O. Reg. 272/21: TRANSFER OF HOSPITAL PATIENTS

Emergency Management and Civil Protection Act

ONTARIO REGULATION 272/21

TRANSFER OF HOSPITAL PATIENTS

Historical version for the period April 28, 2021 to June 1, 2021.

Note: This Order is revoked on June 16, 2021, unless it is extended. (See s. 7.0.8 of the Act and O. Reg. 25/21, Sched. 1, s. 1)

Last amendment: 319/21.

Legislative History: 319/21.

This is the English version of a bilingual regulation.

1. The terms of this Order are set out in Schedule 1.

Schedule 1
Transfers

Definitions

1. For the purposes of this Order,

“alternate hospital site” means, with respect to a hospital,

(a)  a different location or site of the same hospital, or

(b)  a different hospital; (“autre site hospitalier”)

“alternate level of care” means a designation that is given by an attending clinician to a patient indicating that the patient does not require the intensity of resources or services that are provided in a hospital; (“niveau de soins différent”)

“attending clinician” means, within a hospital,

(a)  the attending physician, registered nurse in the extended class or midwife or, if the attending dentist is an oral and maxillofacial surgeon, the attending dentist, or

(b)  a member of the medical, extended class nursing, dental or midwifery staff of the hospital that is designated by a person referred to in clause (a); (“clinicien traitant”)

“hospital” means a health service provider within the meaning of paragraph 1, 2 or 3 of the definition of “health service provider” in subsection 1 (2) of the Connecting Care Act, 2019; (“hôpital”)

“licensee” means,

(a)  in relation to a long-term care home, a licensee within the meaning of the Long-Term Care Homes Act, 2007, and

(b)  in relation to a retirement home, a licensee within the meaning of the Retirement Homes Act, 2010; (“titulaire de permis”)

“local health integration network” has the same meaning as in subsection 2 (1) of the Local Health System Integration Act, 2006; (“réseau local d’intégration des services de santé”)

“long-term care home” has the same meaning as in subsection 2 (1) of the Long-Term Care Homes Act, 2007; (“foyer de soins de longue durée”)

“major surge event” means an increase in demand for critical care resources of a hospital that is attributable to COVID-19 and which is overwhelming, or imminently threatens to overwhelm, the critical care resources of one or more hospitals; (“situation d’engorgement majeur”)

“placement co-ordinator” means a placement co-ordinator designated under subsection 40 (1) of the Long-Term Care Homes Act, 2007; (“coordonnateur des placements”)

“resources” includes health human resources, services, equipment and supplies; (“ressources”)

“retirement home” has the same meaning as in subsection 2 (1) of the Retirement Homes Act, 2010; (“maison de retraite”)

“substitute decision-maker” means a person who is authorized under the Health Care Consent Act, 1996 or the Substitute Decisions Act, 1992 to give or refuse consent or make a decision on behalf of another person. (“mandataire spécial”)

Hospitals

2. (1) Subject to subsection (2), a hospital is authorized to transfer a patient to an alternate hospital site, and where the alternate hospital site is operated by a different hospital, the receiving hospital is authorized to admit that patient, whether or not the transfer has been consented to by the patient or, if the patient is incapable, the patient’s substitute decision-maker.

(2) A hospital may not transfer a patient to an alternate hospital site under subsection (1) unless the following conditions are met:

1.  The transfer is necessary to,

i.  respond to a major surge event,

ii.  enable the hospital to optimize the availability of its critical care and acute care resources, or assist another hospital in optimizing the availability of such resources, and

iii.  reduce a foreseeable risk of serious bodily harm to a person.

2.  Efforts have been made that are reasonable in the circumstances to obtain consent to the transfer from the patient or, if the patient is incapable, their substitute decision-maker.

3.  The attending clinician is satisfied that the patient can receive the care that the patient requires at the alternate hospital site and that the transfer can be effected without compromising the patient’s medical condition.

4.  Where a proposed transfer is to a different hospital, a member of the medical, extended class nursing, dental or midwifery staff at the receiving hospital is prepared to issue an order to admit the patient to that hospital.

Long-term care homes

2.1 (1) Subject to subsections (2) and (3), a hospital is authorized to transfer a patient to a long-term care home, a placement co-ordinator is authorized to approve the admission of the patient, and the licensee of the home is authorized to admit the patient to the home as a resident, whether or not the transfer has been consented to by the patient or, if the patient is incapable, the patient’s substitute decision-maker.

(2) A transfer under subsection (1) only applies to a patient who has been designated by their attending clinician as requiring an alternate level of care in a long-term care home.

(3) A hospital may not transfer a patient to a long-term care home under subsection (1) unless the following conditions are met:

1.  The transfer is necessary to,

i.  respond to a major surge event,

ii.  enable the hospital to optimize the availability of its critical care and acute care resources, or assist another hospital in optimizing the availability of such resources, and

iii.  reduce a foreseeable risk of serious bodily harm to a person.

