Health and Social Services

Overview

The innovative spirit of Lavery’s lawyers leads us to develop expertise in new areas. Health law is one such field in which the firm has created a team offering integrated services and know-how adapted to the needs of individuals, organizations, and companies in Québec’s extensive health care system.

Our team is trusted by many players in all sectors of the health and social services industry. Public and private institutions, professional bodies, representative associations, lobby groups, and research companies all know us as experienced advisers who understand their operating requirements and development projects. They see us as professionals interested in working with them to develop optimal complementarity and collaboration to pinpoint solutions adapted to their needs. Lavery’s expertise in this field is recommended by the Canadian Legal Lexpert Directory.

With the many changes to legislation, regulations, directives, and standards that have amended, set aside, and clarified the general principles of law, health law must be seen as a specific set of standards. When you add the hundreds of legal rulings made over the years, the need for access to competencies at the cutting edge of knowledge and practices becomes clear.

Services

We offer professional services in many fields, including the following:

  • Administrative health law
  • Infrastructure design and construction, through traditional methods or public-private partnerships
  • Bioethics and human rights
  • Labour relations and occupational health and safety
  • Governance and management of health and social service institutions
  • Regulations and contracts
  • Public health issues
  • Directors and officers liability
  • Professional and disciplinary law
  • Management of scientific research
  • Technology transfer and commercialisation
  • Civil liability of health and social services institutions
  • Management of information technology

Representative mandates

Together with the health care system and its partners, we have achieved the following results:

  • We have represented health and social services institutions throughout Québec for more than thirty years. In addition, we played an active role in the formulation and drafting of the first Act respecting health services and social services and its regulations
  • In addition to acting as legal advisers, we represent clients before common law courts and administrative tribunals as well as authorities such as the Régie de l'assurance maladie du Québec and the Ministère de la Santé et des Services sociaux
  • We also draft contracts, service and partnership agreements, regulations, resource use rules, rules of care, service protocols, and policies
  • Some of our lawyers are legislative drafters and sought-after strategic advisers who regularly help to resolve delicate issues related to the organization and delivery of health and social services
  • Our expertise in the protection of personal information is not only recognized but constantly enriched by regular updates to reference books on the subject and put to good use in a variety of mandates
  • Our lawyers develop innovative contract management solutions for public institutions, companies, and organizations in Québec's life sciences sector and specialize in the preparation and negotiation of technology transfer license agreements, research and development contracts, distribution agreements, fundamental and clinical research agreements, and agreements regarding the assignment of intellectual property rights
  • Over the years, our highly specialized lawyers have advised many institutions and university research centres on the management of research and commercialization contracts; they have also advised biotechnology and pharmaceutical companies at all stages of their development
  • We have been involved in many cases related to hospital and professional liability since the launch of the insurance program in the1980's
  • For almost thirty years, we have represented hospitals and other organizations and institutions in the health and social services system in a variety of disputes with a team of advisors and litigants experienced in these fields
  • On behalf of our clients, we have contributed to the analysis and preparation of briefs to be presented to parliamentary committees
  • We have an active team specialized in class action suits
  • At the request of clients, we have produced, and continue to produce, guides to the implementation of current regulations, which have become vital reference tools
  • We have represented our clients at every stage of the formulation, adoption, and implementation of most of the laws and regulations governing the provision of health care and services enacted by Québec and Canadian authorities

Our team

Many members of our team are well-known authors who have published texts and documents routinely used by players in the health care system.

We participate regularly in professional training activities for health care institutions, managers, and professionals. Some of our members are active in national and international scientific and academic communities.

Our focus on professional and scientific excellence and rigour lead us to establish personalized relations with every client in accordance with their needs and means. This approach is facilitated by our ability to offer a full range of services.

We favour interventions upstream of the decisions and actions of our clients. Over the years, we have demonstrated that the legal implications of their initiatives must be considered along with factors of a financial or organizational nature. By participating in the planning stages of projects and pointing out their legal ramifications, we contribute to the ultimate success of those projects.

We offer flexible terms facilitating on-going business relations with our clients and have developed packages adapted to the specific needs of each one. With these packages, we can assign a member of our team to act as their primary contact and liaise with colleagues, as necessary, to gain access to any additional expertise required. We can also offer our services to groups established on a territorial or other basis. Finally, we can of course carry out specific ad hoc mandates.

Whether straightforward or complex, all questions submitted to members of Lavery's health law team are handled with the same rigour and concern for efficiency.

