HPPA and Communicable Diseases Quiz

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Questions and Answers

What is one requirement that an order under the HPPA may impose regarding premises?

Requiring the owner to close the premises (correct)

Requiring tenants to vacate their homes permanently

Requiring the installation of security systems

Requiring the premises to be open to the public

Which action related to communicable diseases is mandated by an order?

Requiring individuals to travel freely to prevent spread

Requiring individuals to isolate if they may have a communicable disease (correct)

Requiring individuals to submit to group vaccinations only

Requiring individuals to promote open gatherings

What can a health order require regarding cleaning measures?

Prohibiting all forms of cleaning in the premises

Allowing only certain cleaning products

Mandating cleaning only when a communicable disease is confirmed

Requiring cleaning or disinfecting of the specified premises (correct)

What requirement may be imposed on a person with a virulent communicable disease?

To place themselves under the care and treatment of a physician Signup and view all the answers

Who can be the subject of an order under the HPPA?

A resident or someone present in the health unit Signup and view all the answers

Who is responsible for reporting a potential disease of public health significance in a hospital?

The hospital administrator Signup and view all the answers

What information is required in a report regarding a person with a communicable disease?

Full name, address, date of birth, and sex Signup and view all the answers

When must the administrator or superintendent report to the medical officer of health?

As soon as possible after the entry is made Signup and view all the answers

What does the term 'communicable disease' imply in the context of reporting?

A disease that can be spread from person to person Signup and view all the answers

If a report regarding a communicable disease is requested, what additional information might be needed?

Any information deemed necessary by the medical officer of health Signup and view all the answers

What is the role of the superintendent of an institution concerning disease reporting?

To report to the medical officer of health Signup and view all the answers

Which of the following is NOT included in the required report information?

Occupation of the person Signup and view all the answers

What is the responsibility of a medical officer of health concerning reports made under section 27?

To collect additional necessary information upon request Signup and view all the answers

What information must be included in a report regarding a deceased individual?

Name and address of the physician who attended the deceased Signup and view all the answers

What is the duty of the Medical Officer of Health regarding reportable diseases?

Report to the Ministry and the Ontario Agency for Health Protection and Promotion within seven days Signup and view all the answers

What must a medical officer of health do upon receiving a report under specific sections of the Act?

Immediately forward a copy of the report to the Ministry in a secure manner Signup and view all the answers

What is the specified method for forwarding reports according to the regulation?

Using the integrated Public Health Information System (iPHIS) Signup and view all the answers

Under what section must a medical officer of health report deaths from diseases of public health significance?

Section 31 (1) of the HPPA Signup and view all the answers

What constitutes a reportable event for a medical officer of health?

Events defined in section 38 of the Act Signup and view all the answers

Which entity is referred to by the acronym OAHPP?

Ontario Agency for Health Protection and Promotion Signup and view all the answers

What must be reported by the medical officer of health regarding deaths?

Deaths from diseases of public health significance Signup and view all the answers

Who is responsible for designating a physician when a person is detained in a facility other than a hospital?

The administrator of the facility Signup and view all the answers

What must the physician report to the medical officer of health?

The care, treatment, and condition of the person Signup and view all the answers

Under what condition can a person detained under an order be released from a facility?

Upon the certificate of the medical officer of health Signup and view all the answers

What is the maximum duration for which a person can be detained and treated under the order issued by the Ontario Court of Justice?

Six months Signup and view all the answers

What is required of the medical officer of health before issuing a release certificate?

Assessment of the person's treatment and condition Signup and view all the answers

What action can a judge take if a person continues to be infected with a virulent disease?

Extend the period of detention and treatment Signup and view all the answers

What determines the manner and timing of the reports that a physician must make?

The medical officer of health's specifications Signup and view all the answers

Which of the following factors does NOT influence the issuance of a discharge certificate?

The physician's personal opinion Signup and view all the answers

Which of the following does the Health Care Consent Act, 1996, not apply to?

Examinations to determine infection with a virulent disease Signup and view all the answers

What is the primary role of the physician designated by the administrator in a facility?

To provide care and treatment for the detained person Signup and view all the answers

Who designates a physician responsible for the care and treatment of a person named in the order?