2.  Efforts have been made that are reasonable in the circumstances to obtain consent to the transfer and admission to the long-term care home from the patient or, if the patient is incapable, their substitute decision-maker.

3.  The attending clinician is satisfied that the patient can receive the care that the patient requires at the long-term care home, and that the transfer can be effected without compromising the patient’s medical condition.

4.  The placement co-ordinator and the licensee of the long-term care home have complied with the requirements set out in subsection 208.2 (2) of Ontario Regulation 79/10 (General) made under the Long-Term Care Homes Act, 2007, except for paragraph 11 of that subsection.

(4) For greater certainty, nothing in this section requires a licensee of a long-term care home to accept the patient other than under the admissions process in section 208.2 of Ontario Regulation 79/10 (General) made under the Long-Term Care Homes Act, 2007.

Retirement homes

2.2 (1) Subject to subsections (2) and (3), a hospital is authorized to transfer a patient to a retirement home, and the licensee of the home is authorized to accept the patient as a resident of the home, whether or not the transfer has been consented to by the patient or, if the patient is incapable, the patient’s substitute decision-maker.

(2) A transfer under subsection (1) only applies to a patient who has been designated by their attending clinician as requiring an alternate level of care in a long-term care home.

(3) A hospital may not transfer a patient to a retirement home under subsection (1) unless the following conditions are met:

1.  The transfer is necessary to,

i.  respond to a major surge event,

ii.  enable the hospital to optimize the availability of its critical care and acute care resources, or assist another hospital in optimizing the availability of such resources, and

iii.  reduce a foreseeable risk of serious bodily harm to a person.

2.  Efforts have been made that are reasonable in the circumstances to obtain consent to the transfer to the retirement home from the patient or, if the patient is incapable, their substitute decision-maker.

3.  The attending clinician is satisfied that the patient can receive the care that the patient requires while a resident at the retirement home, and that the transfer can be effected without compromising the patient’s medical condition.

4.  It is confirmed by the licensee of the retirement home that a bed is available for the patient at that home.

5.  The licensee of the retirement home ensures that an assessment of the resident to develop a plan of care is conducted pursuant to section 62 of the Retirement Homes Act, 2010.

6.  The placement co-ordinator has determined the patient is eligible for admission to a long-term care home.

(4) For greater certainty, nothing in this section requires a licensee of a retirement home to accept the patient as a resident of the home.

(5) The following rules apply to a patient transferred to a retirement home pursuant to subsection (1):

1.  Once the Minister makes a determination under subsection 208.3 (1) of Ontario Regulation 79/10 (General) made under the Long-Term Care Homes Act, 2007, the placement co-ordinator shall place the patient in category 1 of the waiting list referred to in section 171 of that Regulation for the patient’s first choice of home, and shall keep the patient in that category for as long as the patient is awaiting placement in that first choice, unless they would otherwise be placed in a higher ranking category.

2.  If the patient is admitted to a long-term care home that is not the patient’s first choice, the patient shall be considered a resident admitted to the long-term care home under section 208.2 of Ontario Regulation 79/10 (General) made under the Long-Term Care Homes Act, 2007 for the purposes of section 247.4.1 of that Regulation.

Disclosure of information

3. (1) Where a hospital transfers a patient to a different hospital in accordance with subsection 2 (1), the hospital is authorized to disclose to the receiving hospital any information, including personal health information, that is necessary to facilitate the provision of care to the patient.

(2) Where a hospital transfers a patient to a long-term care home in accordance with subsection 2.1 (1), the hospital is authorized to disclose to the placement co-ordinator and to the licensee of the long-term care home any information, including personal health information, that is necessary to facilitate the provision of care to the patient as a resident of the home.

(3) Where a hospital transfers a patient to a retirement home in accordance with subsection 2.2 (1), the hospital is authorized to disclose to the licensee of the retirement home and, where necessary to co-ordinate the provision of community services to the patient while in the retirement home, to the responsible local health integration network, any information, including personal health information, that is necessary to facilitate the provision of care to the patient as a resident of the home.

Transfer back

4. In the case of patients who have been transferred to an alternate hospital site, as soon as possible following the conclusion of the major surge event, the alternate hospital site shall make reasonable efforts to transfer the patient back to the original hospital site or to another suitable care location which is consented to by the patient or, where the patient is incapable, the substitute decision-maker.

Application

5. (1) This Order applies despite any other statute, regulation, order, policy, arrangement or agreement, including the Public Hospitals Act, the Health Care Consent Act, 1996, the Long-Term Care Homes Act, 2007, the Retirement Homes Act, 2010, the Residential Tenancies Act, 2006, the Substitute Decisions Act, 1992, the Mental Health Act, the Personal Health Information Protection Act, 2004, and any policies, practice standards or guidelines made by a college under the Regulated Health Professions Act, 1991.

(2) To the extent that this Order conflicts with Ontario Regulation 95/20 (Streamlining Requirements for Long-Term Care Homes) made under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020, this Order prevails.

O. Reg. 319/21, s. 1.