Canadian Legal Lexpert Directory

  1. Single-Use Plastics Prohibition Regulations: Impact on Businesses

    On June 20, 2022, the federal government registered regulations that, as the name implies, prohibit (or restrict, in some cases) the manufacture, import and sale of certain single-use plastics that pose a threat to the environment. The Regulations will come into force on December 20, 2022, with the exception of certain provisions taking effect in the following months.1 Manufacturing, importing and selling certain single-use plastic products made entirely or partially of plastic, such as foodservice ware, checkout bags and straws, will be soon be prohibited. This regulation is expected to affect more than 250,000 Canadian businesses that sell or provide single-use plastic products, primarily in the retail, food service, hospitality and healthcare industries. The following is a comprehensive list of items that will be prohibited: Single-use plastic ring carriers designed to hold and carry beverage containers together2; Single-use plastic stir sticks designed to stir or mix beverages or to prevent liquid from spilling from the lid of its container3; Single-use plastic foodservice ware (a) designed in the form of a clamshell container, lidded container, box, cup, plate or bowl, (b) designed to serve or transport ready-to-eat food or beverages without further preparation, and (c) made from certain materials4; Single-use plastic checkout bags designed to carry purchased goods from a business and (a) whose plastic is not a fabric, or (b) whose plastic is a fabric that will break or tear, as the case may be, (i) if it is used to carry 10 kg over a distance of 53 m 100 times; (ii) if it is washed in accordance with the washing procedures specified for a single domestic wash in the International Organization for Standardization standard ISO 6330, as amended from time to time5; Single-use plastic cutlery that is formed in the shape of a fork, knife, spoon, spork or chopstick that either (a) contains polystyrene or polyethylene, or (b) changes its physical properties after being run through an electrically operated household dishwasher 100 times6; Single-use plastic straws that either (a) contain polystyrene or polyethylene, or (b) change their physical properties after being run through an electrically operated household dishwasher 100 times7. The main exceptions Single-use flexible plastic straws Single-use flexible plastic straws, i.e. those with a corrugated section that allows the straw to bend and maintain its position at various angles,8 may be manufactured and imported9. These flexible straws may also be sold in any of the following circumstances:  The sale does not take place in a commercial, industrial, or institutional setting10. This exception means that individuals can sell these flexible straws. The sale is between businesses in packages of at least 20 straws.11 The sale is made by a retail store of a package of 20 or more straws to a customer who requests it without the package being displayed in a manner that permits the customer to view the package without the help of a store employee12; The sale of straws is between a retail store and a customer, if the straw is packaged together with a beverage container and the packaging was done at a location other than the retail store13; The sale is between a care facility, such as a hospital or long-term care facility, and its patients or residents14. The export of single-use plastic items - All the manufactured single-use plastic items listed above may be manufactured, imported or sold for export15. That said, any person who manufactures or imports such items for export will be required to keep a record of certain information and documents as appropriate for each type of plastic manufactured item16. Records of the information and documents will have to be kept for at least five years in Canada17. Conclusion: an opportunity to rethink common practices In the short term, businesses will need to start thinking about how they will replace the plastic manufactured items they use. To help businesses select alternatives to single-use plastic items, the federal government has released its Guidance for selecting alternatives to the single-use plastics in the proposed Single-Use Plastics Prohibition Regulations.18 According to this document, the aim should be to reduce plastics.  Businesses may begin by considering whether a single-use plastic should be replaced or no longer provided. Only products that perform essential functions should be replaced with non-plastic equivalents. Stir sticks and straws can be eliminated most of the time. Another way to reduce waste is to opt for reusable products and packaging. Businesses are invited to rethink their products and services to provide reusable options. Reusable container programs (i.e. offering customers the option of using their own reusable containers) are a reuse option that businesses may want to consider, in particular to reduce the amount of plastic food containers. Only where reusable products are not feasible should businesses substitute a single-use plastic product with a recyclable single-use alternative. Businesses in this situation are encouraged to contact local recycling facilities to ensure that they can successfully recycle products at their end of life. Ultimately, charging consumers for certain single-use substitutes (e.g. single-use wooden or moulded fibre cutlery) may also discourage their use. Ibid, s. 1 Ibid, s. 3 Ibid, s. 6 Polystyrene foam, polyvinyl chloride, plastic containing black pigment produced through the partial or incomplete combustion of hydrocarbons or oxo-degradable plastic; Ibid. This standard is entitled Textiles – Domestic washing and drying procedures for textile testing; Ibid. Ibid. Ibid, ss. 4 and 5. Ibid, s. 1. Ibid, s. 4. Ibid, para. 5(2). Ibid, para. 5(3). Ibid, para. 5(4); According to Guidance for selecting alternatives to the single-use plastics in the proposed Single-Use Plastics Prohibition Regulations, the goal is to ensure that people with disabilities who need flexible single-use plastic straws continue to have access to them at home and can carry them to restaurants and other premises. Ibid, para. 5(5). Ibid, para. 5(6). Ibid, para. 2(2). Ibid., s. 8 Ibid, para. 9(1). https://www.canada.ca/en/environment-climate-change/services/managing-reducing-waste/consultations/proposed-single-use-plastics-prohibition-regulations-consultation-document.html

