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Location: Consent and Capacity Board > Publications > Annual Reports > Annual Report 2001 - 2002 (HTML)


Consent and Capacity Board
2001/2002 Annual Report



Coat of Arms


Office of the Chair and
Chief Executive Officer
Consent and Capacity Board
151 Bloor St. West, 10th Flr.
Toronto ON M5S 2T5
Telephone: (416) 327-4142
Facsimile: (416) 327-4207

Bureau du Président
et le Chef de la Direction
Commission du consentement et de la capacité
151 rue Bloor Ouest, 10e étage
Toronto (Ontario) M5S 2T5
Téléphone: (416) 327-4142
Télécopieur: (416) 327-4207

Coat of Arms


June 14, 2002

The Honourable Tony Clement
Minister of Health and Long-Term Care
80 Grosvenor Street
Toronto, ON M7A 2C4

Dear Minister:

On behalf of the Consent and Capacity Board, it is my pleasure to submit our Annual Report for the fiscal year 2001/2002.

The Consent and Capacity Board is not a typical tribunal. Daily we decide matters of life, death and liberty.

Our work became substantially more challenging during the course of the year. We continue to grapple with the legislative changes of December, 2000. Hearing volume has again increased. Hearings have continued to get longer and more complex as a result of legislative changes and the presence of an ever more sophisticated and informed group of stakeholders. Health practitioners and other stakeholders continue to increase their reliance on the services of the Board.

This has also been a time of change and renewal for the Board. Over half of our lawyer members and 37 per cent of our community members joined the Board in the last two years. In the last year alone the Board has grown from 123 members to 143 members. Administratively, the Board has also been engaged in a process of renewal. The diffuse structure without a central core that has served so well for the past thirty-five years can no longer sustain us. We are, therefore, engaged in a process of constructing an organizational infrastructure that will serve the current and future needs of the Board and its stakeholders.

I thank you for your continued support of our important work.

Sincerely,




Michael Bay
Chair and Chief Executive Office


TABLE OF CONTENTS


OVERVIEW OF THE BOARD

JURISDICTION OF THE BOARD

ORGANIZATIONAL CHALLENGES

CONTINUING IMPACT OF LEGISLATIVE CHANGE

BOARD MEMBERSHIP

BOARD STAFF

FINANCIAL ANALYSIS


OVERVIEW OF THE BOARD

The Consent and Capacity Board is an independent body created under the Health Care Consent Act by the provincial government. The Board conducts hearings under the Mental Health Act, the Health Care Consent Act, the Substitute Decisions Act and the Long-Term Care Act. The Board functions under statutory requirements and a memorandum of understanding between the Chair, the Minister of Health and Long-Term Care, and the Deputy Minister of Health and Long-Term Care.

Board members are psychiatrists, lawyers or members of the general public. For the vast majority of its cases, the Board is required, by law, to sit in panels of three (lawyer, psychiatrist and community member) or in panels of five. A small number of cases may be heard by a Senior Lawyer Member (who meets certain legislated criteria) sitting alone. For administrative purposes, the Board is divided into nine regions and members belong to the region in which they live or work. For the most part, members adjudicate within their own region but travel to other regions as required.

Each of the nine regions covers a defined geographic area of the province and has a regional office managed by a Regional Vice-Chair (RVC) who is accountable for all aspects of the Board's work in that region. With the exception of the Toronto Region, the regional offices are all set up in a similar fashion. As part of her or his own private business or professional practice, the RVC maintains an office, which also serves as the local Board office. RVC’s assign Board-related administrative tasks to individuals in their offices who function as regional office personnel. Since April 2001, the Toronto regional office has been housed in government premises and staffed by government employees.

The regional office is responsible for all aspects of the hearings taking place in that region. This includes everything from receipt of applications, to scheduling Board members, to ensuring that decisions and reasons for decision are delivered within the statutory timeframes, to preparing the record for decisions that are appealed to the courts.

In keeping with its legislative mandate, the Board has adopted the following mission and purpose statement:

The Board will meet the individual needs of consumers and those who care for and about them with the highest level of customer service. This will include speed, courtesy, accessibility, sensitivity, and impartiality with a commitment to high quality decision making in keeping with the principals of fairness and fundamental justice.