The administrator of the hospital Signup and view all the answers

What must a medical officer of health do to initiate an extension of detention and treatment?

File a motion with the court Signup and view all the answers

Which statement is accurate regarding the role of the medical officer of health in the discharge process?

They can issue a certificate for discharge based on public health considerations. Signup and view all the answers

In what scenario can a judge extend the detention period beyond the initial six months?

If there is a significant risk to public health Signup and view all the answers

Who is responsible for ensuring the application of generally accepted medical practices in treating a person under an order?

The designated physician Signup and view all the answers

What is required for a judge to extend the treatment period when a motion is filed?

Verification of continued infection Signup and view all the answers

What is NOT a reason for entry under the specified act?

Inspection for structural integrity Signup and view all the answers

Which of the following powers is granted upon entry according to the act?

Access to or through premises Signup and view all the answers

Who is NOT classified as a person eligible for entry under the act?

A legal representative of a property owner Signup and view all the answers

Under what condition can entity representatives enter a private residence?

With a warrant or consent Signup and view all the answers

What action is NOT permitted under the powers upon entry?

Removing personal belongings of residents Signup and view all the answers

What must be ensured regarding the timing of actions taken under right of entry?

They must be conducted at reasonable times Signup and view all the answers

Which purpose is NOT mentioned as a valid reason for entry in the act?

Inspecting for fire hazards Signup and view all the answers

What type of information can be taken during an entry for an inquiry?

Samples or extracts related to the inquiry Signup and view all the answers

Study Notes

Environmental Health Law - ENH 121 - Unit 10 - HPPA II

Course: Environmental Health Law, ENH 121
Unit: 10 - HPPA II
Presenter: Daniel Huynh, BASc, School of Occupational and Public Health, Toronto Metropolitan University
Slides by: Dr. Peter Strahlendorf
Year: 2024

Health Protection and Promotion Act

Act: R.S.O. 1990, Chapter H.7 (Parts 4-5)
Revision Date: September 2023

Unit 10 - Contents

Part IV - Communicable Diseases:
- Section 22 Orders
- Section 24 Direction
- Duties to Report Diseases
- Communicable Disease Outbreak Order
- More duties to report
- Court Orders
- Persons under detention
- Immunization/Confidentiality
Part V - Rights of Entry and Appeals:
- Rights of Entry
- Appeals to HSARB or to the Court
Part IX - Enforcement

Part IV - Communicable Diseases (Detailed)

Duties to report diseases
Medical Officer of Health's powers to issue Communicable Diseases Orders
Medical Officer of Health's powers to issue Communicable Diseases Directions
Cooperation between health units
Court Orders

"Institution" Definition

Definition for "Institution" includes various "homes," "facilities" and "institutions."
Broadly, encompasses places where people share food and sleeping, primarily non-private residential facilities.
Schools are excluded from this definition.

Definitions, Part IV (Specific Types of Institutions)

21(1) "institution" includes various types:
- (a) (repealed)
- (b) Premises approved under subsection 9(1) of Part I of the Child and Family Services Act (before repeal)
- (c) "children's residence" within the meaning of Part IX (Residential Licensing) of the Child, Youth and Family Services Act, 2017
- (b) and (c) were introduced in 2017
- (d) "child care centre" within the meaning of the Child Care and Early Years Act, 2014 (previously known as the Day Nurseries Act)
- (e) "supported group living residence" under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008
- (f) “intensive support residence" under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008
- (g) "home for special care" under the Homes for Special Care Act
- (h) "long-term care home" under the Fixing Long-Term Care Act, 2021
- (i) "psychiatric facility" under the Mental Health Act
- (j) (repealed)
- (k) "correctional institution" (prisons) under the Ministry of Correctional Services Act (to be amended in 2018 to Correctional Services and Reintegration Act, 2018)
- (l) "detention facility" under the Police Services Act (to be repealed in 2018)
- (m) (repealed)
- (n) "private hospital" under the Private Hospitals Act
- (o) Place of secure custody under the Young Offenders Act (Canada) or elsewhere (youth Criminal Justice Act or otherwise)
- (p) a prescribed place, and includes any other place of a similar nature
21 (1) - Continued (Definitions for roles): "Superintendent" is the person in charge of an institution. "Administrator," "hospital," "out-patient," and "patient" have meanings established in the Public Hospitals Act.