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  2. Confinement in an institution: a judge must intervene where evidence is insufficient

    In a judgement rendered on June 3, 2022,1 the Court of Appeal of Quebec reiterated that a judge who has an application for confinement in an institution before them must inform the parties when they consider that the psychiatric reports filed are insufficiently detailed. In these circumstances, the Court must allow the parties to remedy deficiencies in the evidence rather than dismissing the application. The Court of Appeal based its reasoning on the following articles: Article 268 of the C.C.P.2 allows a judge to draw a lawyer’s attention to any deficiency in the proof of procedure and authorize the parties to remedy it, especially when the judge notes that the insufficient evidence concerns an essential element and could affect the outcome of the dispute. Article 50 of the C.C.P. gives judges the power, even on their own initiative, to require the attendance of witnesses or the presentation of evidence. Given the importance for a judge to make an informed decision, both with respect to a patient’s personal integrity and in assessing the danger they may pose to themselves or to others, the Court of Appeal considers that a judge has an obligation to exercise their discretionary power and require the attendance of one or even both psychiatrists who signed the reports filed in support of an application.  In 2009, the Court had previously concluded that a judge in charge of ruling on an application for confinement in an institution is at liberty to [translation] “report, at the time of the hearing, that the references indicated in two sections of the form used by physicians to prepare a psychiatric examination report for an order of confinement in an institution—one concerning the reasons and facts upon which the physician has based their opinion and the other the assessment of the seriousness of the condition and its likely consequences for the patient and for others—appear to them to be insufficient.”3 It appears that this issue has been taken a step further, as the Court has concluded that the discretion granted by articles 50 and 268 of the C.C.P. must be exercised in order to give the health institution applying for confinement the opportunity to complete its evidence. Centre intégré de santé et de services sociaux de l’Outaouais v. J.L., 2022 QCCA 792 Code of Civil Procedure, CQLR c. C-25.01. (C.C.P.) Centre de santé et de services sociaux Pierre Boucher v. A.G., 2009 QCCA 2395, para. 38.

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  3. Managing Employment Injuries in the Age of COVID‑19

    The management of employment injury claims has not halted due to the current pandemic. Not only are new employment injuries taking place and claims being filed, ongoing claims are still being processed.  Managers must be vigilant in order to limit the financial impact of the pandemic with respect to employment injury claims. They can act in one of two (2) ways: Investigating the circumstances in which the worker contracted COVID-19 in order to determine whether it can be considered an employment injury; Monitoring employment injury cases to identify the impact of the pandemic on the way cases are treated to then try to obtain a reduction in financial consequences for the employer by an assignment of costs. Can COVID-19 be considered an employment injury? Although a worker infected with COVID-19 is at liberty to file an employment injury claim, they are responsible for proving that they contracted the disease or came into contact with the virus due to or in the course of their work. According to the current laws and jurisprudence, a COVID-19 diagnosis does not trigger the application of any legal presumption facilitating the acceptance of a worker’s claim under either the category of occupational disease or that of industrial accident. Helpful tip: If one of your employees has contracted COVID-19, investigate the origin of the infection. Ask the following questions and document the answers you receive: Has the worker travelled recently? Where and when? When did they return from abroad? Has one of their loved ones recently been diagnosed with COVID-19? Have one or more colleagues, clients or business partners contracted the disease? What symptoms did they experience, and when did they begin experiencing them? What was their schedule and who did they work with in the days before they began experiencing symptoms? Why do they believe they contracted the disease at work? What hygiene, preventive and protective measures and distancing did they use in the workplace? Can employers apply for an assignment of costs due to COVID-19? In terms of employment injuries, the pandemic can have many consequences, such as treatments and temporary assignments of work being temporarily interrupted and medical assessments and examinations by the Bureau d’évaluation médicale (BEM) being cancelled or postponed for an indefinite period. This situation will inevitably prolong the period during which employment injury benefits are paid, potentially significantly in some cases. Employers could apply for an assignment of costs for these claims in order to reduce the financial impact of the pandemic by demonstrating, for example, that the treatments necessary to consolidate the worker’s injury were suspended due to the pandemic, delaying consolidation or increasing the consequences o permanent impairment. A pandemic the size of COVID-19 is probably very much outside the scope of risks most employers generally have to face. When applying for an assignment of costs due to “undue burden”1, the employer will need to demonstrate that the consequences stemming from the pandemic such as delayed consolidation or more substantial permanent consequences represent a significant proportion of the costs attributable to the employment injury.  Helpful tips: If you have workers who are currently receiving income replacement benefits, find out whether their treatments or medical care have been interrupted due to the pandemic, if they have had medical or surgical appointments cancelled, etc. Document this information. The impact of these events on the cost of the claim can be documented retrospectively. Keep in mind, however, that applications for an assignment of costs due to “undue burden” must be submitted within the time limit established by law, as interpreted by jurisprudence2. The members of our Labour and Employment team are available to answer any questions you may have about occupational health and safety measures you are considering or the solutions you are seeking given the realities of your organization and its activities.   Section 326 of the Act respecting Industrial Accidents and Occupational Diseases (“AIAOD”). Section 326 of the AIAOD states that the application must be made in writing within the year following “the date of the accident”, and must include an explanation of the reasons for the application. However, the Court of Appeal has interpreted this time limit as being able to start from the day the right to the exception begins in Commission de la santé et de la sécurité du travail v. 9069-4654 Québec inc., 2018 QCCA 95 (known as the “Supervac 2000” case), as has the majority of the Tribunal administratif du travail jurisprudence that followed.

