On August 22, 2008, the Divisional Court released its reasons in Ontario Public Service Employees Union’s ("OPSEU") judicial review of the Central East Local Health Integration Network’s ("CELHIN") decision to enter into an Accountability Agreement with Rouge Valley Health System ("RVHS" or the "Hospital") in March 2008. RVHS was an interested party.

For the first time, the Court interpreted sections of the Local Health System Integration Act, 2006 ("LHSIA" or the "Act") regarding community engagement and integration of health services, finding that the CELHIN and RVHS complied with the Act and dismissing OPSEU’s application for judicial review. The Court also affirmed that the Hospital has the authority to make its own decisions regarding consolidation of health services within its two sites. The applicant special interest group’s attempt to read an enhanced right to consultation into the new legislation was rejected by the Court, which held that while there are specific provisions in the Act which require community engagement, the legislation does not create any new consultation rights in the context of routine funding decisions.

Overview

OPSEU argued that in the context of approving the RVHS Accountability Agreement the CELHIN made a decision to approve the Hospital’s plan to consolidate inpatient mental health services at one of its two sites, and further argued that the consolidation decision was an integration. Pursuant to the community engagement and integration sections of the LHSIA, OPSEU argued, the CELHIN was required to engage the community prior to approving RVHS’ consolidation, and having failed to do so, the CELHIN’s decision ought to be quashed.

The Court disagreed, finding that the decision to consolidate inpatient mental health beds was made by RVHS, did not require approval by the LHIN, and was an internal hospital decision.

Further, the Court held that the LHIN’s obligation to engage the community as set out in section 16(1) of the Act relates to planning activities, finding that it does not require public consultation during budget negotiations with individual health service providers. The Court also held that RVHS complied with its obligation at section 16(6) to engage the community when developing plans and setting priorities.

Finally, the Court held that there was no integration of services for the purposes of the Act in respect of the Hospital’s mental health consolidation, and therefore the community consultation provisions with respect to integrations did not apply.

Based on these findings, OPSEU’s judicial review application was dismissed by the Court.

Key Findings

  • A hospital with multiple sites constitutes a single health service provider pursuant to the LHSIA, and therefore a hospital-initiated movement of services from one site to another is not an integration;
  • Hospitals are free to make independent decisions regarding movement of services from one site to another without requiring approval by their LHIN;
  • LHINs are only required to consult the community in limited circumstances, which do not include the negotiation of accountability agreements with health service providers;
  • Hospitals are required to consult the community when "developing plans and setting priorities for the delivery of health services", but not necessarily when entering into their annual Accountability Agreement with the LHIN.

In this case it was clear that the Hospital had gone to great lengths to engage the community. It remains to be seen how section 16(6) of the Act will be interpreted in different circumstances. Hospitals should be aware of this section and of its obligation to engage its diverse community, potentially in a broad range of circumstances.

You can access the Local Health System Integration Act, 2006 at: http://www.e-laws.gov.on.ca