Section 22 Order (Communicable Diseases Order)

A medical officer of health can issue a written order in specific circumstances to require a person to take or refrain from actions related to communicable diseases.
Conditions for issuing an order (subsection 22(2)):
- Communicable disease exists or may exist, or imminent risk of outbreak
- Risk to public health in the health unit
- Necessary requirements to reduce/eliminate the risk
A medical officer of health may specify the time or period for compliance with the order (subsection 22(3)).
Possible content of an order (subsection 22(4)): closure of premises, placarding of premises, isolation, cleaning/disinfecting, destruction of things, medical examination, care for virulent disease (locked facility), not exposing others

Section 22 Order (Addressed to Whom?)

Residents of a health unit.
People present in a health unit.
Owners/occupiers of premises in a health unit.
People owning or in charge of things in a health unit.
People engaged in activities in a health unit.

Section 22 Order (Additional Considerations)

Overrides the Health Care Consent Act.
Must state the reasons for issuing the order.
Orders to people under age 16 are addressed to the parent or guardian.
Person directed:
- (a) Resides in the health unit.
- (b) Owns/occupies premises.
- (c) Owns/is in charge of something.
- (d) Engaged in an enterprise/activity.
Class Orders: directed toward groups of people, with notice delivered to each. Methods for general notice delivery are considered.
Information in the notice: clear details of whom is directed., terms of the order, and inquiry locations.
Class Member Hearing Provisions: a class member the subject of an order can request a hearing before the Board

Communicable Disease Order (Class Orders)

Section 22(5.0.1): An order can be directed to a class of people residing/present.
Section 22(5.0.3): General notice delivery of the order when individual notice is impractical.
Section 22(5.0.4): Specific information required in the notice.
Section 22(5.0.5): Class member hearing provisions.
Section 22(5.1): Health Care Consent Act, 1996 does not apply to medical examination or treatment pursuant to a Communicable Disease Order.

Additional Contents of Order (Class Orders)

Medical Officer of Health can specify that only physician reports meet requirements.
May specify a required timeframe for reporting.

Reasons for Order (Class Orders)

An order issued under this section is not effective unless the reasons for the order are listed.

Order By M.O.H. for Persons Under 16

If an adult has parental responsibility, compliance with an order must be ensured for a person below 16 years

Section 24 Directions

If a person is not likely to comply with a medical officer of health order, the officer may direct health employees or contractors to do the work, and the cost will be billed, to the person.
Directions by M.O.H.
- A medical officer of health can give directions to people whose services are involved in or are agents of the board of health.
- Circumstances where M.O.H. can give direction,
  -(a) Refusal to comply with the order -(b) Not likely to comply with the order promptly -(c) Unidentifiable or difficult to locate, preventing prompt order carriage. -(d) Request for assistance in risk reduction
- Content of Directions by M.O.H: -(a) Authorize/require placarding of premises for notice -(b) Require Cleaning/disinfecting of a thing or premises -(c) Require the destruction of a thing
- Recovery of expenses incurred by board of health, billed to the individuals

Duties to Report Diseases

Section 25: Physicians, chiropractors, dental surgeons, nurses, pharmacists, optometrists, naturopaths, and "prescribed persons" are required to report any knowledge of a communicable disease.
Duty of Medical Officer of Health to Report
Medical Officer of Health reports to the Ministry and Ontario Agency on cases of diseases & deaths

Duty to Report Disease (Physician/Practitioner)

Section 25(1): A physician acting outside hospital settings has to report if a person is suspected of possessing a public health significant disease

Duty to Report Communicable Disease (Physician/Nurse)

Section 26: Physicians and registered nurses are required to report any communicable disease to health officers.

Duty to report disease (Hospital Administrator)

Section 27(1): Hospital administrators responsible for reporting if patient records indicate a disease or infection.

Duty to report disease (Institution Superintendent)

Section 27(2): Institution superintendents have a duty to report if lodged records indicate illness

When reports need to be delivered (Hospital/Institution)

Section 27(3): Reports should be given as soon as records indicate illness, or possible illness

R.R.O. 1990, Reg. 569 - Reports (Information Requirements)

Reporting requirements include name, address, date of birth, gender and date of onset of symptoms.

