COVID-19 Links to Documents and Directives
College of Chiropractors of Ontario
Ontario Ministry of Health
COVID-19 Guidance and Resources
COVID-19 Vaccine Information
COVID-19 vaccines in Ontario will be distributed by each local public health unit. Please follow the link to a list of Ontario local public health units for the most up-to-date information about the distribution of the COVID-19 vaccine.
The Ontario Government also has a portal to register for an appointment for a COVID-19 vaccine.
Please see the following links to information from specific local public health units in Ontario as it becomes available. These links include information about the vaccine rollout in that specific public health unit region, including links to register for the vaccine for chiropractors within that public health region.
CCO may also email notices from specific public health units to members in specific public health regions if instructed by that public health unit not to make this information publicly available on the CCO website.
CCO will continue to post and/or distribute information about the COVID-19 vaccine distribution as it becomes available. Please continue to visit this page for updates.
Public Health Ontario
Government of Canada
Ontario Human Rights Commission
Ontario Chief Medical Officer of Health Revokes Directive #2 – Wednesday, May 19, 2021
The Ontario Chief Medical Officer of Health has revoked Directive #2. Please see the following memorandum for further details.
Please note, the change to Directive #2 on April 20, 2021 and subsequent revocation on May 18, 2021 has no change to the current practice of chiropractic in Ontario.
Message from the CCO President – Monday, May 3, 2021
Two weeks ago, CCO successfully concluded the 2021 Elections for Council and CCO Executive. After having served on Council and Executive for many years as a government appointed public member, it is an honour to have been named CCO President at this challenging but opportune time for regulating chiropractic in the public interest in Ontario.
As the first public member to lead the CCO since its inception, I am proud to be a part of establishing this historic first. I would be remiss if I did not also note that fellow public appointees now chair several of CCO’s statutory committees. Together with our elected professional member colleagues, we will continue to ensure the public interest remains front and centre in all our activities.
The challenges we face are readily apparent as the province is again experiencing high numbers of COVID-19 cases and related impacts on the provincial health care system, which necessitate public health measures that affect all Ontarians as well as the practice of chiropractic care in the province.
Throughout the pandemic response, CCO has provided guidance to members in support of Ministry of Health directives and specific instruction with respect to requirements for the provision of safe chiropractic care.
Emergency Management Update
On April 22, 2021 Ontario’s Deputy Minister of Health wrote to all Health Care Regulators and system partners in the province outlining new measures to alleviate the pressure on hospitals and critical care providers. Specifically, the new emergency order authorizes regulated health care professionals to provide patient care services outside their regular scope of practice and enables hospitals to employ or otherwise engage regulated health professionals from out-of-province.
It is important to stress that this pertains only to duties that are assigned, or privileges that are granted, by a hospital, and are necessary only to respond to, prevent and alleviate the outbreak of COVID-19.
CCO continues to engage with the Ministry to determine what specific role, if any, CCO members might play in conjunction with this new order. I share this now to avoid any confusion among the public or CCO membership, as there has been media coverage of the new measures. Rest assured we will communicate further on this latest directive if, and as, required.
COVID-19 Relevant Provisions
I have been impressed with the overall response of the profession and the professional behaviour demonstrated by so many during what is an unprecedented time for all of us. CCO supports the government’s efforts to address the global health crises. I know the vast majority of members are focused on continuing to provide high quality, patient centered care. CCO members are reminded about the relevant standards of practice, policies and guidelines which rise to a higher level of importance at this time, including CCO’s Professional Advisory on Vaccination and Immunization
, standards of practice S-001: Scope of Practice
and S-016: Advertising
, and guidelines G-016 Advertising
, and G-012: Use of Social Media
. CCO has received some inquiries relating to the posting of vaccine ‘selfies’ which some vaccination sites are encouraging. Please know that the disclosure of vaccination status for COVID-19 is personal health information, so disclosure is voluntary. If posting any information on social media, please exercise caution, be mindful of CCO’s provisions, and do not imply or suggest that your vaccination status gives you superiority in terms of patient treatment or care.
