My Background in Law
Healthcare is a highly regulated and complex industry. With my deep expertise in hospital operations and health law matters, I am able to assist you in ensuring compliance with statutory and regulatory requirements, addressing emerging trends and implementing best practices, and designing and implementing effective risk management and business strategies.
Over the course of my seven-and-a-half-year tenure as General Counsel to St. Michael’s Hospital, I was involved in virtually the entire span of activities and operations of a large academic health sciences centre, from clinical, research, and educational activities through to providing legal advice to corporate operations. These activities and operations are subject to a significant number of laws and regulations, particularly in the last few years as public expectations about transparency and accountability in healthcare have grown.
St. Michael's Hospital
My work at St. Michael’s included responding to real-time crises in the Emergency Department and ICU through to professional practice issues and commercial disputes, ensuring regulatory and statutory compliance, as well as undertaking and completing a variety of strategic initiatives.
My practice included advising internal clients on a very broad range of corporate and governance issues, commercial law, risk management, privacy, quality improvement and patient safety, and conflict management and dispute resolution, particularly involving physicians and other regulated health professionals.
Representative Advice and/or Transactions
Clinical and Professional Domain
- Led redevelopment, navigated internal consultations and approval process for implementation of new Medical/Professional Staff By-laws;
- Working with a sub-committee of the Medical Advisory Committee, led redesigning of Credentialing and Privileging policies and procedures, drafted new Applications for Appointment and Re-Appointment of Professional Staff.
- Developed policies on Communication of Adverse Events (Disclosure of Harm); Mandatory Reporting of Health Professionals; Restraints Policy;
- Developed framework and Terms of Reference for corporate and local/departmental/programmatic Quality of Care Committees and quality improvement projects; advised on Critical Incident reporting processes to MAC, Board Committees, and Board of Directors; statutory and regulatory compliance with requirements under the Excellent Care for All Act.
Management and Administration of Professional Staff
- Developed procedural model for professional practice reviews arising from critical incidents, adverse events; managed procedures and processes relating to professional practice reviews;
- Provided legal advice leading to the establishment of the St. Michael’s Hospital Academic Family Health Team;
- Advised with respect to engagements/appointments of Clinical Department Chiefs, physician leaders; development of collaborative and inter-disciplinary practice plan agreements; facilitated introduction of new health professionals into family medicine; training and educational placements;
- Led response to compliance issues relating to breaches of institutional policies, alignment of a clinical department’s practice plan with Hospital By-laws and the Affiliation Agreement with the University of Toronto; compliance and alignment strategies for professional staff re: institutional policies.
Conflict Management and Dispute Resolution
- Developed and managed framework and process for review of allegations of disruptive behaviours and conduct by professional staff, workplace harassment and discrimination, breaches of hospital policy, competency and incapacity issues, mandatory reporting to professional colleges;
- Developed template letters of engagement for clinician and staff scientists;
- Developed and managed framework for review of allegations of research misconduct, ensuring alignment with University of Toronto research misconduct requirements;
- Inter-institutional and inter-governmental agreements for funding, collaborative research endeavours; educational and training placements.
- Developed a template affiliation agreement between a teaching hospital and educational institutions sending students for clinical training and education;
- Led negotiation of Affiliation Agreement between the University of Toronto and St. Michael’s Hospital;
- Inter-institutional agreements, including agreements for faculty and educational training and placements;
- Provided advice regarding agreements for establishment of Academic Chairs at the University of Toronto.
Supported clinical practitioners and teams on a very broad range of health care issues, policies, and procedures, including consent, capacity, substitute decision-making, Consent and Capacity Board, end-of-life decision-making, mental health law, organ donations, donations after cardiac death (“DCD”), alternate level of care (“ALC”) placements and discharges, investigations and relationships relating to professional colleges, Coroners’ Inquests, scope of practice issues for Registered Nurses in the Extended Class; Mandatory Gunshot Wound Reporting Act.
- Led redevelopment, navigated internal consultations, and approval process for implementation of new Corporate/Administrative By-law;
- Supported activities of the Board of Directors and Board Committees of St. Michael’s Hospital, including terms of reference for Board committees; conflict of interest issues for directors; advising regarding professional practice and case reviews, by-law interpretation and application; Public Sector Salary Disclosure Act.
- Involved in negotiating, advising and responding to a broad range of commercial matters, including contractual disputes, Requests for Proposals (RFPs) and RFx, purchase and supply agreements, consultant agreements, leasing agreements, licensing agreements, joint venture agreements, shared services agreements, letters of intent, transcription services; outsourcing arrangements; strategic and collaborative relationships with vendors; service agreements with government and Crown agencies; nursing agency services; advising on relationships with Group Purchasing Organizations;
- Spearheaded redesigning of various Hospital policies and procedures to conform to new requirements under the Broader Public Sector Accountability Act relating to Procurement, Expenses, and Perquisites Directives;
- Advised on development of Signing Authorities Policy, Code of Conduct, Code of Business Conduct, Conflict of Interest; Workplace Discrimination and Harassment Policies;
- Advised on insurance issues, including consulting with HIROC, claims management for liability and property insurance;
- Developed Joint Venture model among three hospitals for the establishment and management of the Centre for Clinical Ethics.
