Optometric jurisprudence

What is law?

law is a form of order, system of riding rules and reflects what a society believes

What are the 3 components of Law?

1) legal values: beliefs or principles being promoted by a particular law

2) system of rules: establish person's rights and dtuies= what ppl can and can't do

3) legal institusion: make and enforce the rules

What is the function of law? 5 main functions= each law does not need to fulfill all 5 function

law establish rules governing behaviour so society can be in order

1) establish government and provide a guide for making laws

2) protect the public

3) establish rights and duties

4) prevent or resolve disputes

5) give remedies

What are the 4 levels/ hierarchy with legislation. start from the top

1) acts: legal doceumneted/ set of rules

2) regulations: attached to an act

3) bylaws: day to day things

4) policy

What is a bill?

Bill are new legislation introduced into Parliament = it may affect the whole country or province or small number of ppl

Whocan introduce bills?

minister of the government or by any member of the parliament or ligislature

What are the 5 stages in creating a new law (government bill)

1) first reading: intro and explain the objective of the bill

2) second reading: discuss the principles and purpose of the bill

3) bill go to standing committee for consideration = hear testimony, what they like and don't like

4) thrid and final reading by parliament

5) promulgation= bringing the bill into force

Which laws are considered private law?

private law: deals with relationship b/w individuals= dispute b/w ppl

family (divorce, child custody), contract, tort (damages harm done to someone), property, labour, employment

Which laws are considered public law?

constitutional law (what government can do), criminal law, administrative law

What is regulation?

regulation: intentional activity of attempting to control, order or influence the behaviour of others

What are the 3 requirements incorporated in regulation?

1) setting standards

2) processing for monitoring compliance with the standards

3)enforce the standards

Who requires regulating?

primary criterion:risk of harm = protect public from harm in delivery of the health care

secondary criteria: professional autonomy: assurance that professional can exercise their judgment in care and tx to their px.

other criteria: have educational requirements to practice, does professional have the knowledge to fulfill scope of practice, able to pay regulation fee,

What are the 3 models of professional regulation?

1) direct state control

2) partial self-regulation

3) self-regulation

What is direct state control?

government employees conduct most regulatory matters, professionals have limited role. legistralation is done by government or professional association

What is the partial self-regulation?

government employees conduct most business. lesgislation is done by professional assocations

What is self-regulation?

members of the profession are elected to govern and nonprofessionals are appointed by government. professional association bring forward legislation

What do most associations define optometrist's work?

specialized in examination, diagnosis, treatment, management and prevention of disease and disorder of the visual system, the eye and associated structures as well as the diagnosis of ocular manifestations of systemic conditions

What are the eight features of quality practice of optometry in canada?

assessment, equipment/ facilities, diagnosis, communication, maintaining accurate record, treatment, prevention and integration

What does scope of practice statements are used in the legislative context?

scope= describes what a profession does, limit who can perform certain tasks

What are the 2 different legislative models for controlling the scope of practice?

1) exclusive scope of practice model-only members of profession can provide defined scope

2) controlled acts model= restriction to risky task

What is the exclusive scope of practice model?

specify what the profession does, prohibit anyone other than members from performing activities. and protection to title = only members of college can be called optometrist.

contain: definition of scope, offences, exclusions (who the act does not apply to)

Provinces with exclusive scope of practice model for regulating optometrists: 6

newfoundland, PEI, saskatchewan, new brunswick, nova scotia and manitoba

What are the 3 effects of having the exclusive scope model?