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  4. Dr. Robot at your service: artificial intelligence in healthcare

    Artificial intelligence technologies are extremely promising in healthcare.1 By examining, cross-referencing and comparing a phenomenal amount of data,2 AI lets researchers work more quickly at a lower cost3 and facilitates doctors’ decision-making with regard to diagnosis, treatment and choice of prescription. The integration of AI into the healthcare field can take various forms:4 Management of electronic medical records (e.g., Omnimed) Direct patient care to improve decision-making with regard to diagnosis, prognosis and choice of treatment method Integration in the area of monitoring and medication (e.g., Dispill) The performance of robotic exams and surgeries Indirect patient care functions, such as: Optimization of workflow Better management of hospital inventory Home care applications, where portable devices and sensors would be used to assess and predict patient needs. Working to protect innovators, their clients and the public No matter what form AI takes when it is implemented into the healthcare field in Quebec, as with any innovation, we must adapt and work to protect the public, innovators and their clients. What is an innovator? An innovator is a developer, provider or distributor who is involved in the development and marketing of products that use artificial intelligence. 1 - Innovator protection As the future of healthcare lies in an increased integration of AI, innovators must be properly supported and protected, which means that they must be equipped with all of the appropriate tools for protecting their rights, especially intellectual property rights. At the time of product development: they must make sure that they obtain the necessary guarantees and commitments from their partners in order to be able to assert their rights in the event that their technology is appropriated by a third party.  At the time of product marketing: having taken care to properly protect their rights, they will avoid prosecution or claims, whether for patent infringement or otherwise. In addition, if the proposed technological solution implies that the data collected, transmitted or analyzed is stored and pooled or that it is shared with other stakeholders, innovators must ensure in particular that the patients’ personal information is protected in accordance with the applicable laws and regulations5 and that this data is not used for commercial purposes. If not, an innovator could be the target of a claim by professional organizations or by patient groups and, when certification is required, that certification could be withdrawn by the Ministère de la Santé et des Services sociaux [health and human services ministry]. To learn more about innovator protection, we invite you to read the following article: Artificial intelligence: contractual obligations beyond the buzzwords. 2 - Protection of clients (buyers of artificial intelligence solutions) Artificial intelligence operations have several intrinsic limits, including the prioritization of quantity over quality of the data collected; systematic errors that are reproduced or amplified;6 and even human error in the entry of the data relied on by professionals and researchers. Accordingly, innovators must ensure that they properly warn their clients of the limits and risks tied to the use of their products in order to protect themselves against potential claims. They must therefore be objective in the way that they represent their products. For example, terms like “intelligent database” should be used rather than “diagnostic systems.” This word choice will avoid both potential civil liability claims and the possibility of being reprimanded for violating the Medical Act for performing functions reserved only for doctors.7 The innovator will also be required to enter into a contract with the client that is clear and detailed with regard to the use, access and sharing of data collected in electronic medical records (EMR). 3 - Protection of the public (Collège des médecins du Québec [“Quebec college of physicians”] regulation) All products using AI technology must allow doctors to respect their obligations with regard to creating and maintaining EMR. These obligations are included in Section 9 of the Collège des médecins draft regulation, which is expected to come into force in the near future and will make the use of EMR mandatory. The Collège also intends to specify in this regulation that collected data may not be used [TRANSLATION] “for any purpose other than to monitor and treat patients.”8 The Inquiries Division of the Collège has also recently cautioned its members that the technological tools that they use [TRANSLATION] “must be used exclusively within the context of their duties, meaning the administration of care.”9 The current position of the Collège des médecins and the Ministère de la Santé is that the marketing of data contained in EMR is prohibited even if the data is anonymous. Furthermore, according to Dr. Yves Robert, Secretary of the Collège, even if the shared data is anonymous, it may not be used either to promote a product, such as a less expensive medication in the case of an insurance company, or to influence a doctor’s choice when making a decision. 