BCPA Position Statement on Healthcare Regulation in BC and the Cayton Report

Health Professions in British Columbia are overseen by government within a variety of frameworks.  Currently, the most common framework is professional self-regulation under the BC Health Professions Act.

Paramedicine does not fall under a college based self governance model in BC and instead is overseen by a government appointed licensing board. The Emergency Medical Assistant Licensing Board (EMALB), oversees entry to practice and maintenance of licensure within BC. Paramedics are actually considered Emergency Medical Assistants (EMAs), within provincial legislation.  The title paramedic and its variations is not protected in BC which presents risk to the protection of the public.

The legislation under which BC paramedics are licensed and regulated has not kept up with modern evolutions of medicine. Skills, procedures and authorities in the Act are piecemealed together through a series of schedules that are confusing and fail to reflect current practice. Additionally, education standards have failed to keep pace with the rest of Canada for Paramedics; as a result the primary paramedic employer, BC Emergency Health Services (BCEHS), now bears a significant educational burden bridging knowledge gaps that have become entry to practice knowledge expectations in other canadian jurisdictions.

At the request of the Hon. Health Minister Adrian Dix, Mr. Harry Cayton has released a recent report on the status of regulated health professions in British Columbia.

It is the position of the British Columbia Paramedic Association (BCPA), that paramedics in BC should become a self-regulated health profession within the context of any new approach to regulating health professions. Should health regulatory reform come to pass, the BCPA would request a seat at the table designing the new regulatory structure and process.

Background

The Cayton Report, published April 2019, was commissioned at the request of the provincial health minister to address complaints about current self-regulatory colleges. This report breaks into two sections, each with a specific mandate.

Powerful beneficial ideals are frequently born of adversity. As a result of regulatory difficulties with the College of Dental Surgeons of BC (CDSBC), the Hon. Health Minister Adrian Dix commissioned Harry Cayton to investigate and report upon both the CDSBC and BC’s current health regulatory framework (as defined by the Health Professions Act). Mr. Cayton had the excellent foresight to clearly delineate the report into two sections: the first section being a comprehensive reflection upon the regulatory status of the CDSBC, the second section being a comprehensive reflection upon potential regulatory reform for BC’s health professions.

The first section of Mr. Cayton’s report is clear and does an excellent job of outlining issues found within the CDSBC. It has no direct bearing upon paramedic practice aside from serving as a cautionary tale with respect to the duties and obligations of a regulatory college.

The second section of Mr. Cayton’s report is one of the most relevant pieces of government commissioned literature with respect to paramedic practice from the last decade. It clearly outlines reasoning as to why a profession should be regulated for the protection of the public while laying out a potential new regulatory framework to both enhance protection of the public and reduce regulatory costs.

Section 9.14 of the Cayton report succinctly relays the core principles of health regulation reform:

9.14 The overall objectives of reform of health professional regulation should be:

• To protect the safety of patients, to prevent harm and to promote the health and well-being of the public

• To provide a framework for safe, competent and ethical professional practise

• To have the trust of the public and the confidence of regulated occupations

• To be able to adapt to change and respond to new risks and opportunities

• To be efficient and cost effective in the interests of all citizens

Each of these points deserves specific address with respect to the future of paramedic practice in British Columbia.

“To protect the safety of patients, to prevent harm and to promote the health and well-being of the public”

As part of his recommendations for the enhancement of patient safety, Mr. Cayton proposes amendment of the Health Professions Act to state “It is the duty of a college at all times; To protect the safety of patients, to prevent harm and promote the health and well-being of the public.” This excellent statement of duty would apply to all health professions falling under the Health Professions Act. At present paramedics are separately regulated through the Emergency Medical Assistants Licensing Board (EMALB) under the Emergency Medical Assistants Regulation. As such, any changes to the Health Professions Act will not apply to paramedicine unless amendments to the regulation include the formation of a BC College of Paramedics.