The Board is committed to accommodating the diversity of Ontario’s population.

The Board will help ensure acceptance and meaningful implementation of the requirements and principles of new and existing legislation by such activities as:


JURISDICTION OF THE BOARD

The Board has authority to hold hearings to deal with the following matters:

Health Care Consent Act

Mental Health Act

Substitute Decisions Act

Long Term-Care Act


ORGANIZATIONAL CHALLENGES

During fiscal 2001-2002, the Consent and Capacity Board focused on organizational challenges in two key areas: membership renewal and administrative restructuring. Membership renewal is an ongoing challenge for the Board, but particularly so over the past two years. The high rate of renewal and growth among members has had a significant impact on Board resources. The administrative restructuring began in 2000 and is ongoing.

The Minister's office has worked closely with the Chair to assess the regional needs of the Board and to ensure that the very best candidates are put forward for membership. Over the years, the Board has developed a rigorous screening program for candidates in an effort to ensure that the qualities and expectations of both the candidate and the Board are a good match.

In 2001-2002, Board membership grew dramatically, increasing by 17% (from 123 members to 143). Thirty-three per cent of the lawyer members and 27 % of the community members were appointed within that timeframe. The need to train so many new members dramatically impacted the Board's resources. To more efficiently deal with the volume of training required, the Board created and implemented a central, formalized training program.

In addition to managing membership renewal and training, the Board continued the administrative restructuring begun last fiscal year. The Toronto Region, which accounts for approximately 40% of the Board's cases, was moved in-house. This included appointing a new Regional Vice-Chair for the region, and addressing issues of staffing, space allocation and communication with the region's stakeholders. The Board's administrative reorganization included moving from within the administrative framework of the Health Boards Secretariat to internal administration. The Board's organizational restructuring is ongoing.

In addition to the ongoing organizational challenges, the Board completed and promulgated its Code of Conduct. The Board initiated and completed a consultation with its members and stakeholders on draft Rules of Practice. It anticipates finalizing and promulgating the Rules of Practice next fiscal year. The Board also undertook to develop a formal Complaints Procedure which it expects to complete and implement in fiscal 2002-2003.


CONTINUING IMPACT OF LEGISLATIVE CHANGE

Mental Health Legislative Reform, 2000 (Bill 68) made several changes to the Mental Health Act and the Health Care Consent Act, including the following:

The amendments, which came into effect December 1, 2000, expanded the role and function of the Consent and Capacity Board to include optional review of Community Treatment Orders and a mandatory review of the second consecutive order and every second order thereafter. Reviews of involuntary committal are substantially longer than before because the changes to the legislation essentially tripled the number of potential factors to be considered. Furthermore, as a result of the amendments, the Board is now required to conduct a hearing into the patient's relevant decision-making capacity virtually every time a hearing is convened for any purpose under the Health Care Consent Act. Overall, the Board is doing more hearings and those hearings are greater in length, more complex in nature, and significantly higher in sensitivity.

While the number of CTO applications has remained low (16 in this fiscal year), they are time consuming. The expanded involuntary committal criteria continues to have significant implications for the Board's resources because of the length of the hearings. Hearings also take longer because lawyers and physicians are still familiarizing themselves with the nuances of the amendments to the legislation. Moreover, because the courts have not yet heard these matters on appeal, many questions of legal interpretation remain unanswered in a conclusive way.

Ontario has always been seen as a leader in the area of mental health and consent law. Because of the aging population, and increased interest and changing views with respect to mental health law and services, the Ontario experience in this area is subject to an ever-increasing level of legal, academic and public interest. Not surprisingly, the amendments to the legislation in 2000 significantly increased the level of legal scrutiny, as well as, public and academic interest – both in Ontario and internationally. Consequently, the decisions and work of the Board are undergoing closer scrutiny than ever before. In fact, for the first time, the Supreme Court of Canada has granted leave to hear a case on appeal from the Consent and Capacity Board.


BOARD MEMBERSHIP

Membership Changes (April 1, 2001 to March 31, 2002)
Please refer to "Overview of the Board" (page 3) for more information on the Board's membership and regional structure.