10 The Inquiries Division has also reminded members of their ethical obligation to “disregard any intervention by a third party which could influence the performance of their professional duties to the detriment of their patient, a group of individuals or a population.11”   The use of Big Data would create more than $300 billion USD in value, with two-thirds of that amount coming from reduced expenditures.  Big Data Analytics in Healthcare, BioMed Research International, vol. 2015, Article ID 370194; see also Top health industry issues of 2018, PwC Health Research Institute, p. 29. The American consortium Kaiser Permanente holds around 30 petabytes of data, or 30 million gigabytes, and collects 2 terabytes daily. Mining Electronic Records for Revealing Health Data, New York Times, January 14, 2013. For examples of the integration of AI in healthcare in Canada, see Challenge Ahead: Integrating Robotics, Artificial Intelligence and 3D Printing Technologies into Canada’s Healthcare Systems , October 2017. See in particular S. 20 of the Code of ethics of physicians, CQLR c. M-9, r. 17 and the Act respecting the protection of personal information in the private sector, CQLR c P-39. See When artificial intelligence is discriminatory. Medical Act, CQLR c. M-9, s. 31. Id., S. 9, par. 9. L’accès au dossier médical électronique : exclusivement pour un usage professionnel [“Access to medical records: exclusively for professional use”], Inquiries Division of the Collège des médecins du Québec, February 13, 2018. Marie-Claude Malboeuf, “Dossiers médicaux à vendre ” [“Medical records for sale”], La Presse.ca, March 2, 2018. Accès au dossier médical électronique par les fournisseurs [“Access to electronic medical records by providers”], Inquiries Division of the Collège des médecins du Québec, May 29, 2017, citing section 64 of the Code of Ethics of Physicians, supra, note 12.

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  1. Charles Olivier Thibeault delivers training for the Association des centres d’urgence du Québec

    On November 22 and 29, Charles Olivier Thibeault provided training to emergency call centre operators and dispatchers at the request of the Association des centres d’urgence du Québec (ACUQ). The seminar was entitled “Le rôle et les responsabilités des préposés des centres d’appels d’urgence” and Charles Olivier discussed the legislative and regulatory framework governing emergency call centres, and the different cases resulting in disciplinary measures imposed on operators/dispatchers or civil lawsuits against emergency call centres.

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  2. Charles Olivier Thibeault meets with the Regroupement des médecins examinateurs du Québec

    Charles Olivier Thibeault, a partner of the Health Law group, participated in a meeting held by the Regroupement des médecins examineurs du Québec at the CHUM on November 16.  During the meeting, Mr. Thibeault discussed with medical examiners, responsible for reviewing complaints concerning hospital physicians, a number of problems often encountered when complaints are handled. Mr. Thibeault also suggested several solutions to address these problems as well as other issues raised by the medical examiners. 

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  3. Charles Olivier Thibeault speaks at the Annual Interdisciplinary Conference 2017

    Charles Olivier Thibeault, an associate with the Health and Social Services group, spoke at the 4th edition of the Annual Interdisciplinary Conference 2017, held April 20 and 21 at the Faculty of Law of the Université de Montréal. His presentation was entitled D’avocat à conseiller: sortir de la pratique conventionnelle pour faire du droit autrement and discussed how having two degrees (law and health administration) has a positive influence on the way in which he practises law. Mr. Thibeault also pointed out the advantages and obstacles that arise when handling files involving professionals from different fields.

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