The government of Ontario has introduced Bill 179, an omnibus bill that seeks to improve access to health care in the province of Ontario. If enacted, Bill 179 will amend 25 Acts administered by the Ministry of Health and Long-Term Care and one Act administered by the Ministry of Community and Social Services. Bill 179 has passed second reading and has been referred to the Standing Committee on Social Policy.  

This bulletin is intended to be a high-level overview of key elements of Bill 179. It is not intended to be a complete summary of the Bill. We invite readers to contact the authors for more information.  

Purpose Of Bill 179

According to the government, Bill 179 is part of the province of Ontario’s health human resource strategy that seeks to ensure access to and a better mixture of qualified regulated health care providers. Bill 179 seeks to increase patient access and to improve chronic disease management by better utilizing regulated health care professionals and reducing barriers to their practice. It also seeks to improve public safety through strengthening the health professional regulatory system.  

Highlights Of Bill 179

New College Object  

A new object for health profession Colleges will be added through an amendment to the Health Professions Procedural Code under the Regulated Health Professions Act. Colleges will have a duty to develop in collaboration and consultation with other Colleges standards of knowledge, skill and judgment relating to performance of controlled acts common among health professions to enhance interprofessional collaboration, while respecting the unique character of individual health professions and their members.  

The College Supervisor  

Bill 179 would permit the Lieutenant Governor in Council to appoint a person as a “College supervisor”, on the recommendation of the Minister of Health and Long-Term Care, where the Minister considers it appropriate to do so. Unless the appointment provides otherwise, a College Supervisor would have the exclusive right to exercise all the powers of a Council and every person employed, retained or appointed for the purposes of the administration of the Regulated Health Professions Act S.O. 1991, c. 18 and a health profession Act, among other specified Acts. The Lieutenant Governor in Council would be able to specify the powers and duties of a College supervisor and the terms and conditions governing those powers and duties. When deciding whether to make a recommendation to appoint a College supervisor, the Minister will be entitled to consider any matter he or she considers relevant, including, but not limited to:  

  • the quality of the administration and management, including financial management, of the College;  
  • the administration of the Regulated Health Professions Act or the health profession Act as they relate to the health profession; and  
  • the performance of other duties and powers imposed on the College, the Council, the committees of the College, or persons employed, retained or appointed to administer the Regulated Health Professions Act and the health profession Act, among other specified Acts.  

Remote Dispensing

Bill 179 seeks to provide a legislative platform for remote dispensing of prescription drugs in Ontario. Remote dispensing refers to the dispensing of prescription drug products under the supervision of a licensed pharmacist, but without the pharmacist being physically present at the dispensing location. Through amendments to the Drug and Pharmacies Regulation Act, R.S.O. 1990, Chapter H.4, the definition of pharmacy will be expanded to include a “remote dispensing location”. Prescribed standards for the accreditation of remote dispensing locations will be set by the Council of the College of Pharmacists of Ontario, subject to the approval of the Lieutenant Governor in Council.  

The Use of Drugs and Substances

Through amendments to various health profession Acts under the Regulated Health Professions Act, Bill 179 seeks to authorize certain health care providers to provide prescribed services with respect to the use of drugs. In particular, the following changes would be made to give regulated health professionals the power to administer, prescribe, dispense, compound, sell, mix and use drugs and other substances:  

Chiropodists and Podiatrists:

  • Give a patient certain substances by inhalation  

Dental hygienists:

  • Prescribe, dispense, sell or mix certain drugs  

Dentists:  

  • Sell or mix drugs (can already prescribe and dispense)  

Midwives:  

  • Administer to a patient any substance on the order of a physician  

Nurse practitioners:

  • Dispense, mix, and sell certain drugs (can already prescribe certain drug designation)  

Pharmacists:

  • Administer, by injection or inhalation, certain substances to a patient  
  • Prescribe certain drugs  

Physiotherapists:

  • Administer certain substances by inhalation as ordered by authorized persons (e.g., a physician)  

Respiratory therapists:

  • Independently give a patient certain substances by inhalation

Furthermore, the amendments would authorize the Lieutenant Governor in Council to make regulations establishing one or more expert committees. These expert committees would be used to create or approve documents setting out lists of drugs or substances that may be prescribed, administered, injected, inhaled, dispensed, compounded, used, or sold (as case may be), to be adopted by reference in regulations made by the Colleges of Chiropodists, Dental Hygienists, Midwives, Nurses, Optometrists, Pharmacists or Respiratory Therapists. The Lieutenant Governor in Council will have the power to make regulations regarding expert committees. Through this power, the Lieutenant Governor in Council can make regulations establishing expert committees, specifying their functions, duties, powers and membership, requiring them to provide reports and information to the Minister, requiring information to be provided by a College or Council to the expert committee and governing the content of the information and the form and manner and time within which the information is to be provided to the committee.

Additional Authorized Acts

Through amendments to various health profession Acts under the Regulated Health Professions Act, Bill 179 would authorize certain health care providers to perform specific health care acts. These amendments would be over and above the amendments regarding the use of drugs and substances. Along with the authorized acts, Colleges would be able to make regulations governing its members in the performance of these acts. The following is a summary of the proposed new controlled acts and powers that would be authorized, listed by health care provider:

Nurse Practitioners:

  • Communicate a diagnosis to a patient  
  • Apply specified forms of energy (e.g., diagnostic ultrasound)  
  • Set or cast a fracture or dislocation of a joint  

Pharmacists:  

  • Perform a procedure on tissue below the dermis  

Physiotherapists:  

  • Communicate a diagnosis to a patient  
  • Treat a wound below the dermis using certain procedures  
  • Insert an instrument, hand or finger into certain body openings for assessment or rehabilitation of the pelvic musculature  
  • Order certain forms of energy (e.g., diagnostic ultrasound)  

Midwives:  

  • Tell patients their diagnosis  
  • Administer suppository drugs  
  • Place a tube beyond the larynx of a newborn  
  • Take blood samples from fathers and donors  

Dieticians:  

  • Prick skin to check a patient’s blood readings  

Medical Radiation Technologists

  • On the order of a physician be able to:  
    • perform procedures below the skin (e.g., give a needle)  
    • tracheal suctioning of a tracheostomy  
    • put contrast media into certain body openings and artificial openings into the body  
    • put an instrument, hand or finger past certain body openings and artificial openings into the body  

Health Professions Regulatory Advisory Council (“HPRAC”)

The duties of HPRAC will be modified. HPRAC’s duties will be to advise the Minister and no other person regarding prescribed matters, but only if the Minister decides to refer the issue to HPRAC in writing, seeking its advice, and in no other circumstance. Although a Council of a College or person may still ask the Minister to refer a matter to HPRAC, the Minister is no longer obligated to do so. Furthermore, HPRAC is to provide advice to Minister only, and shall only provide advice on what is referred to it, unless the Minister or the Regulated Health Professions Act provides otherwise. The advice is be provided only in the form and manner specified by the Minister.