1) public will be protected= need to be registered and trained to perform

2) profession has monopoly to perform all activities within the defined scope of practice= disc: access issues, affordable

3) liegistration relating to diff profession dvp at diff times

What is the controlled acts model?

act identifies risky procedures (controled/ restricted acts) and establishes broad prohibitions on th performance on them > only certain professions will be given authority to perform these controlled acts.

look at where the harm is to px

what are the legal values of the ontario's regulated health professions act?

protect the public from harm, promote high quality care, make regulated health professions accountable to the public, give px access to health care professions of their choice, all regulated health professions adhere to same purposes and public interest priniciples, treat px and professionals fair

What are the main parts of the RHPA?

outlines duties of the minister of health, creates health profession regulatory advisory counsel and HP appeal review board, identifies and sets out prohibits on performing the controlled acts, restrictions on use of title doctor, sets out provisions for confidentiality and immunity

What are the 2 functions of the HPARB:

health profession appeal review board functions:

1) deal with registration issues= if college refuse issue of certificate= person can appeal

2) consider appeals from complain committee

What in the ontario regulated health professions act= example of controlled acts model

includes a prohibition on perforation controlled acts, sets out 13 to 14 controlled acts that have a risk of harm associated with their performance. professions may have one or more acts authorized to members

Who can perform a controlled act? 2 types

no person shall perform a controlled act set out in act in the course of proving health care service to px unless

1) person is a member authorized by health profession act to perform the controlled act

2) the performance of the controlled act has been delegated to person by member . person delegating will be accountable and responsible

What is a harm clause?

harm clause: protects public from unregulated practitioner or from regulated practitioners practising outside their scope of practice. so even tho not a controlled act= doctors can't perform outside scope = can't do anything that would risk px being harmed= more protection for public

What are the 3 effects of controlled acts model

1) public will be protected= only profession with training can perform

2) public has access to a variety of providers of health services= increase access

3) providers for a coorindatekd approach across a range of professions = all profession governed by same legislation

What is the profession specific acts?

PSA: establish health regulatory colleges= deal specifically to that profession.

describe scope of practice for the specific profession, list the controlled acts that are authorized to the profession, list the protected title for each profession

whats the scope of practice under the optometry act?

scope of practice= practice of optometry is the assessment of the eye and vision system and the diagnosis, treatment and prevention of

disorder of refraction, sensory and oculomotor disorders and dysfunctions of the eye and visions system

prescribed disease

What are controlled/ authorized acts optometry has? 4

1) communicating a dignosis identiying, as the case of a person's symptoms, a disorder of refraction, a sensory or oculomotor disorder of the eye or vision system or a prescribed disease

2) applying a prescribed form of energy = Xray

3) prescribing drugs designated in the regulations

4) prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses

what are prescribed diseases under the optometry act?

1) in relation to diagnosis and prevention, disease of the ye and visions system th can be determined by findings from an oculo-visual assessment

2) in relation to treatment, diseases of the ey and vision system that can be treated by other than the application of srugery.

prescribed disease= any disease limited to and manifested int he eye and vision system that was determined by the findings from an oculo-visual assessment

what are the protected titles under the Optometry act?

no person other than a member shall use the title optometrist.

no person other than a member shall hold himself or herself out as a person who is qualified to practice in Ontario as an optrometrist

What is patient's bill of rights?

patients have rights that can't be taken away from them and they deserve it.

consumer has rights in this code, provider is subject to the duties in the code, every provider must take action to inform consumers of their rights and enable consumers to exercise their rights

What are then patient's rights in th new zealand legislation?

1) right to be treated with respect/privacy, take into account their needs and values

2) right to freedom from discrimination, coercion, harassment and exploitation

3) right to dignity and independence

4) right to service of an appropriate standard= care and skill, professional, ethical

5) right to effective communication

6) right to be fully informed of their condition, options, estimated time for appt, honest answers

7) right to make an informed choice an give informed consent

8) right to suppore= have relative, friend unless not safe

9) rights in respect of teaching or research

10) rights to complain

what is in the tommy douglas act?

