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Health sector waiting to see how LHINs use broad new powers

Ontario’s Patients First Act (Bill 41) proposes to expand the mandate of Local Health Integration Networks (LHINs), giving them considerable new powers over the expanded list of health service providers — raising eyebrows across the sector, Toronto health lawyer Kathy O’Brien writes in Lawyers Weekly.

“Recall that the Ontario government established LHINs in 2006 under the Local Health System Integration Act, 2006 (LHSIA), creating 14 geographic LHINs throughout the province. The networks were set up to fund and oversee a finite list of ‘health service providers,’ including hospitals, psychiatric facilities, long-term care homes and community care access centres. They were originally given the power to review and refuse voluntary integrations between health service providers and order integrations between health service providers,” writes O’Brien, partner with DDO Health Law.

A focus on health system integration has led many health service providers to look at merging or establishing formal alliances with other organizations, O’Brien adds.

Bill 41 — previously known as Bill 210 before the legislature prorogued in September — proposes to expand the role of LHINs by adding to the list of health service providers under their jurisdiction, mainly primary care health providers, such as family health teams, nurse practitioner-led clinics, aboriginal health access centres and primary care nursing services, she says, as well as palliative care and physiotherapy services in a clinic setting.

The bill also puts in place the mechanics by which the LHINs will take over the community care access centres (CCACs), which are currently responsible for providing health and social services in home and community settings and managing the placement of individuals into long-term care homes, supportive housing programs and chronic care and rehab beds, says O’Brien.

However, she adds, the most commented on new power is the ability of the LHIN to issue (when it is in the public interest to do so) “operational or policy directives,” which, when issued, are mandatory for health service providers.

“There was serious concern expressed that Bill 210 was a first step in eroding self-governance (volunteer local boards) of Ontario’s health service providers. The Ontario Hospital Association was particularly vocal about the overly broad power given to LHINs to issue these directives, on virtually any possible subject matter, without any need for consultation or prior notice. Bill 41 was a win for the Ontario Hospital Association — in the amended bill, hospitals are exempted from the LHINs’ directive-making powers. Some hospital leaders commented that Bill 41 is more ‘respectful of local boards,’” writes O’Brien.

LHINs will also have the power to appoint an investigator over health service providers, with broad powers to investigate and report on the quality of the management of a health service provider, the quality of care provided, or any other matter that the LHIN considers in the public interest.

“Investigators may enter premises, require the production of records and question people on matters relevant to the investigation. Investigators must prepare a report that will be made public,” O’Brien explains.

In addition, Bill 41 also gives networks the power to appoint a “supervisor” over any health service provider other than long-term care homes or hospitals.

“A supervisor is appointed at the pleasure of the LHIN for an indeterminate period of time and has the exclusive right to exercise all of the powers of the health service provider’s board, its directors, officers and members or shareholders,” writes O’Brien.

As a result, O'Brien says, many will be "watching closely to see how the LHINs approach their newly minted powers, once Bill 41 becomes law."

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