CCO’s review of all matters is through the lens of public protection, including of course a review of any complaints or concerns brought to CCO’s attention. All complaints include a consideration of submissions from the member and complainant, the context and circumstances of the complaint and the applicability of CCO standards of practice, position statement, policies and guidelines.
As part of CCO’s annual review of all standards of practice, policies and guidelines, every committee will be considering recommendations for amendments to existing provisions to ensure public interest protection, particularly in view of the events of the past several months. As always, members are expected to uphold the highest standards of professional conduct, and to use sound judgement in line with the relevant provisions when using social media.
I have been remarkably encouraged by the professionalism of the vast majority of members throughout the pandemic. Please continue to monitor the website for the most recent COVID-19 related information, including relevant Government orders and directives.
I noted earlier that this was both a challenging and opportune time to assume the CCO presidency. This is an important moment for all health regulatory colleges in the province, owing to the transition to a new College Performance Measurement Framework reporting standard. Having just submitted CCO’s inaugural benchmarking report to the Ministry of Health, we are now in a good position to further reinforce those aspects of CCO’s operations that currently meet or exceed the ministry’s performance standard, and to move aggressively on those aspects identified for further improvement.
I look forward to engaging with you all as we drive this evolution forward, and to sharing some of my additional aspirations for my term as CCO President in future.
Mr. Robert MacKay
Robert MacKay, Vice President CCO
Ontario Government News Release – Tuesday, January 12, 2020
The Ontario Government announced a province-wide stay-at-home order beginning Thursday, January 14, 2021 at 12:01 am.
Please note, regulated health professionals, including chiropractors, are listed as a business that may remain open in accordance with page 27 of the updated stay-at-home order, dated January 12, 2021, and may continue to operate in accordance with current guidance around COVID-19. There is no change to the scope of care that chiropractors are permitted to provide resulting from the Government’s announcement.
Ontario Government News Release – Monday, December 21, 2020
The Ontario Government announced a province-wide shutdown beginning December 26, 2020 at 12:01 am. Please note, regulated health professionals, including chiropractors, are listed as a business, under Ontario Regulation Section 53, that may remain open under the lockdown time period, and may continue to operate in accordance with current guidance around COVID-19. There is no change to the scope of care that chiropractors are permitted to provide resulting from the Government’s announcement.
President’s Message #15 re: COVID-19 – Thursday, December 10, 2020
On Wednesday December 9th Health Canada authorized the first Covid-19 vaccine
for distribution in Canada. I say first, because there are several other vaccine candidates that could also receive approval in future and become available alongside the Pfizer-BioNTech vaccine. Health Canada’s chief medical advisor Dr. Supriya Sharma characterized the announcement as a momentous occasion.
CCO members are reminded as per CCO Standard of Practice S-001: Chiropractic Scope of Practice
and the Professional Advisory on Vaccination and Immunization
that treating or advising in relation to vaccination is outside of the chiropractic scope of practice. This of course applies in equal measure to the new category of approved Covid-19 vaccines. Members must not express views, treat or advise patients or prospective patients with respect to vaccination, including providing information on vaccination on their websites or social media accounts
. I am confident that CCO’s Quality Assurance Committee will review Standard of Practice S-001 as part of its regular review of standards and will recommend any revisions to Council as required and appropriate.
It is a minute number of Ontario’s 5100 registered chiropractors who are the subject of complaints regarding vaccination claims. In fact, according to a nationwide study
published in the Canadian Medical Association Journal last May, in their initial study period (2016) researchers found only 94 unique websites maintained by all Canadian chiropractors provided information on vaccination. Of these 94 sites, 63 per cent were critical of vaccination, 20 per cent were neutral, and the rest (17 per cent) were supportive. When the researchers revisited these same sites in 2019, more than half of the initially identified content had been removed. While not designed to attribute causality, the study’s authors did note CCO’s introduction of our Professional Advisory (linked above) during this study period.
