sanitation maintains sanitary conditions and prevents health hazards, including safe drinking water from small systems.
• It controls infectious diseases and of public health significance with provision of immunization services to children and adults.
• It supports of health promotion, health protection, and disease and injury prevention, including the prevention and control of cardiovascular disease, cancer, AIDS and other diseases.
• Family health, including counselling and family planning services, supports iii. health services to infants, pregnant women in high risk health categories and the elderly, iv. preschool and school health services, including dental services, v. screening programs to reduce the morbidity and mortality of disease, vi. tobacco use prevention programs, and vii. nutrition services.

Health Programs for School Pupils (Section 6)

• Boards of health programs must provide programs to pupils with consent of school.
• Programs can only apply to certain classifications of pupils. Medical Officer of Health approves school-requested programs. Separate school rights are preserved.

Public Health Standards (Section 7)

• The Minister sets the mandatory standards for health programs.
• Boards must adhere to health standards, which override conflicting regulations.
• Codes/procedures are adopted, and updates are incorporated.

Extent of Health Programs (Section 8)

• Boards are required to follow applicable regulations and standards for mandatory programs but do not need to go further than that.

Optional Health Programs (Section 9)

• Boards may offer additional health programs if necessary and approved by local municipalities for flexibility for local needs.

PART III - Community Health Protection (S. 10 - 20)

• Every medical officer of health must inspect the health unit to prevent/eliminate/decrease health hazards. (R.S.O. 1990, c. H.7, s. 10 (1)).
• Duty of the medical officer of health includes inspecting food premises along with their equipment, and premises used as a boarding house or lodging house.

Duty to Inspect

• Inspects: Food premises, boarding/lodging houses, residential institutions, schools, daycares, swimming pools, and persona; services.

Complaint re health hazard related to occupational or environmental health

• Medical officers of health in Ontario must investigate complaints of health hazards related to occupational/environmental health, notify the applicable government ministry, and deliver a report. (R.S.O. 1990, c. H.7, s. 11 (1)).
• The findings of the investigation is reported to the complainant and protects personal health information under the Personal Health Information Protection Act, 2004. The obligation imposed on the medical officer of health under subsection (2) prevails under the Personal Health Information Protection Act, 2004.

Duty of M.O.H. re occupational and environmental health

• All medical officers of health must stay informed about occupational/environmental health matters (R.S.O. 1990, c. H.7, s. 12 (1)).
• Ministries/municipalities must provide medical officers of health with requested occupational/environmental health information (R.S.O. 1990, c. H.7, s. 12 (2); 2006, с. 19, Sched. L, s. 11 (3)).
• A medical officer of health may vary requirements in prescribed provisions of small drinking water systems.

Section 13 Order

• Medical officers of health or public health inspectors can issue written orders requiring individuals to act or not act based on health hazards (section 13(1)).

Section 13 Order Requirements

• It must be issued by a PHI or a Medical Officer of Health.
• There must be a health hazard.
• Requirements outlined in the order must relate to the health hazard.
• The order can specify a time frame for compliance and must provide reasons. Oral orders are permissible in emergencies.

Section 13 Order - Time

• Orders from a medical officer of health or public health inspector can specify compliance times or periods (13(3)).
• Types of nature orders include vacating/closing/placarding premises, doing work on premises, removing health hazards, cleaning/disinfecting premises, destroying things, and regulating activity/use.

Section 13 Order Recipients

• Orders related to sanitation are given to an owner / occupier of premises, the owner of a thing, and a person engaged in the activity.

Section 13 Order - Reasons

• Orders must include the reasons for them, however and oral orders are permissible for imminent health hazards where delay is likely to jeopardize health (13(7)).

Section 14 Order - Direction

• If the order recipient may not comply, Medical officers of health can direct a contractor to do the work with the costs billed to whoever received the order.

Section 14 Order - Direction facts

• Medical officers of health can give directions, upon reasonable and probable grounds, that a health hazard exists.
• The direction may include where a person has refused to or is not complying with the order, is not likely to comply, cannot be readily identified by located or requesting the assistance of the medical officer of health in eliminating or decreasing the effect of the health hazard. (2)
• Under this section, a medical officer of health may direct to the person who takes action in eliminating or decreasing the health hazard. (3)

Section 14 - Directions

• Directions may authorize placarding premises, require work on premises, remove/detain hazardous items, require the premises to be cleaning, and destroy items.

