Volume 8, No. 37

Bill 105 - Physician Information Sheet
(new legislation effective September 1, 2003)

Bill 105, an Act to amend the Health Protection and Promotion Act (HPPA), requires the taking of blood samples to protect victims of crime, emergency service workers, Good Samaritans and other persons. This legislation took effect on September 1, 2003. The information contained in this update will be invaluable to you if you receive such a request, and it is recommended that this sheet be kept on file. Information is also available on the OMA Web site (https://www.oma.org/phealth/hea_main.htm).

The Ontario legislature gave final passage to Bill 105 in December 2001. In response, the OMA established an expert committee to consider all aspects of the medical and scientific, policy, legal and fiscal impacts relating to the statutory provisions of the bill, and to provide expert advice and recommendations to the profession and the Ministry of Health and Long-Term Care (MOHLTC) about implementation of the legislation.

Beginning September 1, 2003, you may be asked to complete a legal document you have never seen before (Form 1 - Physician Report, attached). Note: A physician who fully completes Form 1 will be paid $100 (K031).

The passage of Bill 105 provides for a new mechanism whereby a person (the applicant) who, as a victim of crime or as provider of emergency first aid or emergency health care (e.g. fire, police or ambulance), believes they were exposed to Hepatitis B, Hepatitis C and HIV, may ask the medical officer of health to order that blood be taken from the individual believed to be the source of the exposure (the respondent), even without consent from the individual. (See Appendix 1 for the process an applicant will have to comply with for the respondent to be tested. See Appendix II for the process algorithm.)

If the respondent refuses to voluntarily provide a blood sample, you may be asked by the applicant to complete Form 1 - Physician Report. Consider the following carefully:

1. In order to complete this form, you must be able to state that you are a physician “who is informed in respect of matters related to occupational and environmental health and all protocols and standards of practice in respect of blood-borne pathogens” as per section 22.1 of the HPPA. Pay careful attention to the word “all,” as it sets a high threshold of knowledge required to complete the form and you may be required to provide evidence of such knowledge to the medical officer of health.
   
   It should be noted the blood taken as a result of an order by the medical officer of health cannot be used as part of a criminal action, but that does not eliminate the possibility of a physician being called upon to give evidence at a criminal or civil proceeding.
   
   
2. Information about the exposure that you report on Form 1 will simply be the information reported to you by the applicant. For example, you are not required to verify the occurrence of a crime, nor identify the perpetrator.
   
   
3. If you agree to complete this form, the applicant must consent to an examination, counselling, and baseline testing, as outlined on the form. This is a legislative requirement. If the applicant refuses, the application will not proceed.
   
   
4. If you agree to complete this form, you will be required to do an assessment of risk with regard to the exposure that occurred.
   
   
5. If you agree to complete this form, there is yet another complexity to be aware of:
   
   • Under Section A, Applicant Information, where it asks for the “Family Physician - if different from the Reporting physician,” enter “No family physician” if you are not the family physician and if you are unable to determine the identity of the applicant’s family physician, or you may receive the results of the respondent’s blood test. (See Appendix II.)
     
   • If you cannot arrange the required follow-up care, you may become the physician responsible for the care that is required.
     
     
6. If you do not agree to complete the form, you should refer the person to a physician with the knowledge to do so.
   
   
7. Information regarding Form 1 can also be obtained by calling 1-888-664-2273, which is an MOHLTC information line.

Questions about Bill 105, or this update, may be forwarded to Carol Jacobson, OMA Health Policy Department, 1-800-268-7215, ext. 2984 or 416-340-2984, or via e-mail (carol_jacobson@oma.org); or Adam Farber, OMA Legal Services Department, 1-800-268-7215, ext. 2894, 416-340-2894, or via e-mail (adam_farber@oma.org).

Appendix I

Bill 105, An Act to Amend the Health Protection and Promotion Act (HPPA), requires the taking of blood samples
to protect victims of crime, emergency service workers, Good Samaritans and other persons.

The Process

1. An exposure occurs to a victim of crime, or to an individual while providing emergency health-care services or carrying out emergency first aid.
   
2. The respondent refuses to voluntarily have his or her blood taken for testing.
   
3. The applicant requests a physician to complete Form 1.
   
4. The applicant must complete Form 2 - The Applicant Report. The applicant must provide the name of the respondent on the form.
   
5. The applicant must submit Forms 1 and 2 to the medical officer of health (MOH) where the respondent resides within seven business days after the occurrence.
   
6. The MOH determines whether the application will be accepted.
   
7. If the application meets the criteria, the MOH will attempt to obtain voluntary seropositivity information and/or a blood sample from the respondent.
   
8. The MOH determines if to obtain further information a hearing is necessary to proceed with the application.
   
9. A hearing is held by means of written information.
   
10. The MOH makes a decision to:
    
    • dismiss the application
      
    • refuse to make an order, or
      
    • issue an order for the respondent
      to be tested.
      
11. The MOH makes an order - the respondent’s physician may be ordered to draw the blood.
    
12. The applicant’s physician will receive the results of the respondent’s blood test and provide the information to the applicant with appropriate interpretation, where needed.
    
13. The respondent may appeal the order to the Health Services Appeal Review Board within 15 business days of receiving the order.
    
14. The applicant may appeal the dismissal of the application or the refusal of the MOH to make an order to the Chief Medical Officer of Health (CMOH).
    
15. The CMOH either accepts or rejects the appeal.
    
16. If accepted, the application is referred back to the MOH.

Appendix II

Bill 105, An Act to Amend the Health Protection & Promotion Act, requires the taking of blood samples
to protect victims of crime, emergency service workers, Good Samaritans and other persons.

Note: During the process, the applicant may appeal if the MOHLTC refuses to write the order, and the respondent may appeal the MOHLTC’s order.

Link to Form 1 (pages 4 and 5 of OMA Fax Network)
https://www.oma.org/phealth/4229-64.pdf

An information package about Bill 105 is available on the Ministry of Health and Long Term Care web site: http://www.health.gov.on.ca/english/providers/project/bill_105/105_phys.html