R.R.O. 1990, Reg. 569 - Reports (Additional Information Request)

Medical officers of health may request further details in relation to the disease and or an agent of communicable disease.

Duty of School Principal to Report Communicable Disease

A principal must immediately report if a student is perceived to have a communicable disease.
Report information: name, address, date of birth, sex, and name and address of the school the student attends.

Duty to Report Disease (Laboratory Operator)

Section 29(1): Laboratory operators required to report positive findings of public-health significance for diseases.

Duty to Report Reportable Disease (Laboratory)(Contents and Time of Report)

Section 29(2): Report content includes findings; time-frame determined by regulations.
Definition: "laboratory", as defined in the Laboratory and Specimen Collection Centre Licensing Act.

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

A report under section 29(1) should occur within 24 hours and includes a case's specific details, such as when a sample was taken.
The report should also list physician, registered nurse (extended class) or dentist information.
Section 3.1(1): A laboratory operator must report every finding of possible public health significance to the designated medical officer of health.

Duty to Report Communicable Disease Acquired at Facility (Reporting Requirements)

Section 29.1(1): The Medical Officer of Health is given the responsibility to report a communicable disease to facility administrators if they are suspected or known

Definition of "Health Facility"

Section 29.1(2): "health facility" defined as a hospital under the Public Hospitals Act, a long-term care facility, a psychiatric facility, or a designated "health facility."

Communicable Disease Outbreak Order (Facilities)

Section 29.2(1): Medical Officer of Health has authority to make orders to manage outbreaks.
Section 29.2(2): Conditions for issuing orders (disease existence, public health risk, necessary actions).
Section 29.2(3): Medical officer of health has the right to decide on the time period of orders.

Communicable Disease Outbreak Order (Facilities)(Reasons For Order)

Section 29.2(5): Orders must state the reasons behind it.

General Information (definitions)
"Institution" defined
"Public Hospital" defined

Duty to Report Death (Physician/Nurse)

A physician or a registered nurse, who signs a death certificate related to a or a disease of public health importance in their unit. , should inform the Health ministry or the designated agency about the death

R.R.O. 1990, Reg. 569 – Reporting Death

Reports on death certificates should contain the deceased's name, address, date of birth and date of death; and the attending physician or nurse's name and address

Duty of Medical Officer of Health to Report to MOHLT

Reports on diseases and deaths from public health significance diseases that occur, are reported to a government body (Ministry & Ontario Agency for Health Protection and Promotion).
Reports on other reportable events under section 38 to said bodies are required within 7 days.

R.R.O. 1990, Reg. 569 - Reports (Reporting to the Ministry & Agency)

The MO Health is required to forward a copy of the report to both the Ministry and Ontario Agency for Health Protection & Promotion.
Any required information from this Act is passed on to the right individuals in a protected manner (i.e., secure).

OAHPP - New (Definition)

Ontario Agency for Health Protection and Promotion = Ontario Body for said protections

Communication Between Health Units

A medical officer of health can transmit information about an individual with any public health significant illness or disease to other health jurisdictions as necessary

Transmission of Report

The medical officer of health must send the report to the officer of the health jurisdiction where that individual lives in cases where they don't reside within the same.

Communicable Diseases of the Eyes

Every physician, public health nurse, or health care professional must ensure that regulations are followed for communicative diseases of new-borns eyes

Physician or Nurse to Report Refusal or Neglect of Treatment

A physician, or nurse needs to report any person who is being treated for a communicable disease and refuses/neglects treatment

Report Refusal to Cooperate (Report Requirements, Transmission)

Reports on instances of refusal from individuals under treatment for communicable diseases shall be made to the Medical Officer of Health, with that information being transmitted as needed to other relevant health jurisdiction.
Additional information to be reported at specified times by set regulatory standards

Court Orders

Application by Medical Officer of Health to the Court (if virulent or non-compliances)
Court order content: isolation, medical examination, and care, not exposing others, possible detention
Order by Ontario Court of Justice
- Application details & conditions
- Content and details of orders
- Detention and treatment
- Hospital/Facility specifics (capacity)
- Delivery of the individual to the ordered facility.
- Police assistance

