An updated Professional Misconduct Regulation, made under the Midwifery Act, 1991, came into effect on July 1, 2024. We have prepared information on the regulation, a summary of changes, and some frequently asked questions to help explain these changes.
Overview
The College establishes and enforces professional standards to ensure that midwives provide safe, effective, and ethical care. Professional misconduct encompasses any behaviour, action, or omission by a midwife that breaches these established standards of practice and ethical guidelines, that compromises client safety, care quality, or professional integrity.
The Inquiries, Complaints, and Reports Committee (ICRC) reviews complaints and Registrar Investigations about midwives to decide if regulatory action is required in the public interest. The ICRC will assess whether the allegations raise concerns of professional misconduct that, if proven true, are serious enough to warrant a formal discipline hearing. In those cases, it will refer specified allegations to the Discipline Committee for a hearing. Only a panel of the Discipline Committee can make findings of professional misconduct.
Engaging in professional misconduct is serious. Some examples of professional misconduct are listed in the Regulated Health Professions Act, 1991 (RHPA), for example, breaking a federal or provincial law or failing to participate in the Quality Assurance Program. Sexual abuse of a client is also specifically identified in the RHPA as professional misconduct.
The College’s Professional Misconduct Regulation, made under the Midwifery Act, 1991, defines parameters of professional practice, identifying specific conduct that constitutes misconduct and could result in disciplinary action by the College. The regulation addresses a wide range of professional activities, from record keeping to billing practices, as well as unacceptable conduct such as abuse of a client or a client’s representative.
In 2016-2017, the College sought feedback from the public, midwives, and other stakeholders on proposed changes to the Professional Misconduct Regulation and subsequently submitted the revised regulation to the Ministry of Health. The College collaborated with the Ministry on the regulation, and the final revisions were officially filed with the Registrar of Regulations as O. Reg 229/24 effective July 1, 2024.
What’s New in the Regulation
There is nothing new in the regulation that will change the ways midwives currently practise.
The revised regulation better aligns with the language of other health colleges’ regulations to maintain consistent standards for health practitioners and avoids duplicating content already covered in the RHPA or the Health Professions Procedural Code. This removes barriers to the delivery of safe, timely, and quality midwifery care and may improve client experience in the health care system.
The regulation also now uses gender-inclusive language.
New provisions to the Professional Misconduct Regulation that are already standards of practice for midwifery are:
- Failing to appropriately supervise a person whom the member is professionally obligated to supervise.
- Making a claim respecting a drug, substance, remedy, treatment, device, or procedure other than a claim that can be supported as reasonable professional opinion.
- Failing to make reasonable attempts to collaborate with a client’s other relevant health care providers respecting the care of the client, where such collaboration is necessary for the client’s health, unless the client refuses to consent.
- Failing to advise a client, a client’s authorized representative, or a member of the public, when requested, of their right to file a complaint with the College.
The change to the regulation on discontinuing care aims to provide clearer and more consistent guidelines, aligning with other health colleges and Canadian midwifery regulators. The revised language removes challenging language about “trust and confidence,” focusing instead on the appropriateness of discontinuing services based on the midwife’s reasons, the client’s condition, availability of alternate services, and the opportunity given to arrange such services. This update ensures clients are not abandoned in labour or other situations where immediate care is required and removes references to the rescinded When a Client Chooses Care Outside Midwifery Standards of Practice, making the regulation more practical and adaptable.
Similarly, the change to the regulation which deals with the expectation of midwives closing their practice has been updated to be clearer in its intent.
FAQs
Professional misconduct includes any behaviour, action, or omission by a midwife that breaches established standards of practice and ethical guidelines, thereby compromising client safety, care quality, and professional integrity.
If a panel of the Discipline Committee makes findings of professional misconduct or incompetence, the hearing proceeds to the penalty phase, where the panel may issue one or more of the following orders:
- Direct the Registrar to impose terms, conditions, or limitations on the midwife’s Certificate of Registration (for example requiring the midwife to complete remedial activities).
- Reprimand the midwife.
- Direct the Registrar to suspend or revoke the midwife’s Certificate of Registration.
While costs are not part of the penalty, requests for costs related to the investigation, prosecution, and hearing are considered during the penalty phase of the hearing.
No, not every complaint gets referred to Discipline. In fact, historically, the ICRC has referred few cases to the Discipline Committee. The ICRC will first determine if remedial actions outside of a referral to discipline adequately protects the public. If the ICRC doesn’t have any concerns with a midwife’s conduct, it will take no action on the complaint. If the ICRC has concerns but does not refer the case for a hearing, it may decide on other remedial actions, such as providing advice or requiring additional training for the midwife.
No, the revised regulation will not change the ways midwives currently practice. It aims to maintain consistent standards and improve regulatory processes without altering daily practices.
The regulation was revised to better align with the language of other health colleges’ regulations to maintain consistent standards for health practitioners, and avoid duplicating content already covered in the RHPA or the Health Professions Procedural Code. Clearer and inclusive language was incorporated throughout.
No, for conduct that occurs after July 1, 2024, the ICRC and the Discipline Committee will rely on the revised Professional Misconduct Regulation when considering a matter. For conduct that occurred prior to July 1, 2024, the provisions of the Professional Misconduct Regulation in effect before that date will be considered and relied upon.
No, you do not need to speak with your clients about the changes in the new regulation. The revisions to the Professional Misconduct Regulation are primarily administrative and aimed at improving regulatory processes and standards. These changes will not impact the way you currently practice or interact with your clients. A review of what constitutes professional misconduct may serve as a good reminder for midwives for what to avoid and may serve to improve a midwife’s practise.
Yes, there was a public consultation on the proposed changes to the regulation. In 2016-2017, the College sought feedback from the public, midwives, and other stakeholders on the proposed changes to the Professional Misconduct Regulation. This feedback was incorporated into the revised regulation, which was then submitted to the Ministry of Health and officially filed as O. Reg 229/24 which came into effect July 1, 2024.
You can refer to the Professional Misconduct Regulation. You can also read the College’s Professional Misconduct Guide. The Jurisprudence Handbook includes information about professional misconduct, and the various College guides and guidelines refer to it where appropriate.
FAQ Regarding the Ending the Midwife-Client Relationship
The old regulation focused on discontinuing care if there was no longer a relationship of trust and confidence, if the client requested discontinuation, if alternative services were arranged, or if the client requested services inconsistent with midwifery standards.
The new regulation adds clarity by emphasizing the appropriateness of discontinuing services based on the midwife’s reasons, the client’s condition, the availability of alternate services, and the opportunity given to the client to arrange such services.
The language about “trust and confidence” was challenging to interpret and apply consistently. The new regulation removes this language to align more closely with the practices of other health colleges and Canadian midwifery regulators, making it more practical and easier to enforce.
The College’s Guideline to Ending the Midwife-Client Relationship has been updated to reflect the new regulation, providing clearer guidance on appropriately discontinuing care. It now aligns with the revised Professional Misconduct Regulation to ensure consistency and clarity.