1) right to receive all necessary health care services in health care system

2) right to give or refuse consent to the provision of health care service

3) right to all information nesccessary to make fully informed health care choices

4) right to recivepublicly funded heath care of high quality

5) right to receive information above choices that promote good heath

6) right to be dealt with by health care serve providers

7) right to participate i any assessment

8) right to make complaints, raise concerns, recommend changes without fear

9) right to be informed of law rules, polices affecting providers

10) right to confidentiality of health care

How do colleges assure patient expectations are met? 6

initial registraion, labour mobility issues, on-oging programs, annual registration, quality assurance, complains/ discipline

What occurs in initial registraion?

need to meet requirements before get certificate to practice:

education requirement, examination (pass CACO boards), good character

what are the requirement for the issuance of certificate of registration in Ontario?

complete of application form, successful completion of an appropriate academic curriculum, fluency in english,letter of good standing, no criminal record, citizenship, successful completion of examinations, pay fees

What are different classes of registration?

general: can practice

acadmeic: only practice in school approved by college

courtesy: can only practice in a location of a specific time period

full A: can prescribe drugs

full B: hold can practice but can't prescribe drugs

non-practicing: stop practicing for a period of time= so don't need to pay full membership fee

What is labour mobility?

agreement on internal trade for federal, provincial government to reduce carrier to inter-provinical mobility= can practice in other province without writing an different board exam czu recognize similarities of initial registration requirements and similar continuing registration requirements

What is needed for on going registration?4

practice hours= to maintain skills = 750 hours in 3 years

cotinuing education= field keeps advancing, up to date =55-70 every 3 years

professional liability insurance

annual fees = pay regulatory body so they can operate

what are at the 4 ways professionals are guided by?

1) standard of practice

2) guidelines (Clinical practice guidelines/ best practice)

3) advisory statement

4) position of policy statement

What is the definition of standard?

standard: something which has authority. the detail design specification for a material, product of process, established by a competent body ad not automatically mandatory

What is standards of practice?

a standard of practice is the minimum requirement= required authority, usually in the form of a regulation or bylaw, to be enforced.

threshold that has to be met

will have consequences for failing or maintain standards

What the purpose of having standards of practice?

1) to develop, establish and maintain programs and standards of practice to assure the quality of practice of the profession.

2) prescribing the standards of practice of the profession and prohibiting members from acting beyond the scope of practice of th profession int he course of practicing the profession

How are standards of price enforced?

professional misconduct reguation: failing to maintain he standard of practice of the profession

what are guidelines and how are they different from standards?

guidelines: suggestion for voluntary behaviour. no legal authority.

used to encourage practitioners to improve the care they provide.

soem guidelines can become standards

Where do guidelines come? where are they found? who is responsible for maintaining them?

guidelines come from variety of source= anyone can publish. they are found in professional literature or journal articlesm open to public on OAO website. no one needs to maintain them.

some guidelines get adopted some are forgotten

How do new guidelines come about?

changes reflect the changing scope of practice, knowledge and technology.

What are advisory statements?

Advisory statements: used to warn or advise members of legal requirements

What are position statements?

position statements: used to interpret or clarify certain issue = describe what the college is likely to do in circumstances

What are 4 opportunities the regulatory colleges are including to establish quality assurance and continuing competence?

1) continuig education

2) practice (record) assessment

3) practice evaluation

4) remediation

member participation may be required in any or all components

What is the purpose of quality assurance

to develop, establish and maintain programs and standards of practice = to maintain and enhance the knowledge, skills, and judgement of members so that appropriate care of high quality is provided to the public

2) protect and serve th public interest by reaffirming that all regulated members practice in a safe and competent manner

What are the minimum requirement for quality assurance program?

1) self, peer and practice assessment

2) mechanism for college to monitor member participation in and complication with quality assurance program

Who are the suppliers of continuing education?

professional associations, scoolsand colleges of optometry, regulatory colleges, suppliers product and entrepreneurs.

What occurs during a practice(record) review in quality assurance?

records are measured against standards of practice = must record if test was completed.

misconduct: if failture to maintain the standards of practice.

optometrist may explain themselves before decision body takes adverse action

What happens in a practice evaluation?

evaluation of members knowledge, skill or judgement.

differtiates b/w members who don't so and those who don't know what to do

What happens in redemption?

to address deficiencies in a members knowledge, skill or judgement

What is considered a profession misconduct

engaging in conduct or perfomatin an act that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable, unprofessional or unethical

What does it mean to have the right of privacy?

right to privacy means that individuals get to decide what and how much information to give up, to whom it is given and for what use

what are the 10 universal principles of privacy in the canadian standards association in the model code of protection of personal information?