I am sure there will be much public discussion in the coming months about Covid-19 vaccines, the quantities received, and how they are distributed etc. It is only to be expected after these many months of disruption, loss and sacrifice in all our personal and professional lives. The Health Canada announcement this week represents a beginning, but the road ahead is long, and significant challenges remain. The public interest in Ontario will continue to be served by members providing safe and effective chiropractic care, by observing all Ministry and CCO guidelines and directives.
The profession in Ontario has done remarkably well during this global health crisis and I thank all of you for your ongoing diligence, perseverance and commitment to providing high quality, ethical care to the public of Ontario. As the health landscape continues to evolve, you have my ongoing commitment to communicate with all of you in a timely, focused way on all matters related to CCO’s public interest mandate.
Thank you for continuing to be engaged in the regulation of the chiropractic profession and for demonstrating understanding, responsibility and accountability. Your efforts are both recognized and appreciated.
Dr. Dennis Mizel, President
Government of Ontario Announcement – Friday, November 20, 2020
Please note, chiropractors may continue to operate in Toronto and Peel, consistent with current guidelines for regulated health professionals. The Ontario Government’s news release can be found at the following link.
On Friday, November 20, 2020, the Ontario Government ordered a lockdown of Toronto and Peel regions and raised the restrictions of other areas in Ontario. At this time, in accordance with Ontario Regulation 654/20 Section 53, regulated health professionals may continue to operate in these regions, consistent with the guidelines for the health sector.
Please continue to visit the CCO website for any further updates.
President’s Message #14 re: COVID-19 – Friday, November 20, 2020
Throughout the pandemic response, I have tried in these President’s Messages to highlight just a few of the ways your College has shown itself to be adaptable and demonstrated great resourcefulness in continuing to deliver on our mandate of regulating chiropractic in the public interest. I dare say that the ‘new normal’ of conducting the business of the CCO virtually, is beginning to feel quite normal indeed. It has certainly not slowed CCO down, whether it be the work of the Executive, Council or its many Committees — who, superbly supported by College staff, have driven forward several new initiatives at the same time as maintaining (or in some cases even expanding) upon the important functions of the College in the areas of registration, peer assessments, complaints and investigations, and discipline, among others.
I am not the only one who has noticed this creativity in action. I am pleased to share that in a recent meeting with the Ontario Fairness Commissioner, CCO received very positive feedback about our recent Provisional Certificate of Registration initiative. The Fairness Commissioner is responsible for ensuring registration practices across all Ontario colleges, professional bodies and trade associations are fair, impartial and transparent — just one of the many layers of government oversight and legislative obligation to which CCO is accountable.
As you may recall, the pandemic response forced the cancelation of the spring 2020 sittings of the Canadian Chiropractic Examining Board (CCEB) examinations and CCO’s Legislation and Ethics Examination, effectively preventing new chiropractic graduates and other applicants from being able to complete the requirements for registration. CCO’s provisional certificate initiative entitled new registrants to practise under the direct supervision of a CCO member until such time as they were able to sit the required exams. Provisionally registering these applicants provided greater public access to chiropractic services and allowed graduates to further develop their competencies under appropriate mentorship and guidance.
CCO congratulates and welcomes a total of 128 new members registered between March 1, 2020 and November 15, 2020, 61% of whom first registered with a provisional certificate of registration and who have now successfully completed their CCEB and legislation and ethics examinations and may now practice without terms, conditions or limitations. Thank you again to those CCO members who agreed to serve as supervisors, and all CCO stakeholders who helped to shape and ultimately reward our leap of faith in making this initiative a success.
As a self-regulating organization committed to continuous improvement, CCO is always looking at ways to enhance our capabilities and strengthen the delivery of our core services and functions. This includes strengthening our individual capabilities.