Board Total Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 32 13 -6 11 39
Psychiatrist Members 56 12 -5 23 63
Community Members 35 11 -5 11 41
  123 36 -16 45 143


Hamilton Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 4 3 -1 0 6
Psychiatrist Members 8 2 -1 3 9
Community Members 3 1 -1 2 3
  15 6 -3 5 18


Kingston Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 3 0 0 3 3
Psychiatrist Members 5 2 0 2 7
Community Members 6 0 -1 1 5
  14 2 -1 6 15


London Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 4 1 0 1 4*
Psychiatrist Members 8 2 0 4 8**
Community Members 6 2 0 1 8
  18 5 0 6 20


North Bay Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 1 1 0 1 2
Psychiatrist Members 0 1 0 0 1
Community Members 2 0 0 2 2
  3 2 0 3 5


Ottawa Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 6 2 -2 1 6
Psychiatrist Members 8 0 0 5 8
Community Members 3 1 -1 1 3
  17 3 -3 7 17


Penetanguishene Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 1 0 0 1 1
Psychiatrist Members 1 1 0 0 2
Community Members 1 1 0 1 2
  3 2 0 2 5


Sudbury Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 1 2 0 1 3
Psychiatrist Members 3 0 0 2 3
Community Members 3 1 0 0 4
  7 3 0 3 10


Thunder Bay Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 1 1 0 1 2
Psychiatrist Members 2 0 0 2 2
Community Members 2 0 0 1 2
  5 1 0 4 6


Toronto Members
April 1st
New
Appointment
Not
Renewed
Re-
Appointed
Members
March 31st
Lawyer Members 11 3 -3 2 12*
Psychiatrist Members 21 4 -4 5 23**
Community Members 9 5 -2 2 12
  41 12 -9 9 47

Notes:
* 1 lawyer member relocated from London Region to Toronto Region
** 2 psychiatrist members relocated from London Region to Toronto Region

  1. The Chair of the CCB is included as a Toronto region lawyer
  2. 2 members in the Toronto region are designated as both lawyer and psychiatrist but are included only as psychiatrist members on the charts because they do not sit as lawyer members for the CCB


BOARD STAFF

Staffing As of March 31, 2002

Jim Curren Chief Operating Officer & Registrar
Janet Martell Operations Manager
Catherine McNamara Professional Development & Outreach Coordinator
Margaret James Administrative Officer
Queenie Wan Financial Assistant
Neda Rastinehad Secretary
Rosa Cirillo Scheduler – Toronto
Shelina Virjee Scheduler – Toronto
Chris Dinica Scheduler – Toronto


FINANCIAL ANALYSIS

Financial Expenditure Report (April 1, 2001 to March 31, 2002)

  Internal
Allocation*
Actual
Expenditures
Surplus
(Deficit)
DIRECT OPERATING EXPENSE      
Salaries and Wages 151,500 542,623 (391,123)
Benefits 24,900 54,919 (30,019)
Subtotal $176,400 $597,542 $(421,142)
OTHER DIRECT OPERATING EXPENSES      
Transportation and Communications   396,462  
Services   2,525,128  
Supplies and Equipment   64,825  
Subtotal $2,128,500 $2,986,415 $(857,915)
TOTAL OPERATING EXPENSES $2,304,900 $3,583,957 $(1,279,057)


* NOTE: The Consent and Capacity Board’s budget is contained within the overall Branch budget of the Health Boards Secretariat. The "Internal Allocation" shown in the table is established through internal Branch and Ministry processes and is based on experience during the previous fiscal year and estimates of cost pressures within the context of available funds.


The major cost driver for the Board is the conduct of hearings. The Board has no discretion regarding the holding of hearings. Board decisions impact on the life and individual liberty of people in Ontario and are usually urgent in nature. The Board has a statutory obligation to commence a hearing on an application within seven days.

Additional costs for scheduling and Board members' travel are attributed to the growth in the number of hearings under the Health Care Consent Act and the Substitute Decisions Act which require the Board to hold hearings in residences, local hospitals, etc. A shortage of psychiatrists in some regions requires that some of the members incur considerable travel costs to attend hearings in other regions.

Board caseload has been increasing annually. For example, applications have increased from 2,494 in 1995/1996 to 3,653 in 2001/2002. Board caseload has also been increasing in intensity. Hearings that are more complex have resulted in increased requests for written reasons, increased need for the services of court reporters and in appeals to the courts.