1) accountability: held responsible for the personal info

2) identifying purpose: at or before info collected need to identidy why you need it

3) consent: px allow collection, use and disclosure of personal info

4) limiting collection: info collected limited to what is necessary

5) limiting use, disclosure and retention= don't use info in other ways

6) accuracy: info complete, uptodate

7) safeguards: protected by security safeguards

8) openness= policies and practice management is readily available

9) individual access: px can gain access

10) challenging compliance: if not happy with optima

what does the personal information protect and electronic document act regulate?

PIPEDA regulate the collection, use, disclosure of personal information in private sector for business purposes

what is the personal health information protection act of ontario?

PHIPA: can replace PIPEDA if all 10 privacy principles are fulfilled but also allow info exchange b/w health care professionals

What are the 5 goals/ purpose of ontario PHIPA?

1) establish rules for collection, use and disclosure of personal health info but still protect confidentiality, privacy and having effective provision of health care

2) indivualds have right to access personal health info about themselves

3) provide individuals with right to require correction of personal health info about themselves

4) independent review and resolution of complaints

5) provide effective remedies for contraventions of this Act

when can you refuse to disclose health information to an applicant?

1) results in immediate harm to applicants mental or physical health or safety

2) threaten the mental or physical heath or safety of another individual

3) pose trheat to public safety

What are the consequence for failure to comply with provincial or federal privacy legislation?

1) natural person= done by you = < $50,000

2) done by school, bigger organiation < 250,000

What is health information?

health information = diagnostic, treatment and care information or registration information.

registration information= info related to demographic, health number, location, telephone number, house info, health service eligibility info, billing info

What is personal health information?

inforation relating to physical or mental health of individual, health history, individual's family, providing healthcare o px= identifying px health care providers, payments, coverage for heath care, donation of body part, health number

what are the 3 types of record keeping?

1) daily appointment record

2) financial record

3) patient health records

who has access to information contained in health records?

1) patients

2) patients authorized person

3) if px has lack of capacity of dead = spouse, children, parent

What is circle of care?

circle of care: describe the ability of certain health information custodians (record keepers) to assume an individual's implied consent to collect, use or disclose personal health information for the purpose of providing health care

What is a health information custodian?

HIC: only assume an individuals implied consent to collect, use or disclose personal information if size conditions are satisfied

What are the 6 conditions needed to assume an indivualds implied consent?

1) HIC msut fall within a category of HICs that are entitled to reply on assumed implied consent

2) PHI must been recieved from individual

3) HIC must have recieved the PHI for the purpose of providing or assisting in provision of health care

4) collection, use and disclosure of PHI by HIC mystic be for provision of health care

5) disclosure of PHI by HIC must be to another HIC

6) HIC that received PHI must not be aware that the px has expressly withheld or withdraw his consent to disclosure

What is the lock box concept?

lock box= px has a the right to expressly withhold or withdraw consent to the collection, use or disclosure of their personal health information unless collection, use, disclosure is permitted or required by PHIPA.

if px not comfortable with giving all info to other HIC, disclosing HIC must notify the incompleteness of infro

What is the purpose of the health care consent act?5 purposes

1) provide consistent rules with respect to consent to tx

2) facilitate tx for persons asking the capacity to consent

3) enhance the autonomy of persons= px can control what happens

4) promote communication and undersantind b/w heath vare and px

5) ensure role for supportive family members when person lacks capacity and permit intervention from public guardian and trustee

What are some exceptions to consenting?

1) don't access capacity

2) taking person;s health history

3) communication of their assessment or diagnosis

4) admission of a person to a hospital

5) personal assistance service

6) a tx that in poses little or no risk of harm

What are the 4 elements of a valid consent?