Recovery of Action Expenses

• Boards of health can recover costs for health hazards from the owner/occupier of premises, through court action (15 (1)).
• Alternatively, if unpaid after 60 days, the board can transmit a statement to the municipal clerk for inclusion in municipal property taxes (15(2)).
• An occupier responsible for a health hazard can recover/deduct costs from the owner of a premises. R.S.O. 1990, c. H.7, s. 15 (4). While an owner responsible for the health hazard can recover the amount incurred to the occupier R.S.O. 1990, c. H.7, s. 15 (3).

General Duty - Food Premises

• Every food premise must be maintained / operated under ONTARIO REGULATION 493/17.

Food Premises

• Those commencing food operations must notify the medical officer of health in the health unit, without any stipulation on when they will be located (16(2)).
• People employed must comply with applicable regulations (16(3)), and they must furnish the medical officer of health of the health unit with requested information of the premises.

General Duty - Food

• No person shall sell food that is unfit for consumption due to disease or adulteration and no person shall sell unsterilized milk that is not licensed under the Milk Act. R.S.O. 1990, c. H.7, s. 17.

Tattoos and Eye Jewellery

• No one can sell scleral tattooing or implantation of eye jewellery under the conjunctiva unless the person is a member of a health profession set out in Schedule 1 of the Regulated Health Professions Act, 1991.

Powers of Health Officials

• Medical officers/public health inspectors can seize substances/things/plants/animals other than man if there is a health hazard in the opinion of health inspectors.
• Medical officers/public health inspectors must detain/examine/investigate seized items to determine if there is a health hazard.
• Non-hazardous items will be returned while hazardous items must be destroyed by medical officers/public health inspectors.
• Authorities can destroy hazardous food without examination.

Residential Buildings

• Owners of residential buildings have a duty to provide potable water, sanitary facilities, or a privy for residents

Part IV - Communicable Disease

• Duties to report diseases.
• Medical Officer of Health's powers to issue Communicable Diseases Orders/Directions.
• Co-operation between health units and also the presence of Court Orders.

Part IV Definitions

• "institution” means residential or care-oriented premises approved under subsection 9 (1) of Part I (Flexible Services) of the Child and Family Services Act, or residential facility, daycare, living residence, care home or other prescribed place.
• “superintendent" is the person who has charge of the institution.
• "administrator,” “hospital”, “out-patient" and "patient” share the same meanings as in the Public Hospitals Act.

Section 22 Order - Communicable Diseases Order

• The medical officer can requires someone to to take measures during a communicable disease where there is an immediate risk (R.S.O. 1990, c. H.7, s. 22 (1)). This is only on the condition that requires the medical officer of health, upon reasonable and probable grounds. (1)

Section 22 Order, Time

• An order can include Closure and placarding of premises, isolation of communicable disease, Cleaning, Submit to medical examination and care if virulent disease, and Do not expose others.

Section 22 Order - Communicable Diseases

• The orders are issued to individuals residing/present in the health unit, or those owning/managing something or an activity in the health unit.

Section 22 Order

• Section 22 Orders overrule Health Care Consent Act; reasons must be provided for the Order, and orders for someone under 16 must be addressed to their parent.

Section 24 - Direction by M.O.H

• Medical officers of health may give directions for communicable diseases.

Section 24 - M.O.H - Regulations

• Directions from the Medical Officer of Health may also give directions to the person who takes action to spread notice of the existence of such orders.
• Expenses acquired in providing directions are recovered with costs by the person to whom a direction is directed.

Section 25 - Duty to Report Disease

• If one has or may have a reportable disease, physicians, chiropractors, dental surgeons, nurses, pharmacists, optometrists, and naturopaths must report to the Medical Officer of Health.

Section 25-Carrier of disease

• Physicians/nurses form an opinion and must report communicable diseases after forming an opinion (R.S.O. 1990, c. H.7, s. 26; 2007, c. 10, Sched. F, s. 4.).
• Hospital administrators report if a hospital record states a patient has a disease for public health significance.

