On May 14, 2020, Premier Ford announced Ontario’s first stage of reopening which included a full-scale return to construction, retail operations with street-front entrances, and certain outdoor recreational amenities (golf courses and marinas). The full press release can be found here.
When Will Regulated Health Services Resume in Ontario?
While the Province had previously announced a scaling up of elective and planned surgeries (see here for the Measured Approach to Planning for Surgeries and Procedures During the COVID-19 Pandemic), our office has fielded numerous calls from health care practitioners (physicians, dentists, chiropractors, physiotherapists, naturopaths, registered massage therapists, etc.) as to when they might be able to resume seeing patients. Given that Ontario’s Stage 1 reopening plan made no mention of resumption of day-to-day operations for regulated health professionals (other than allowing certain in-person counselling, including psychotherapy and other mental health support services) naturally, there have been many questions from practitioners
Regulation of In-Person Care
At the time of the announcement on May 14, 2020, regulated health professionals were constrained by two distinct requirements:
1. Directive #2 issued by Ontario’s Chief Medical Officer of Health on March 19, 2020, pursuant to section 77.7 of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7, which requires that all non-essential and elective services should be ceased or reduced to minimal levels.
2. Ontario Regulation 82/20 (O.Reg. 82/20) (the Closure of Places of Non-Essential Businesses Regulation) stated that regulated health professionals could provide urgent care only. The ‘urgent’ care directive is more stringent than the ‘essential only’ language of the Directive, and therefore takes precedence over the Directive. This regulation is clear that it should not be construed as preventing any business from operating remotely, including by telephone or other remote means, and many practitioners have continued to see patients virtually for day-to-day, non-essential and non-urgent needs. However, for manual practitioners such as chiropractors and registered massage therapists, online visits are only a stop-gap measure.
Regulated Practitioners May Be Essential, But Not Necessarily Considered Urgent
With the announcement on May 14, 2020 that limited in-person counselling services would be permitted, many colleges for the various self-regulating medical professions issued bulletins to their members advising that Ontario’s Stage 1 reopening did not apply to their field of work and that members were to continue with the status quo. However, over the long weekend, the government appeared to go a step further and has now amended O.Reg. 82/20 to remove the qualification that in-person care must be ‘urgent’. Paragraphs 38 and 38.1 of the Essential Workplaces regulation now list the following as ‘essential’:
38. Regulated health professionals
38.1 Professionals or organizations that provide in-person counselling services
While Directive #2 remains in force, thereby limiting in-person visits to ‘essential’ only services, the implications of the removal of the ‘urgency’ criteria will be far-reaching.
For example, the College of Massage Therapists of Ontario (CMTO) had previously advised that it does not consider the practice of massage therapy to be ‘emergency/urgent’ care.
As of May 15th, the CMTO website continued to state the following:
Number 38 on the list of essential businesses [O.Reg. 82/20] lists “regulated health professionals (urgent care only) including dentists, optometrists, chiropractic services, ophthalmologists, physical and occupational therapists and podiatrists”. CMTO’s position is that until the Government of Ontario lifts its order, RMTs should not practice. CMTO does not view the practice of Massage Therapy as emergency/urgent care.
Therefore, as of 12:01am on May 19, 2020 (when the majority of Ontario’s Stage 1 reopening takes effect), Registered Massage Therapists (and all regulated health professions) should be able to resume providing essential in-person services.
The same applies for chiropractors, physiotherapists, dentists, and numerous other medical disciplines whose practices are not well-suited to virtual patient care.
There is no doubt that countless people working from home, perhaps with poor ergonomic workstations (the kitchen table perhaps?) would greatly benefit from the ability to see a chiropractor or registered massage therapist. These patients, who are suffering in pain, will quickly benefit from these essential medical services to relieve pain and suffering. Allowing these patients to seek essential care (by removing the ‘urgent only’ modifier) is a welcomed move that will result in better outcomes for patients that might otherwise seek medicated pain relief at an emergency room.
May 27, 2020 Update
Late in the day on May 26, 2020, Directive #2 was amended to state that “All deferred and non-essential and elective services carried out by Health Care Providers may be gradually restarted, subject to the requirements of this Directive”.
The Ministry of Health also published a document entitled ‘COVID-19 Operational Requirements: Health Sector Restart’, to guide practitioners in best practices for restarting practices in a clinical setting. While virtual visits are still being encouraged wherever possible, non-essential and routine health services (for example: regular dental visits) can now start resuming. This represents an expansion of the ‘essential-only’ limitation that existed when this blog was first published last week. Each individual regulatory college for Ontario’s 26 regulated health professions will also have its own policies and guidelines that members will need to follow.
For practitioners who are looking to reopen for the purpose of providing in-person services (in accordance with Directive #2), please do not hesitate to reach out to SV Law for guidance on regulatory compliance and best practices for PPE and patient protection in a clinical setting.
The content of this article is intended to provide a general guide to the subject matter and is not legal advice. Specialist advice should be sought regarding your specific circumstance.