The infection prevention and control (“IPAC”) craze has had dentists scratching their heads for quite some time wondering where to turn for answers about IPAC, Public Health Ontario (“PHO”) inspections, which of the many IPAC guidelines to follow, how to respond to inspectors, etc. If you’re out of the loop and need to find out more about the “craze” that started last summer, see our previous IPAC blogs by clicking here.
The description of the checklists on the PHO website states:
These checklists were developed to assist public health units and others during IPAC lapse investigations and can be used to conduct inspections, audits and reviews of IPAC programs in dental practice settings.
That’s helpful, right? But it appears that an inspector who comes to your practice may be using these two checklists to assist in ensuring compliance. The language is not definitive and room is left for inspectors to use other documents. What’s more, the checklists reference sources from the RCDSO guidelines and Dispatch articles, the Occupational Health and Safety Act, PHO documents, Provincial Infectious Diseases Advisory Committee (PIDAC) documents, the Centres for Disease Control and Prevention (CDC) documents, etc.
So, although instructive on the matter, the new checklists may not be the definitive answer dentists were waiting for about their IPAC obligations!
The RCDSO put out a news release early this month stating that they have worked closely with PHO to develop the new checklists.
The RCDSO also took the opportunity to confirm that the RCDSO has always and continues to suggest that dentists’ professional obligations include
following public health guidelines as well as the recommendations of manufacturers of sterilization and other dental office equipment to ensure patient safety at all times.
They also hint at “potential changes” to the RCDSO Guidelines but confirm that no changes are anticipated until at least the new year.
What’s interesting is that despite recommendation that dentists follow public health guidelines and manufacturer recommendations for sterilization, they also state the current RCDSO guidelines will remain in effect and that “We have had no reports of any dental office that follows the current Guidelines being closed” which is a confusing message to send to dentists.
Right now, dentists don’t know where to turn for authoritative IPAC information. They are pulled in every direction from PIDAC to RCDSO to CDC to CDA – each of which have their own guidelines, recommendations and IPAC documents – some of which are similar but not always the same. And with confusing and contradictory information about which document to follow for proper IPAC measures in their dental practice, no wonder there is so much head scratching going on.
Although not the definitive answer dentists were waiting for, the new checklists are certainly instructive and a step in the right direction. But it is my hope that the PHO and RCDSO continue to collaborate to create a consolidated guideline document for dental practices that will help dentists to easily access one authoritative document and then feel safe and at ease knowing that they are conducting their IPAC using the authoritative guideline on the matter.
In the meantime, dentists should be familiar with both PIDAC and RCDSO guidelines on IPAC. If you are a dentist in Ontario you should absolutely use the new checklists to conduct an internal inspection and to see if your office would comply if an inspector walked into your dental practice today! And be sure to familiarize yourself with the other documents cited in the checklists!
Please note that the information provided herein should not be considered legal advice and is provided for informational and educational purposes only. If you need advice about IPAC at your dental practice, please contact me (Ljubica Durlovska), Jonathan Borrelli, David Mayzel or Michael Carabash. We are your legal dental team.
Accommodation is a process mandated by the Ontario Human Rights Code where an employee requires some sort of modification to their schedule or duties due to disability or some other reason protected by the Human Rights Code (i.e. family obligations, addiction, religious needs, etc.).
Employers are required to accommodate employees who genuinely require accommodation to the point of undue hardship. For more on what may be considered “undue hardship” read my blog To What Extent Do Dentists Have to Accommodate Employees.
In certain circumstances, and as part of the accommodation process, employers may ask employees to provide a doctor’s note outlining the prognosis and any accommodation requirements which the employee needs to return to work. For more information on your obligations when an employee is sick, read my blog Staff On Sick Leave: What Are Your Obligations As An Employer. But what happens if that note is contradictory (i.e. says the employee does not need accommodation but you notice that the employee cannot perform their job due to the disability) or if the note is from a doctor who is unqualified (i.e. the employee brings a note from their chiropractor regarding the employee’s cancer treatment – a medical issue they are unqualified to diagnose or treat)? Well in circumstances such as these, employers may be justified in asking for a second opinion or independent medical examination (“IME”).