- Conducted and managed RFP process for multi-year retention of external legal services for Employment and Labour Law.
Real Property Law
- Provided advice with respect to on-site retail tenancy leases; external real property leases for hospital operations; municipal tax exemption issues; encroachment agreements; leases, licenses and use of space for health care programs and service delivery;
- Facilitated acquisition of real property of St. Michael’s Hospital from the Sisters of St. Joseph leading to the construction of a new Research Institute at the Hospital, including involvement on donor agreements with Foundation and Hospital.
Intellectual Property Law
- Supported the Hospital’s intellectual property activities, including copyrights, trade-marks, business names, official marks, licensing and assignment agreements;
- Supported Hospital’s commercialization efforts; bridge financing agreement; patent applications.
- Provided advice with respect to executive contracts for members of the Hospital’s senior executive management and for clinical department chiefs; staff secondment agreements;
- Provided advice regarding employee suspensions and terminations, including regulated health professionals, mandatory reporting obligations;
- Advised re: breaches of institutional policy; misconduct; supported implementation of police reference check process for Hospital staff and professional staff;
- Managed appeals of CRA tax rulings re: employment vs. independent contractor status for Program Medical Director and Clinical and Research Fellows.
Records Management, Privacy, and Confidentiality
- Spearheaded compliance readiness plans for application of the Freedom of Information and Protection of Privacy Act for St. Michael’s Hospital;
- Spearheaded development of new Records Management and Retention Policy for St. Michael’s Hospital;
- Assisted in the Hospital’s readiness plans for the Personal Health Information Protection Act in 2004;
- Designed and supported Hospital’s corporate and local Quality of Care review frameworks and processes based on the Quality of Care Information Protection Act;
- Led development and implementation of unique personal health information-sharing protocol among St. Michael’s Hospital, University Health Network, and Toronto Police Services;
- Reviewed and advised respecting research and data-sharing agreements involving clinical departments, researchers, external organizations, including municipalities, CIHI, ICES, NACRS, US Trauma Registry.
Miller Thomson LLP
In this role, I provided legal advice to a range of health organizations and institutions, including public hospitals, community care access agencies, long-term care facilities, health professionals and community healthcare associations and organizations. This role included providing legal advice on contracts, commercial arrangements of all kinds, clinical trials, information technology, privacy law, and general risk management.
Representative Advice and/or Transactions:
- Provided legal support for innovative tele-robotic surgery project involving Hamilton, North Bay, and Yukon hospitals;
- Provided legal support respecting the first Ontario Public-Private-Partnership (P-3) for the construction of a new hospital;
- Advised on establishment of Shared Services arrangements and Joint Ventures between and among hospitals for food services, radiology, IT services, and other services.
Ministry of Health and Long-Term Care and The Ministry of the Attorney General
In these roles, I provided legal advice to a range of Ministry staff and departments as well as a variety of Crown agencies. The advice included corporate law, commercial law, not-for-profit and charitable matters, intellectual property law, Crown law and Crown agency law.
Representative Advice and/or Transactions:
- Provided legal advice for the Ministry’s negotiations with the Ontario Medical Association in primary care reform and chief draftsperson for the original Family Health Network model agreement; provided legal support in relation to the establishment of the Ontario Family Health Network Agency and the Smart Systems for Health agency;
- Provided legal support to the Ministry in responding to recommendations and orders issued by the Health Services Restructuring Commission relating to Hospital program transfers, amalgamations, mergers, and dissolutions [received Achievement Commitment Excellence (“ACE”) Innovation Award];
- Provided legal support in policy development processes and inter-ministerial submissions leading to new legislation, making of regulations, Orders-in-Council;
- Established the Inter-Ministerial Intellectual Property Focus Group that examined government copyright and trade mark practices that led to a review by the Government of Ontario of Queen’s Printer functions, new Management Board Directives and Guidelines, and changes to the Government’s intellectual property practices;
- Supported development of Memoranda of Understanding with a variety of government agencies, including McMichael Canadian Art Collection, Ontario Science Centre, Art Gallery of Ontario;
- Provided legal support to Freedom of Information and Protection of Privacy staff; advised on management of contentious issues and requests;
- Co-chaired inter-ministerial group for Defamation Law Reform Project;
- Facilitated and advised regarding long-term loan of significant collection of Inuit art from West Baffin Eskimo Co-operative to the McMichael Canadian Art Collection;
- Internship in Copyright Law at the United Nations Educational, Scientific and Cultural Organization in Paris, France.