Court Order (Continued)

35(7.1): The Health Care Consent Act, 1996, does not apply to an individual's examination for a virulent disease or treatment for that disease, as per an order
35(8): The designated physician in a given hospital or other facility has responsibility for the care and treatment of the person
35(8.1): The person in care in a non-hospital facility has a physician provided to them by the facility's administrator
35(9): Medical Officer of Health reporting is required on care, treatment and condition.
35(12): Detention release/discharge is done through Medical Officer of Health's certificate

Court Order (Hearing Specifics & Extensions)

35(14): Applications or motions can be made privately, if the relevant individual specifies or for the sake of matters involving security/privacy.
35(15): Effects of an order on further proceedings before the Board/Appeals board
35(16) Appeal to Superior Court of Justice is permitted.

Court Order (Stay, Appeal to Court of Appeal, Grounds of leave)

A judge may be granted a stay of appeal
An appeal to the Court of Appeal is available with leave
Judge of the Court of Appeal required to assess if the public interest and the justice system needs necessitate leave permitting appeal to Court of Appeal

Where a Person Withdraws from Care and Treatment

Section 36(1): If an individual withdraws from the specified care and treatment mandated by the medical Officer of Health's order, section 35 will apply with appropriate modifications.

Court Order - Communicable Disease

If an individual fails to adhere to the mandated isolation directive made by the medical officer of health due to an illness, then section 35 applies with relevant modifications.

Persons Under Detention (Examination Requirements)

Section 37(1): Physicians in correctional facilities must notify the relevant health unit of individuals who may exhibit a communicable disease, or have one; and or be possibly infected with a medical agent of one.

Examination of Person under Detention - Continued

Section 37(2): The Health Officer can order additional measures from the responsible custodian (institution superintendent/administrator) to protect/reduce the spread of disease in such institutions.
Note: A specific day is required on the future for subsection 37(2) replacement; and or substitution.

Examination of Person under Detention - continued

Definitions:
37(3): "correctional institution" definition.
Definition of detention facility is to be repealed in the future, according to the note.

Examination of Person under Detention - Continued (Definitions of Secure Custodies)

The definition of "place of secure custody" and "place of temporary detention" as defined in a statute (Youth Criminal Justice Act or Young Offenders Act)
Removal of the phrase "detention facility"

Immunization - Definition and Reportable Events

Immunizing agent means various immunizations.
Reportable events include things such as crying, screaming, shock, collapse, fever, convulsions, arthritis, urticaria, seizure disorder, encephalopathy, encephalitis, and subsequent death

Immunization - Duty to Inform

If consent is given via the Health Care Consent Act, 1996, the physician or applicable entity must inform the consenting person of the importance of reporting any reactions that are considered a reportable event to either a physician or registered nurse.

Immunization - Duty to Report Reactions

A physician, a member of the College of Nurses of Ontario or the Ontario College of Pharmacists, has to give a report within 7 days if a reaction/event occurred from an immunization.
A Medical officer of health is responsible for receiving and transmitting reports of others health units concerning individuals living outside their jurisdiction

R.R.O. 1990, Reg. 569 - Reports (Immunization Reports)

The necessary provisions of this regulation mandates the Medical Officers' transmission of reports from the reports received concerning any adverse or reportable events from immunizations.

Confidentiality

Section 39(1): Prohibits disclosure of identifying information associated with communicable diseases/reports/applications.
Exceptions:
- Disclosure mandated by the Act or the Personal Health Information Protection Act (2004)
- Information disclosed publicly from an application to the Court of Justice
- Disclosure when explicitly consented by said individual
- Disclosure in the case of Public Health Administration.
- Information disclosed in connection with an authorized procedure as per a regulatory body.
- Information under section 125 of the Child, Youth, and Family Services Act, 2017

Drugs for STIs (Supply prohibition)

Section 40(1): Only registered nurses (extended class) and a physician can provide medication, treatment etc. related to the cure or relief from a STI
Exception to that rule (40(2)): Prescription dispensing by member of the Ontario College of Pharmacists.

