Rip up current system and start over, recommends review of B.C.’s professional health colleges

An independent expert says many of B.C.’s professional health colleges have demonstrated “a lack of relentless focus on the safety of patients,” and he’s recommending the province rip up the current regulatory system and start from scratch.

Harry Cayton, the former chief executive of the U.K.’s Professional Standards Authority, has urged B.C. to draft new legislation to replace the Health Professions Act.

“The current model of professional regulation will not be adequate to protect patients and the public or to represent the interests of citizens in the future,” the report says.

“There is a lack of relentless focus on the safety of patients in many but not all of the current colleges. Their governance is insufficiently independent, lacking a competency framework, a way of managing skill mix or clear accountability to the public they serve.”

Cayton’s report comes after a year of news about regulatory problems within some colleges, including board members at the College of Chiropractors spreading anti-vaccination misinformation. He was appointed in March 2018, in response to numerous concerns about operations at the College of Dental Surgeons of B.C.

Cayton has made 21 recommendations for improving how the dental surgeons’ college functions, including increased transparency, changes to the structure of the board and opening up board meetings to the public.

‘They have a public protection mandate’

Health Minister Adrian Dix said he will ask the dental surgeons’ college to come up with a plan to implement all of Cayton’s recommendations.

“The colleges do not belong to the professions, they belong to the public … they have a public protection mandate,” Dix told reporters Thursday.

“What was apparent was a lack of understanding of that mandate at the College of Dental Surgeons.”

There are 20 colleges in B.C. governed by the Health Professions Act. (Shutterstock)

On the question of amending or replacing the Health Professions Act, the health minister said he hopes to have an answer later this year.

Cayton’s report goes far beyond the dental surgeons’ college, recommending a complete overhaul for all professional health regulators in B.C. It says the 20 colleges regulated by the Health Professions Act need to have a clear mandate to protect public safety.

“Patients I have spoken to do not have great confidence in the colleges or in health regulation generally,” the report says.

It recommends creating a single register for all health professionals in the province, reducing the number of colleges and asking the colleges to agree to a single code of ethics and conduct. The report says the Health Professions Review Board, which oversees all of the colleges, should be replaced with a new body.

And Cayton wants to see changes to the current system for dealing with complaints, which he says is built around secrecy, with only a small number of complaint outcomes made public.

“It is not possible for patients to give informed consent to care if they do not know that their health practitioner has had a complaint upheld against them,” Cayton said.

Deregulation possible

He also recommends introducing a “risk assessed model” to determine which professions should be regulated, based on the potential harms to patients.

Cayton told reporters he believes that should include a review of health professions that are already regulated in B.C., which means some colleges could potentially be eliminated and certain health-care workers could lose their status as professionals.

“I accept that deregulating is quite a difficult thing to do, but this has been a longstanding debate in a number of countries,” he said at a news conference.

Cayton said the current system in much of the world amounts to this: “Whatever profession has lobbied hard enough … has managed to win itself a college.”

Dealing with ‘dysfunctional’ colleges

The last 12 months have seen several high-profile stories highlighting concerns about how B.C.’s professional regulators are functioning.

Cayton’s report points to several of these, saying the headlines reflect a “lack of public trust in the current regulators.”

In May, the vice-chair of the chiropractors’ college, Avtar Jassal, was forced to resign after CBC reported on a Facebook video he’d created that violated college policy on vaccination. In the video, he falsely claimed that smoothies are more effective than the flu shot.

In November 2017, the vice-chair of the College of Chiropractors shared a video in which he suggested smoothies are more effective than vaccination at preventing the flu. (Facebook)

Emails obtained through a Freedom of Information request show the health ministry scrambled to come up with a plan for handling a “dysfunctional” college in response to CBC’s reporting.

Jassal was just one of three members of the chiropractors board who had been the subject of complaints to the college and the ministry for sharing misinformation about vaccines. College policy forbids chiropractors from giving advice about immunization, as they are not trained in treating or preventing infectious diseases.

Since then, the college has implemented a new policy on claims by chiropractors, making it clear that they cannot suggest they’re able to treat conditions like autism, ADHD and ear infections.

Dozens of B.C. chiropractors are under investigation for alleged violations of that policy.

Meanwhile, the College of Naturopathic Physicians of B.C. is also conducting a crackdown on improper advertising by its registrants. That follows CBC reporting on a small number of naturopaths who were offering a homeopathic treatment that falsely claimed to provide “complete elimination” of autism, as well as the case of Anke Zimmermann, a former naturopath who made headlines around the world after she treated a small child with a homeopathic remedy made from rabid dog saliva.