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Fitness to Practice

Health Inquiry Process

The health inquiry process is set out under sections 57-69 of Health Professions Procedural Code (“Code”) being Schedule 2 to the Regulated Health Professions Act, 1991.

There are two ways that the health inquiry process can start: 

  1. Information suggesting that the registrant may be incapacitated is brought to the attention of the Registrar of the College, such as through a mandatory report from an employer. If the Registrar believes the registrant may be incapacitated, they must make inquiries that they consider appropriate. The result of these inquiries is reported to the Health Inquiry Panel. 
  2. A panel of the Inquiries, Complaints and Reports Committee (ICRC) investigating a complaint or considering a report refers a registrant to the Health Inquiry Panel.

The Health Inquiry Panel is made up of members of the ICRC. The panel can conduct inquiries into the registrant’s health, which could include requiring an independent medical examination. If they believe that the registrant may be incapacitated, the panel can refer a matter to the Fitness to Practise Committee for incapacity proceedings.

Incapacity Proceedings Before the Fitness to Practise Committee

Following a referral from a Health Inquiry Panel, the Fitness of Practise Committee may hold a hearing to determine whether a registrant is incapacitated. This would include considering what terms, conditions or limitations should be placed on the registrant’s certificate of registration. 

In many cases, the referral may be resolved through a written process. The registrant enters into an agreement with the College, stating that they are incapacitated and agreeing to specific terms, conditions, or limitations on their practice (such as abiding by a monitoring contract).

Unlike disciplinary proceedings, incapacity proceedings are not public and are strictly confidential. 

Incapacity proceedings are intended to help the registrant regain their health while ensuring the public is protected from unsafe practice. This includes determining suitable restrictions and conditions on the registrant’s certificate of registration to enable the registrant to return to practise in a way that supports his or her recovery while helping to detect and prevent possible relapses.

If a registrant has been referred to the Fitness to Practise Committee regarding possible incapacity, or if a registrant’s ability to practise has been restricted due to a finding of incapacity, that information is available through the Public Register.

What does incapacitated mean?

The Health Professions Procedural Code, being Schedule 2 of the Regulated Health Professions Act, 1991, defines the term “incapacitated” as meaning that a registrant is suffering from a physical or mental condition or disorder that makes it desirable in the interest of the public that the registrant’s certificate of registration be subject to terms, conditions or limitations, or that the registrant no longer be permitted to practise.

A registrant with a physical or mental disability that has been properly addressed may not necessarily meet the definition of incapacitated; for example, a person who uses a wheelchair in an accessible workplace, or a person who has a mental health or substance use condition who takes appropriate measures to manage their condition may not meet the definition.

Incapacitated registrants may suffer from:

  • Physical illness
  • Mental illness
  • Mood disorders
  • Substance use disorder
  • Certain physical, cognitive or sensory disabilities
  • Other

Warning Signs

Many professionals who suffer from substance use challenges or who have an emotional or psychiatric disorder may experience various levels of deterioration in different facets of their personal lives. They are often still able to function professionally when other parts of their lives are not functioning, as work is often the last place to deteriorate — especially if the incapacity involves drug use. As a result, a person’s incapacity may have already escalated to a significant degree before it is observed in the workplace. The following are some typical, well-documented, warning signs for behaviours of a registrant who maybe incapacitated:

Physical changes

  • Change in appearance/poor hygiene
  • Tired appearance/insomnia
  • Frequent shaking and/or sweating
  • Loss of appetite/weight loss
  • Slurred speech

Behavioural Changes

  • Mood swings
  • Memory loss or blackouts
  • Withdrawal from friends and social activity
  • Extreme anger, mistrust, anxiousness, depression, irritability
  • Frequent work breaks
  • Denial of having “problems” or need to be helped

Performance Changes

  • Increased disorganization
  • Increased number of prescription errors
  • Increased number of customer complaints
  • Frequent absences
  • Lack of concentration or focus

Narcotic Shortages of Narcotics or Controlled Substances (in the case of substance use challenges)

  • Shortages associated with the registrant ’s work schedule
  • The registrant asks to have special narcotic responsibilities
  • The registrant volunteers/asks to work shifts when the fewest staff are available

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