Recently, the Ontario Divisional Court upheld a decision by the Human Rights Tribunal which ruled that an employer may, in certain instances, require an employee to undergo an independent medical examination (“IME”) during the accommodation process without the need for specific contractual provisions (Bottiglia v. Ottawa Catholic School Board, 2017 ONSC 2517). Mr. Bottiglia had worked for the Ottawa Catholic School Board (“OCSB”) for over 40 years. He started off as a teacher and progressed to superintendent. Mr. Bottiglia became ill in 2010 and was unable to work for approximately two years. He communicated in February 2012 that he was unable to return to work and that his recovery would take a prolonged period of time. In June 2012, the OCSB received a letter from Mr. Bottiglia’s doctor stating that he was unable to attend work and that a return to the OCSB might place him at a serious risk of a relapse. Then in August 2012, the OCSB was told that Mr. Bottiglia was capable of returning to work on a limited basis sometime in the next two months. The OCSB required Mr. Bottiglia to submit to an IME with a doctor of their choosing. Mr. Bottiglia refused to do so and filed a complaint of discrimination with the Human Rights Tribunal.
The Tribunal assessed Mr. Bottiglia’s case and found it reasonable, given the significant and unexpected changes in Mr. Battiglia’s stated ability to return to work, that the OCSB would want further information about his medical condition and ability to return to work. The OCSB also found it suspect that Mr. Bottiglia’s return to work coincided with the end of his paid leave, which the Tribunal also took into consideration. Ultimately, the Tribunal found that there was no discrimination and that Mr. Bottiglia should have submitted to the IME requested by the OCSB.
The Divisional Court, when reviewing the Tribunal’s decision stated that:
In my view, the Tribunal’s decision on this issue was a reasonable one. In certain circumstances, the procedural aspect of an employee’s duty to accommodate will permit, or even require, the employer to ask for a second medical opinion. Without attempting to define all of those circumstances, they will include the circumstances that the Tribunal reasonably found existed here, where the employer had a reasonable and bona fide reason to question the adequacy and reliability of the information provided by its employee’s medical expert. [emphasis added]
As the OHRC says in its Policy, an employer is not entitled to request an IME in an effort to second-guess an employee’s medical expert. An employer is only entitled to request that an employee undergo an IME where the employer cannot reasonably expect to obtain the information it needs from the employee’s expert as part of the employer’s duty to accommodate.
It is important to note that in August 2017 the Court of Appeal for Ontario refused Mr. Bottiglia’s application for leave to appeal, thereby confirming that the Divisional Court decision remains good law in Ontario and employers may, in some cases, be justified in requiring employees to undergo IME.
The Human Rights Commission has advice of their own (which is cited by the Court in the Bottiglia case):
While the employer is entitled to get all the information needed to make the accommodation, it must also accept accommodation requests in good faith and respect the dignity of employees. A request for a second opinion, an opinion from a specialist or an independent medical examination (IME) must be necessary to provide accommodation. Such a request should not be made to refute whether the employee has the disability in the first place or to avoid providing the accommodation.
Example: An employee provides a doctor’s note that asks for accommodation but does not state any particular diagnosis. The employee shows no observable symptoms of illness in the workplace, and the employer suspects that the employee is making up a disability to get more flexibility in her work arrangements. The employer wants to prove this by having the employee take an independent medical examination. Such an approach would not be consistent with the Code.
It is not normally advisable for an employer to second-guess the validity of an employee’s doctor’s advice, only on a suspicion that it is not objective because it is based on the employee’s own perceptions. Avoid challenging a medical note or requiring a second opinion unless there is evidence that the doctor’s recommendations are based on something other than his or her best opinion as to what is needed to make sure the patient recovers.
The legitimacy of a request for more medical information will depend on the information already received. A request for more medical information will be appropriate if there is a reasonable and objective basis for seeing the initial information as inadequate or inaccurate. Examples might be if there appears to be a problem with the degree of expertise or type of expertise of the doctor who provided the initial medical opinion, or if there is some reasonable basis to believe that the employee is not fit to do the job despite the existence of a medical report to the contrary. Document reasons for requesting more medical evidence.
Example: After a serious car accident, an employee is cleared by her doctor to return to work. On more than one occasion, she becomes dizzy at the end of her 12-hour night shift operating a machine and narrowly misses hurting herself. The employer asks for more information from her doctor about possible accommodations. Once again, the doctor’s note indicates that the employee is fit to work and that no accommodation steps are needed. The employer then asks the employee to attend an assessment by a doctor of her choosing, with expertise in workplace accommodations.
If a second opinion or independent medical exam (IME) is warranted, a good approach is to select a doctor who is acceptable to both the employee and the employer, and the union (if there is one) rather than insisting that an employee meet with a doctor that the employer has chosen. Give the employee enough information to understand the purpose of such an examination, who will conduct it and what assessments will be used.
As an employer, you are required to accommodate employees who are genuinely in need of such accommodation. However, as my colleague Jonnathan Borrelli always says, “accommodation is a two-way street” – see his blog Your Staff Must Co-Operate in Obtaining Accommodation. Employees cannot simply dictate the type and amount of accommodation they need. As an employer you can request information from a medical professional to help guide the accommodation process. In certain, albeit limited circumstances, you may have occasion to ask the employee to submit to a second opinion or an IME.