By comparison the EMALB’s statement of purpose is as follows: “The board, under the authority of the Emergency Health Services Act, sets licence terms and conditions. In addition, the board investigates complaints and conducts hearings where necessary.”  The EMALB’s statement of purpose does not include the all important concept of purpose Mr. Cayton proposes for all regulated health professions: “to protect the safety of patients.”

Paramedics know the protection of patient safety must be at the forefront of practice, but a lay member of the public may ask why this concept should be embedded into the regulatory framework. The answer is surprisingly simple. Paramedics on a daily basis perform a tremendous number of controlled medical acts which, if performed incorrectly or inappropriately, have serious potential for patient harm. As healthcare providers performing controlled medical acts, paramedics must have patient safety minded regulation at the forefront of the professional lexicon. Inclusion of paramedicine within proposed changes to the health regulatory framework would ensure patient safety minded governance rose to a place of prime importance within paramedic practice regulation.

“To provide a framework for safe, competent and ethical professional practise”

Regulation governing the practice of paramedicine in BC, the Emergency Medical Assistants Regulation, consists of a 33 page, 5775 word single document. This, as compared to the scope of paramedic practice, miniscule document can not possibly be expected to encompass a framework for safe, competent, and ethical professional practise. By comparison, the allowed scope of practise document alone for BC’s registered nurses is 72 pages in length (professional responsibilities, code of ethics etc., are all separate documents). Current regulatory structure for the practice of paramedicine in British Columbia fails this test. Inclusion of a College of Paramedicine within a restructured health regulatory framework would serve to rectify this healthcare practise inequity.

“To have the trust of the public and the confidence of regulated occupations”

The paramedic profession by and large has the public’s trust, however it has no mechanism to earn the confidence of other regulated health professions. Consistently paramedics rank among the most publicly trusted healthcare workers yet they lack a regulatory college operated by an appropriate blend of subject matter experts and members of the public. The absence of a regulatory college robs the profession of the ability to professionally interact with other regulators for the betterment of patient safety and patient care standards. The formation of a BC College of Paramedics under proposed health profession regulations would alleviate this disparity by creating allowances for interdisciplinary information sharing.

“To be able to adapt to change and respond to new risks and opportunities”

The current paramedic regulatory framework completely fails in this important area. As medical evidence changes, so too does best medical practice for patient safety and best possible care outcomes. The current EMALB structure requires an act of legislation via the provincial health minister to adapt to changing medical evidence. This cumbersome and inefficient structure is neither quick in its ability to respond, nor guaranteed to be directed by appropriate subject matter experts. The formation of a BC College of Paramedics under an updated Health Professions Act would alleviate this impediment to best patient care by Paramedics.

“To be efficient and cost effective in the interests of all citizens”

At present the administrative costs of the EMALB are almost entirely borne by the BC taxpayer. Some degree of cost recovery is achieved through examination fees and licensing fees. Most regulatory college systems of governance impart the cost of operation directly to the regulated practitioner. As Mr. Cayton astutely points out, professional regulation “is a tax on work; a payment for the privilege of working.” What Mr. Cayton is proposing with respect to a health profession regulatory overhaul could include mechanisms for cost sharing amongst regulated health professions. The United Kingdom Health & Care Professions Council (HCPC) for example oversees sixteen separate regulated health professions which all share the regulatory costs associated with their various professions. Paramedicine is one of the sixteen health professions regulated under the UK HCPC. The formation of a similar health council in BC would ideally include Paramedicine.

Conclusion

As a significant stakeholder seeking improvement in paramedic professional regulation, the BC Paramedic Association (BCPA) seeks a seat at the table as health profession regulation is reformed and ideally a BC College of Paramedics is formed. Whether under an overarching health professions council or as a separate regulatory college, the time for more appropriate paramedic practice regulation in BC has come.

The British Columbia Paramedic Association (BCPA), is an independent, non-partisan, not-for-profit, member supported society that represents the profession of Paramedicine in BC.  The BCPA advocates for the best out-of-hospital medical care for patients in British Columbia by establishing professional standards of practice, continuing professional development opportunities/education, creating original research, and providing knowledge translation for paramedic practice in British Columbia. BCPA membership is voluntary and the association is not a labour representative.