HPPA and Communicable Diseases Quiz

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  • (a) (repealed)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  • (j) (repealed)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

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.