Please note that the information provided herein should not be considered legal advice and is provided for informational and educational purposes only. If you need advice about your obligations as an employer under the Ontario Human Rights Code, or need help with the accommodation process, please contact me (Ljubica Durlovska), Jonathan Borrelli, David Mayzel or Michael Carabash. We are your legal dental team.
Are you a dental office in Ontario with 20 or more employees?
If so, then you are legally required to file an accessibility compliance report by no later than December 31, 2017 under the Accessibility for Ontarians with Disabilities Act (AODA).
The questions/requirements contained in the compliance report include the following:
If a person with a disability is accompanied by a support person, does your organization ensure that the persons are permitted to enter the premises together and that the person with a disability is not prevented from having access to the support person while on your premises?
Does your organization ensure that the required persons receive training on the accessibility standards for customer service?
Has your organization established a process for receiving and responding to feedback on the accessibility of its customer service and does it make information about the feedback process readily available to the public?
Other than the requirements cited in the above questions, is your organization complying with all other requirements in effect under the Customer Service Standard?
If your answer is not YES to all of the questions, then you are not in compliance with the AODA and your office may be audited to check on compliance. You are also required to re-submit the form if your compliance status changes.
Please note that the information provided herein should not be considered legal advice and is provided for informational and educational purposes only. If you need advice about your other obligations under the AODA, please contact me Ljubica Durlovska, Jonathan Borrelli, David Mayzel or Michael Carabash. We are your legal dental team.
The Royal Ottawa Health Care Group was recently fined $75,000 for violating the Occupational Health and Safety Act (“OHSA“).
This decision stems from a series of events at Brockville Mental Health Centre. Starting in August 2014, multiple nurses were assaulted in various ways by patients over the span of a couple of months. Finally, in October 2014 a nurse was stabbed by a patient with a pen. The nurse, who had been escorting the patient to the bathroom when the patient lashed out, sustained serious injuries and the Ministry of Labour was notified of the incident.
The Royal Ottawa Health Care Group, which operates Brockville, was found guilty of failing to reassess the risks of workplace violence and to ensure policies and programs continue to protect workers (section 32.0.3(4) of the OHSA).
Because non-compliance with the OHSA is a provincial offence, the Ontario Court of Justice imposed a fine of $75,000. The court also added a 25% victim surcharge that goes into a provincial government fund to assist victims of crime.
You can read the Court Bulletin about this case here.
If you are wondering what you can do to make sure you don’t end up in the shoes of the Royal Ottawa Health Care Group, here is the takeaway:
Don’t simply provide violence policies / procedures and put them on the shelf, never to be seen again. Dust those policies off at least once a year and even more often when the need arises, as it did in this case.
We also advise involving your health and safety representative or joint health and safety committee in the process; ask them to review the policy and hold a staff meeting about ideas on how to improve the violence policies / procedures, if necessary. More involvement by workers in drafting and revising these types of policies means more compliance and adherence to those policies.
The same principles apply to your other policies, such as harassment, health and safety, sexual harassment, etc. For more blogs about your obligations under the OHSA, click here.
Please note that the information provided herein should not be considered legal advice and is provided for informational and educational purposes only. If you need advice about your obligations as an employer under the OHSA, or need help coming up with and implementing a new office policy manual, please contact me (Ljubica Durlovska), Jonathan Borrelli, David Mayzel or Michael Carabash. We are your legal dental team.
As promised, here is your first of five weekly blogs to help you prepare for the Goodlife Toronto Marathon.
Before we begin, please note these three very important points:
1) Get your doctor / physician’s approval before attempting the race or any related training.
2) Take it easy and listen to your body – if you feel pain, dizziness or fatigue, stop exercising and consult a doctor.
3) Any advice I give you in these blogs does not supplement the advice that a doctor, coach or certified personal trainer will give you, so listen to them first!
Now that we have gotten that out of the way, welcome to Week #1 of your training! My tips are based on my 25 years as a runner, which includes the instruction of running clinics.
1) Once you obtain approval from your doctor, pick an event that you can realistically prepare for. All beginners should only attempt either the 5km run or 5km walk.
2) You need a relatively new pair of running shoes, no more than a few months old or lightly used.
3) When buying shoes, be sure to know what type of shoe best suits you — neutral (most people, and most running shoes on the market, are this type), stability (for people whose feet roll inward or “pronate” moderately) or motion control (for people whose feet pronate severely). Specialty stores like Running Free, The Runners Shop and the Running Room have employees that can help assess your foot type, but you can do it yourself using the “Wet Foot test” here:
4) Avoid the “barefoot” minimalist running shoes. In my opinion, these shoes are not ideal for most runners in general, particularly beginners.
