QCIPA: Tips for midwives attending hospital reviews
The following information is courtesy of Kate Hughes and Danielle Bisnar, Cavalluzzo Chilton McIntyre and Cornish LLP
Most midwives will face an unexpected outcome in a client's pregnancy or birth at some point in their careers. The Quality of Care Information Protection Act (QCIPA), which governs quality of care reviews after “critical incidents” is about to change to require that designated committees perform more reviews and to make more information accessible after reviews. Under this law, a critical incident is an unintended event when a client receives treatment in the hospital or independent health facility (such as a birth centre) that results in serious harm to the client and does not result primarily from the client's underlying medical condition or a known risk to treatment.
The Legislative Changes
Before QCIPA 2004, if a review was convened, all information in that review could be shared.
Under QCIPA 2004, hospitals could form quality of care committees (sometimes under different names) as a legally protected zone of discussion to facilitate frank and confidential review of critical incidents. Subject to certain exceptions, the content of discussions under QCIPA 2004 could not be used in law suits or proceedings before regulatory colleges. Following a quality of care review, clients and their families were only permitted to access information in the client records and to know that the quality of care committee met and conducted a review, but not what the content was of that review.
However, there has been considerable variation in how frequently hospitals across the province have used the QCIPA 2004 confidentiality protection – some used it for all reviews and some used it for none. By not using QCIPA, some hospitals were making a choice, tacitly or explicitly, to have all information provided and discussed at reviews available to patients or “discoverable” in legal proceedings.
A proposed regulatory amendment will require hospitals to conduct a review of all critical incidents and QCIPA 2016 (which is expected to become law soon) will require the hospital or other “independent facility” (such as a birth centre) to disclose to the client the following information:
- the fact that a review took place;
- the material facts of what occurred (which may not be in the chart and there may be disagreement about what is considered to be a "fact");
- the consequences of the incident for the client and any actions taken to address such consequences including any healthcare or treatment that is advisable;
- the cause or causes of a critical incident as identified by the committee or the hospital (which may not have been reached unanimously); and
- any systemic steps taken by a health facility to avoid or reduce the risk of further similar incidents.
Under both the old and the new legislation, if the review were designated as a quality review under a properly constituted “Quality of Care Committee” (perhaps under another name), opinions and speculation, minutes of discussion and documents prepared for the meeting would not be permitted as part of disclosure to the client. QCIPA does not affect other types of reviews, such as departmental or hospital service reviews, peer review, or discussions at M & M rounds.
Implications for midwives
- Hospitals must have a designated committee to conduct reviews of all critical incidents that occur in hospital.
- While there is no legislative requirement for individual health-care providers to participate in such reviews, hospitals or birth centres may require participation as part of privileges.
- If your hospital has been using QCIPA 2004, QCIPA 2016 may change how open midwives and other health-care professionals will be in such meetings if they know that this information must be disclosed outside the "protective zone" of the Quality of Care committee meeting and review.
- Before attending, clarify the nature of the review: is it a review under QCIPA or another type of review?
- Ask who will be in attendance (including lawyers and family members), what the agenda is, and if the discussions in the meeting are confidential or likely to be disclosed.
- If an incident that involves you or your client is to be discussed, contact AOM On Call and HIROC to get advice before participating.
- Clarify what the client and/or family will be told (for example, what are the relevant “facts” and “causes of harm” that will be disclosed) and who will provide the information to the client and/or family and the process for disclosure.
- Be cautious about discussing with anyone the opinions and speculations expressed during the review that are not part of what will officially be shared. Midwives could be guilty of breaching QCIPA and subject to hefty fines or other discipline if they disclose information in contravention of the legislation. Head midwives and department heads, who will attend reviews frequently, should be especially cautious about disclosing any information learned in the review (whether to other midwives, physicians, or the College). If you are being pressured to disclose such information, seek advice from the AOM.
Summary of proposed changes to Regulation 965 under the Public Hospitals Act.
QCIPA Review Committee Recommendations (the report forming the basis of the legislative changes in QCIPA 2016 and proposed amendments to Regulation 965).