Legal news and trends for Canadian in-house counsel and c-suite executives
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The region believes in "full, open, and timely disclosure" of any medical errors, says Weyant, and also in providing compen- sation where errors have caused damages to be suffered, and in-house counsel have to work together with insurer's counsel to facilitate these objectives and try to deal with it without liti- gation. "That's a big push in where health is going now, shifting from treating existing issues to trying to prevent future ones. Like the health system as a whole, we're doing the same thing," he says. The management and disci- pline of doctors in the hospital is one area that concerns Mar- tin, who does get involved in discipline issues on the medical staff side. This can involve many op- health information is always kept confidential from those who shouldn't know of it," he says. In Toronto, privacy issues are also looming large, according to Belaiche, in a variety of forms. After being involved in imple- menting the new privacy legislation at the hospital four years ago, he now helps staff respond to privacy concerns and issues, such as contracts or medical records. Another recent privacy ini- portunities for procedural snags along the way, she says, as independent contractor sta- tus involves a strict regime for discipline or termination, by virtue of Ontario's Public Hos- pitals Act. Risk management and patient safety also remain priorities from treating existing issues to trying to prevent future ones. Like the health system as a whole, we're doing the same thing." — DAVID WEYANT, GENERAL COUNSEL, CALGARY HEALTH REGION for counsel. At the moment, Belaiche is co-chairing an enter- prise risk-management work group at St. Michael's — one of the first such broad initiatives at a Canadian hospital looking at the sources of risk and figuring out how to best address them to minimize and mitigate them. As a by-product of the emphasis on patient safety, Belaiche is involved with practice reviews and determining what the most effective mechanism for dealing with issues that come up in professional practice and has helped to develop a framework along with the hospital's chief medical officer to help the hospi- tal deal with situations where a discussion may be needed with a health-care professional. He is also working on performance evaluations for physicians and has been involved with the Council of Academic Hospitals of Ontario, working with a consultant to develop a toolkit to help govern how these types of assessments are done. Behind the scenes, as the trustee of health information, a hos- pital or health network also deals with some of the most com- plex privacy issues in any sector, says Weyant. One of the key initiatives undertaken by the Calgary Health Network is to have electronic storage of health information. As it builds an electronic health record, legal services is deal- ing with the software providers and systems architects to make sure that the right people have access to information. "It's a fine balance, of course, between access and privacy, ensuring that all of the health-care providers have the right ac- cess so that they can make appropriate diagnoses and can pre- scribe appropriate medicine, but ensuring also that the patient's "That's a big push in where health is going now, shifting tiative involved Belaiche, Mar- tin, and counsel for Toronto Police sitting down to address issues relating to police coming to the ER and seeking patient information for investigations. Counsel looked at the legisla- tion and found a provision that may allow for discretion- ary disclosure, if certain condi- tions are met. The protocol has now been implemented for a six-month pilot period. "We interact with the police not infrequently, often they're the people who bring patients to our emergency department or they're following patients who have come to our emergency department," says Martin. Another hurdle facing counsel in this area of law is the sig- nificantly changing legislative and regulatory environment. Keeping on top of these changes is an ongoing challenge, says Belaiche, but one that is alleviated by professional development, as well as an informal caucus of in-house counsel for Toronto- area academic health-science centres. Through this group, Martin, Belaiche, and other counterparts meet on a bimonthly basis to talk about issues, new develop- ments, and precedents. "Its amazing how many of the same issues come up at each of our hospitals," says Martin. One issue on the horizon is that the landscapes of hospitals themselves are also shifting, as they face the reality, with the ag- ing baby boomer demographic, of a much more informed and demanding client population, says Belaiche, as facilities move in the direction of a patient-centric model. This change in direction is a good thing, says Belaiche, but it does involve a "significant issue of changed management as organizations and clinicians and administrators respond to the challenges that come from a modified model of health-care de- livery," he says. "I think its probably fair to say that in some respects, the health-care industry is like a 19th century cottage industry . . . where society is now demanding that it become a 21st century industry," says Belaiche. "That kind of a monumental change requires a major para- digm shift in thinking by everyone." IH C ANADIAN Lawyer INHOUSE FEBRU AR Y 2008 41