Alberta's patient charter: is it a course worth charting?

• Author: Ammann, Mark

On September 1st, 2009, Alberta's Minister of Health and Wellness created the Minister's Advisory Committee on Health (MACH). This Committee's mandate was to "provide input on the legislative reforms necessary to 'update current health legislation in a manner that will facilitate current and future health system initiatives.'" (1) The MACH conducted an extensive consultation process, with presentations, meetings and written submissions from stakeholders as well as direct public input in the form of surveys and meetings. Various stakeholders in Alberta were involved, including service providers, health care professionals, regulatory bodies, professional associations, academics and members of the public.

The MACH released a report on January 20, 2010 which recommended that an Alberta Health Act be built around core elements, including a patient charter and stronger support for evidence-based decision making. (2)

Following the presentation of the MACH Report, MLA Fred Home chaired the Alberta Health Act Advisory Committee which was aimed at taking the substance of the MACH Report and ultimately recommending legislation based on its findings. During the 2010 consultations on the Alberta Health Act, both an oral submission and a written submission were presented in which we raised cautionary considerations about the creation of a Patient Charier, a number of which were addressed by Mr. Home and his advisory panel. Many of the points in this article are drawn from these submissions.

Mr. Home presented the Health Act Advisory Committee's final report, including fifteen recommendations for the development of an Alberta Health Act, to the government on September 15, 2010. (3) All 15 of the Report's recommendations were accepted and the Alberta Health Act was introduced on November 1, 2010 and is currently awaiting proclamation. (4)

This paper focuses on those recommendations that relate to the creation of a Health Charter (known elsewhere as a Patients' Charter or Patients' Bill of Rights). It will review the creation of Patient Charters, both in Canada and elsewhere, and discuss five key issues that should be considered if contemplating the creation of a Charter.

Patient Charters and recent developments from Alberta

In brief, a Patient Charter is a document that enumerates elements such as citizens' rights and appropriate expectations when dealing with the healthcare system, responsibilities in relation to healthcare, and/ or educational or aspirational statements. No two Charters are identical and some locus on education and aspirational statements rather than specific rights. Nevertheless, these elements frequently overlap when existing Charters are reviewed. For example, virtually every Patient Charter requires that patients be treated with respect and dignity, and have their circumstances considered when prescribing treatment. Some Charters also contain citizen responsibilities; for example, the responsibility for citizens to inform themselves about their healthcare system or use system resources in a responsible fashion. Patient Charters are typically intended to serve several purposes, including fostering trust between citizens and healthcare providers, informing patient expectations, and educating citizens about their rights in relation to the healthcare system.

The Alberta Health Act (5) does not contain the proposed Alberta Health Charter itself, but it does state that the Minister shall establish a Health Charter and may appoint a Health Advocate. The Health Advocate will review complaints made in accordance with the Act if there is no other entity with the jurisdiction to do so, and carry out any responsibilities assigned by regulation. Where there are entities with such jurisdiction, the Health Advocate has a duty to refer complainants to the appropriate organization. (6) The Health Advocate will not have formal sanctions available to him. He will only be able to make recommendations to any person he considers appropriate. (7) Should a person receive a recommendation from the Health Advocate and fail to comply with it, the Health Advocate may then submit a written report to the Minister of Health and Wellness who could presumably elect to address it. (8) The Minister can order those providing health services to comply with the Charter. (9)

While a specific Health Charter has not yet been proposed, Putting People First outlined the following possible patient expectations that might be part of a future Alberta Patient Charter: (10)

When I interact with the health system, I expect that I will:

* Have my health status, social and economic circumstances and personal beliefs and values acknowledged;

* Be treated with respect and dignity;

* Have access to team-based primary care services;

* Have the confidentiality and privacy of my health information respected;

* Be informed in ways that I understand so that I may make informed decisions about my health, health care and treatment;

* Be able to participate fully in my health and health care;

* Be supported through my care journey and helped to find and access the health services and care that I require;

* Receive information on the health system and education about healthy living and wellness;

* Have timely and reasonable access to safe, high quality health services and care;

* Have timely and reasonable access to my personal health information;

* Have the opportunity to raise concerns and receive a timely response to my concerns, without fear of retribution or an impact on my health services and care.

Those proposed Charier elements are followed by a section focused on patient responsibilities. Included are the following Responsibilities: (11)

* Respect the rights of other patients and health providers;

* Ask questions and work with providers to understand the information I am being provided;

* Demonstrate that I, or my guardian and/or caregivers, understand the care plan we have developed together and that steps are being taken to follow the plan;

* Treat health services as a valuable public resource;

* Learn how to better access health services;

* Make healthy choices in my life.

Following the Responsibilities section, a more general statement is made regarding citizens' expectations towards the governance of the public health system. (12)

As I work to be a healthy citizen within Alberta, I expect that:

* When economic, fiscal and social policies are being developed by the Alberta government the impact of those policies on public health, wellness and prevention will be considered and steps taken to ensure that public policy is healthy policy.

The rights and responsibilities listed above are similar to those adopted in Patient Charters from other jurisdictions. It is notable that the rights mentioned above do not create any new entitlements for patients. For each right, there is already legislation, regulation, policy, common law, or some combination thereof supporting its existence. The same, however, cannot be said of the responsibilities section. As we will discuss later, many of the listed responsibilities would not exist but for the Health Charter. Others may be in conflict with existing patient rights at common law.

Canada's experience with Patient Charters

Several provinces, as well as the federal government, have, at various times, either considered or taken steps to create and implement a Patient Charter. Some of these efforts never reached fruition while others produced results that were significantly different than originally envisioned.

Quebec is the only province to have implemented legislation containing the rough equivalent of a Patient Charter. In 1991, Quebec passed An Act Respecting Health Services and Social Services. (13) The rights protected in this Act are partially similar though somewhat more limited than those in Putting People First. The following rights are legislated under ss. 5 and 6 of this Act, though note that this list is not exhaustive:

* The right to be informed of the existence of the health and social services resources available in the community and the conditions governing access to the services;

* The right to receive health services in a continuous and personalized manner, and which are scientifically, humanely and socially appropriate;

* The right to choose the professional from whom or the institution from which health services are to be received;

* The right to receive the care required when life or bodily integrity is endangered;

* The right to be informed of the state of one's...