5) Have exercise clothing that is made of lighter polyester material intended to stay “dry” during workouts e.g. Nike Dri Fit, Cool Max, Adidas Climacool, etc. The shorts should be ones that help prevent chaffing. Avoid running in cotton, especially in warm weather.
6) You need a basic digital watch with a stop watch option. One with a count-down timer and/or a heart rate monitor is a big bonus. Some people run with their Iphones and Ipods, I personally do not recommend this for beginners as they are a distraction and potential safety hazard.
7) Train outdoors as much as possible – an indoor track or treadmill can be used for the odd workout in case of inclement weather.
8) As a safety pre-caution, map out your run or walk training routes ahead of time and keep your family informed of your training routes.
9) Avoid training on back-to-back days. One rest day in between training sessions is ideal.
10) Core and flexibility exercises (such as yoga) are a great complement to your training.
Week 1 – 5km Run
1) Your very first workout should be a continuous walk for 45 minutes. What is the point of this? The average person can easily cover more than 3km during a 45 minute walk.
2) Take the next day off, and then begin your first running workout. Run 1 minute, walk 2 minutes, and repeat 10 times.
3) Take another day off, and then do your second running workout. Run 1 minute, walk 2 minutes, and repeat 10 times. Pick up the pace slightly when you walk.
4) When running, pace yourself evenly at roughly 60-70% effort (with 100% being a sprint) so that you are able to talk clearly while running. The walk breaks should be a continuous walk – keep moving as much as possible.
5) Keep an upright posture and run normally – do not exaggerate your strides or attempt to sprint.
6) Stretch immediately after each workout. You can find many running specific stretch routines on YouTube or other websites.
Week 1 – 5km Walk
1) Dedicate approximately one hour for each training session.
2) Warm up with a light walk for a few minutes. Walk a moderate to brisk pace for 10 minutes, then walk slowly for 1 minute. Repeat 3 times.
3) Take a day off.
4) Your next two workouts will be the same as the first, except add an additional 5 minutes of brisk walking at the end.
5) Be sure to pace yourself – walking workouts are not as easy as they look. Use your first set as a warm-up and build up to a brisk pace. If you feel any pain in your shins, back or leg muscles, slow your pace.
6) Do not try to imitate Olympic race walkers – your walk should be a normal power walk with upright posture and regular arm and leg movement.
7) Stretching is recommended after each training session.
10km, Half-Marathon and Full Marathon
Participation in any of these distances should be for experienced runners only. For those who would enter these events today, here is a break down of my recommended minimum fitness requirements for each distance:
10km: You have a) completed a 6km run or longer, and b) are able to run 20 minutes without walking or stopping.
Half Marathon: You have a) completed a 16km run or longer, and b) are able to run 5km without walking or stopping.
Marathon: You have a) completed at least one 30km practice run, and b) can run 10km at a tempo pace (70-80% effort) without walking or stopping.
If you do not meet any of these minimum requirements, consider switching to a shorter distance for May 1st.
For those who are attempting these distances, I assume you have already been training for some time now and are following an advanced training program. Therefore, I will only provide tips to complement your current training in future blogs.
Stay tuned for more training tips!
David Mayzel is your legal risk manager. He is a trained courtroom lawyer and has spent many years resolving disputes both in and out of court. He knows how to prepare documents and execute transactions in a way that avoids or mitigates legal risks. He can be reached at 416.528.5280. or firstname.lastname@example.org.
Michael Carabash is your business law adviser. He is an entrepreneur at heart who helps you see the big legal picture. He drafts clear and effective agreements that protect your rights while promoting your interests. He can be reached at 647.680.9530. or email@example.com.
Ljubica Durlovska is your transition lawyer. She helps you with staff and associates, maintaining your corporation, and other business matters. She can be reached at 416.443.9280, extension 206 or firstname.lastname@example.org.
Jonathan Borrelli is your employment lawyer. He helps you with staff and associates matters, including hirings, terminations, switching staff to written contracts and resolving disputes. He can be reached at 416.443.9280, extension 204 or email@example.com.
Benjamin Kong is an experienced business law clerk. He assists David and Michael with corporate matters and purchase / sale transactions. He can be reached at 416.443.9280, extension 207 or firstname.lastname@example.org.
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David, Michael, Ljubica, Jonathan, Ben and Julie are a truly dynamic team. Their diverse knowledge, skills, and experiences will help you get the best deal possible while promoting your interests and protecting your rights. You can read dentist testimonials here.