1) must relate to treatment

2) must have been given voluntarily

3) must not have been obtained through misrepresentation

4) must be informed

What information must be relied for an informed consent? 6

nature of tx, expected benefits, material risks of tx, side effects, alternaive tx,consequences of not having the tx

+ patients questions were answered

What is the difference b/w expressed and implied consent?

in expreed consent: an question and answer was present

in implied: tx was told but no direct question asking if it okays but px actions, compliance to optima instructions suggest they agree to tx

What is presumption of capability?

until contrary is demonstrated, every adult (19 or older) is presumed to be capable of giving, refusing or revoking consent to health care = so have rights to give consent, refuse consent, select form of available health care, right to revoke consent, right to expect that a decision to give, right to be involved to the greatest degree is planning and decision making

what is mandatory reporting?

federal or provincial legislation may include specific provisions that require optometrist to provide reports to the appropriate government or regulatory agency = when required by law, breaching confidentiality is not misconduct. legislation provides optometrist who make reports i good faith are protected from civil liability.

What happens if you do not report when you are required to?

fines, penalties or allegations of professional misconduct

What are the 6 acts that require mandatory reports

1) highway traffic act= provincial

2) aeronautics act= same in all provinces

3) child and family services act

4) health insurance act

5) health protection and promotion act

6) regulated health professions act

What is the highway traffic act?

optometrist shall report to the Registrar of motor vehicles of a person 16 years or over who in opinion of optometrist is suffering from an eye condition that may make it dangerous for the person to operate motor vehicle > optima must report this who don't meet legislated requirements

How should an optima handle the situation where a px will be reported?

warn the px, tell px in advance that you will be filing a report to ministry that will make the final decision

What is the aeronautics acts?

optima believes on reasonable group that a px is a flight crew member, an air traffic controller or aviation that imposed optometric fitness, of have a condition that is likely to hazard to aviation safeaty> optima must inform medical adviser of that opinion

What is the child and family service act of ontario?

CFSA: recognize that children are vulnerable member of society > persons working closely with children have a rest to report suspucions of child abuse ( doesn't have to be proven suspicious is enough) > optima report to local children's aid society

if fail o report when required to do so = get fined

What are some patterns of child abuse?

suffering or at risk of suffering:

1) physical harm inflicted by person in charge or failure to care for

2) neglect

3) sexually molested

4) emotional disability of a permanent nature in the child

What is the optometrist job in reporting to children's aid society?

1)must not be delegated to other workers in the office> if optometrist formulated reasons to be suspicious of abuse > they need to file it themselves

2) must continual report if abuse is ongoing. new info= new report

What is the health insurance act?

optometrist shall report to general manager of OHIP if during profession duties has knowledge that

1) an ineligible person received or attempts to receive an insured service as if they were an insured person

2) ineligible person obtains or attempts to obtain reimbursement by the plan for money paid for an insured service

3) an inelgiable person gives false information but their residency

also px can choose who to get tested on and optometrist can choose whether to perform test or not

Who can report to OHIP?

reporting extend to employees who become aware of fraud or attempted fraud > optima make take possession of the health care id surrendered voluntarily when asked to swipe

What is the health protection and promotion act?

an optometrist who forms the opinion that the person has or may have a reportable disease shall report this to the medical officer of health. ex chalmydia

What is the regulated health professions act?

1) reporting requirement that a person who terminated the employment or dissolves a partnership or association with a health professionall for reasons of professional misconduct, incompetence or incapacity shall file a written report with the registrar of apporopriate college within 30 days of doing

2) optometrist file report if they believe that another member of same or different health profession has sexually abused a px = no report is required if the optom does not know the name of health professional

Under regulated health professions act, what are the 2 self-reporting?

1) referrals to discipline and findings of professional misconduct

2) findings of professional negligence or malpractice

college are obliges to include these reports int he register and post them the college website

What is the purpose of the provisions of the HPPC with respect to sexual abuse of px by members: 3?

1) encourage the reporting of such abuse

2)provide funding for therapy and counselling for px how have been sexually abused

3) eraddicate the sexual abse of px by members

What is considered sexual abuse?

1) sexual intercourse

2) touching of a sexual nature, of a px

3) behaviour or remark of a sexual nature by the members towards the patient