R.R.O. 1990, Reg. 569 -- Reports

• When reporting a communicable disease one must provide, as soon as, Name and address with.o
• Date of birth
• Sex
• Date of symptoms

R.R.O. 1990, Reg. 569 - Additional Info

• A person who makes a report of a communicable disease may require additional information from the health official as necessary.
• Duty of school principal to report disease if a communicable disease is suspected; also note Pupil Name/Address/BirthDate/School, etc.

Communicable disease acquired at facility

• Laboratory operators must report positive findings for diseases of public health significance.
• Medical officers can inform health facility administrators if a disease may have been acquired there.
• "Health facility" refers to hospitals that apply to to which the Public Hospitals Act applies, a long-term care facility regulated under a statute of Ontario, a psychiatric facility within the meaning of the Mental Health Act, or a person or entity prescribed as a health facility.

Communicable Disease Outbreak Order 29.2 (1)

• Medical officers of health can order a public hospital/institution be directed on any actions regarding investigation of an communicable disease. Such order may be provided if it will decrease the risk towards persons involved (2). Reason must be included in the order.

Duty to Report Death

• When a cause of death is disease that is significant, where the Vital Statistics Act says to do so, physician/registered nurses must report to medical officer of death (c and physician or

Communication between Health Units

• A medical officer of health can share any information about report diseases to any other office of health from another jurisdiction R.S.O. 1990, c. H.7, s. 32 (1). They transfer said report to the medical office to give the information where the person resides if the person resides outside of their jurisdiction, if he does not preside in health unit, medical officer of health shall transmit the
• Duty to attend newborns with communicable eye diseases (section 33), and also the duty to report patient who refuses treatment.

Physician or extended class nurse refusal or neglect treatment 34 (1)

• The the medical officer of health of the physician care report if a patient has a condition as such should refuse treatment.. (R.S.O. 1990, c. H.7, s. 34 (2); 2007, c. 10, Sched. F, s. 8 (2).
• Transmittal to M.O.H. where person resides, to where patient is mentione..

Court Order

• A judge of the Ontario Court of Justice may order a person who has failed to comply with a medical officer, in the context of a virulent disease, to do such things to isloate, to seek examination. Such orders provide the following criteria (a) that the person isolate himself, the person submit to. Said order will be granted, (a) be taken into custody (b) be examined (c) be treated

Court Order

• A court can order a person to isolate, submit to checks, or place self under medical professional, not expose self to others, and have police assistance It is that that it must be applied.

Immunization

• A "reportable event” means, include symptoms that may develop from taking a immunization.

Imnunization

• Person must be informed of how one should report and take account of potential complications.
• Physicans must form some account that if such should arise, the medical officer have take not of where these complications can be addressed (to where such events can be addressed.

Confidentiality

• Any information that is likely to identify someone in a case is protected information. Some exceptions being (0.a) where the disclosure is authorized under this Act or the Personal Health Information Protection Act, 2004; (a) in respect of an application by a medical officer of health to the Ontario Court of Justice that is heard in public at the request of the person who is the subject of the application; (b) where the disclosure is made with the consent of the person in respect of whom the application, order, certificate or report is made; (c) where the disclosure is made for the purposes of public health administration; (d) in connection with the administration of or a proceeding under this Act, the Regulated Health Professions Act, 1991, a health profession Act as defined in subsection 1 (1) of that Act, the Public Hospitals Act, the Health Insurance Act, the Canada Health Act or the Criminal Code(Canada), or regulations made thereunder; or

Municipal Statutes and Boards

• These encompass the health care legislation governing the city councils
• Various city acts have been designated, including Ottawa/Hamilton/Toronto and are outlined on the following

City of Ottawa Act, 199

• The cities are established under the Health Protection and Promotion Act (HPPA).

City of Greater Sudbury Act, 1999

• The city is now associated in a single distric where seven city council members will represent the board.

Town of Haldimand Act, 1999

• Town becomes the board of health for Haldimand-Norfolk Health.
• Unit if designated by the transition board or the Minister of Health, all through town designation. Allocation is determined by town

Town of Norfolk Act, 1999

• There is board of health to deemed desination, where Health restrictions all power are now deemed as health power under HPPA can only be enacted.
• boundaries cannot be changed until 2004.