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Health Law Blog

Public Hospital Act Changes - Medical Staff Muzzled in Delivery of Care to the Public

December 16, 2010

The recent amendments to the Public Hospitals Act – which were advocated by the management and administration of the Ontario Hospital Association and which the Ontario government embraced whole-heartedly and very rapidly this past year – have had the effect of removing the voice of the medical staff in every hospital by eliminating meaningful participation at the board level. The presence of the medical staff representatives without a vote makes them nothing more than mere observers at the board meetings of our hospitals.

What these changes do not do, however, is remove in any way the legal obligations of the medical leadership (the Medical Advisory Committees or “MAC”s) from responsibility and accountability for delivering safe, timely, and accessible patient care in their institutions.

Every chief in every department in every hospital must ensure that no by-law changes are enacted that would change the make-up or the voting process of their MACs. This is not required by any of the recent legislative changes; however, some hospitals have indicated an intention to change by-laws in order to accomplish such MAC make-up, chairpersonship, and voting.

Regardless of the justification put forward in any hospital, the medical leadership continues to carry the legal and ethical liability for the quality, standards, and timeliness of medical care. To accept the liability without the ability to oversee this onerous responsibility, or to recommend or require meaningful changes, resources, reviews and the like, is an exercise in self-destruction.

Hospitals are the mandatory workplace of our consultants and surgeons. They have a right to have a meaningful voice in their workplace environment and they have a duty to the public and themselves to be listened to in that environment. This right involves more than being simply seen, but not heard. This is particularly true in the functioning and management of the institution at the delivery-of-care level.


Several years ago I was fortunate enough to have been selected as a Tremayne-Lloyd Fellow here at Western Law. I used the funds to finish a book and to begin work on a new one. It dawned on me far too late that I had never thanked you for that splendid gift. The new book is to be published by Harvard Press in 2010. The TTL Fellowships provided ritual seed capital for this project, which required me to spend a good deal of time and money at The National Archive in Washington. Again, with many thanks.

R. W. Kostal Professor of Law and History

Tracey Tremayne-Lloyd Health Law