Part V - Rights of Entry and Appeals

The purpose of the HPPA.
Appeals of Public Health Inspector or Medical Officer (PHI) Orders.
WHO has power of entry under the HPPA (Minister's inspector, PHI, medical officer, people working under a given direction).
Reasons for rights of Entry (Purpose of Act, Enforcement of the Act/Regulations, Exercise of any duty, Executing directions).
Powers upon entry (Access/investigation on premises, examining, investigations, tests, inquiries, copies, samples, extracts).
Private Residences are protected (No private residence entries without explicit authorization).

Rights of entry and powers of inspection

People with such powers, and what their purpose is.
Exercise of powers in specific situations
Accessing and using premises for examining, investigation, testing; or inquiry
Sample/extract rules that apply
Reasonableness in any given action (reasonable time requirement)
Private residence exception to general rule

Operator to cease operation

Operations like food premises or small drinking water systems can be subject to the prompt compliance with orders or cease operation as ordered.

Copies.

A copy of any written/recorded material related to examination/investigation/test/inquiry.

Charter Override (Recent court decisions)

A charter override exists, and that if an Inspector believes an offence has occurred, the inspector's powers of routine inspections cannot apply, implying the need for a warrant.

Application for warrant

Procedure if an occupier denies entry to a person acting under the HPPA
Actions to take, by the party or persons that encounter said situations

Obstruction

Prohibiting obstruction of someone authorised within the HPPA to take any of their mandated actions.
Exceptions are made where an individual is within the privacy of their own residence.

Warrant by justice of the peace

Requirements for a Justice of the Peace to issue a warrant
Issuance of warrants and required forms used to authorise a given person performing an activity associated with said act.

Appeals to Health Services and Appeals Review Board (HSARB)

An Order must state the right to appeal with the given time-frame (15 days).
Appeal to HSARB
Appeal of the given decision of the HSARB in court

Right to hearing (Appeals)

Individuals have the right to an order hearing if they request one and fulfil the necessary steps in the given time-frame associated

Oral Order (Appeals)

Oral or unnamed order need not follow the exact information format as found in subsection 1 for said hearings

Effects of an Order (Appeals)

Effect of order in relation to given hearings (when served, and in cases of oral orders and the like)

Powers of Board (Appeals)

Board powers extend to confirming, modifying, and making a new order within the specified boundaries of the procedure
Substitution of findings from Medical officer of health (MOH) or public health inspector's findings.

Time for hearing (Appeals)

Time-frame determination for given hearings, with any possible extension being granted.

Extension of time for hearing (Appeals)

Circumstances where further time granted for hearings

Parties and evidence (Appeals)

Who has party standing for the hearings' proceedings
Documentary evidence, access, and required forms relating to such

Members holding hearing not to have taken part in investigation (Appeals)

Members of the Board need to be independent of any given investigation or subject matter
Steps to maintain neutrality during hearing procedures, and rules for seeking/ obtaining legal advice

"Recording of evidence (appeals).

Required forms of recording evidence and related information (copies, transcript, procedure similarities to Superior Court of Justice)
Release of documentary evidence.
Documents and or other things used at hearing can be released, but only with proper request.

"Appeal to Court"

Any party can appeal a given decision/ order from the Board, and can be argued to the Divisional Court
"Stay of order:" If an appeal is initiated, a temporary stay can be granted. -"Record to be filed in court :" The Board provides the pertinent record with associated evidence.
"Minister entitled to be heard": The Ministry has the right to be present and be heard via counsel during the proceedings

"Powers of court on appeal."

Court to give the ability to confirm, alter, or rescind any decisions or orders given
Possible court options (e.g., reopening of the matter)

Enforcement (General Summary)

Penalty: Individuals guilty to the HPPA are liable to a fine
Corporation penalties
Rules concerning directors, officers, and or any given corporate employees or agents.
Court orders to prohibit further activities
Recovery of expenses from individuals

Court Order Proceeding Summary

Proceedings to prohibit future contraventions.
Procedures for applications and orders related to such activities and situations

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Test your knowledge on the Health Protection and Promotion Act (HPPA) and its regulations regarding communicable diseases. This quiz covers reporting requirements, orders, and responsibilities related to public health. Perfect for students and professionals in health science fields.