Serving on CCO Council is a privilege and a responsibility, but one that differs in many respects from serving on the boards of other organizations. Currently, CCO Council members undertake mandatory workshops in Governance, Conflict of Interest, Confidentiality, Chairing Effective Meetings and Discipline Training shortly after joining. Building on these foundations, CCO is developing a suite of 12 training modules for Council members to deepen their understanding of the Chiropractic Act and applicable governance principles, duties owed to CCO, and overarching accountability to the public.
Moreover, CCO is working toward facilitating a competency-based process for Council and committee members. This represents a significant evolution with considerable implications for current CCO by-laws and processes. To advance this aim, CCO Executive and Council will consider all available studies and reports in this area as well as what other Colleges under the Regulated Health Professions Act may be doing, or have done to date.
A comprehensive analysis prepared for Council will examine what initiatives or changes to current practices are required, outline what amendments or changes to CCO by-laws are necessary to authorize this transition and importantly, define a set of core competencies for Council and committee members. More information on this far-reaching initiative will be forthcoming in the months ahead.
Finally, with the ever-increasing numbers of COVID-19 cases currently being reported in Ontario and as regulated health professionals continue to provide patient care in Ontario, it is imperative that CCO members remain diligent in their practices and continue to comply with all Government, Public Health and CCO directives to help reduce the spread of COVID-19.
All of these resources are available on the CCO website
, which is updated continually. These include:
Be sure to check the website regularly as government orders and directives change rapidly in response to our changing health environment.
As we move into the darker months of winter amid a growing concern for all those affected by Covid-19, it is important not to lose sight of the many positives we have managed throughout this period — both as a College, and as a community of skilled, committed and caring health practitioners. Thank you for your continued efforts to bring quality, ethical care to chiropractic patients in Ontario during this challenging time.
Dr. Dennis Mizel, President
President’s Message #13, re: COVID-19 – Thursday, October 15, 2020
Since the onset of the pandemic crisis in March of this year, there have been 12 President’s Messages providing guidance to members with respect to complying with government orders and directives – several of which have specifically reminded members of their obligation to ensure they are complying with S-001: Scope of Practice
, G-012: Use of Social Media
, S-016: Advertising
and G-016: Advertising
. If you have not done so recently, please take the time now to carefully review the existing standards of practice, guidelines and policies that relate to advertising, websites and the use of social media.
In my Message dated April 27, 2020, I reported on the then 74 cease and desist letters that had been sent to members resulting in the removal of problematic posts or advertisements. Between March 1, 2020 and September 22, 2020, the CCO’s Inquiries, Complaints and Reports Committee (ICRC) held a number of virtual special meetings to address the over 185 complaints received relating to social media and claims. ICRC has made decisions on every one of those complaints. At this time, one public complainant has requested a review by the Health Professions Appeal and Review Board of 28 ICRC decisions, and a DC has requested a review of one decision.
In addition, CCO has considered what other mechanisms can be implemented to ensure compliance with existing standards and policies as regards social media posts or advertising. You will recall that the CCO’s Quality Assurance committee (QA) currently has a Standard of Practice and Guideline relating to health claims in advertising, websites and social media out for feedback from members and stakeholders
. You have an opportunity to participate in the regulation of the profession by submitting your feedback by October 30, 2020. The QA Committee will be reviewing all feedback received and will make recommendations to Council once the review is complete.
As part of its review of feedback, the QA Committee will continue to consider various mechanisms for the proactive review of websites and social media based on the draft standard of practice and guideline and feedback that is received, keeping in mind the limitations of technology to scan photos and graphics and the importance of determining what is financially feasible. The QA Committee will be exercising all due diligence before making recommendations to Council.
In the interim, the Executive Committee has requested Dr. Gauri Shankar, former CCO President, Chair of the ICRC, and peer assessor, to undertake a pilot project to review the websites and social media sites of all elected Council members and non-Council committee members to determine if such a review could become a component of CCO’s quality assurance program in future. Once the pilot is complete and has been thoroughly evaluated, Council will deliberate and provide further direction.
Assuring the integrity of health care claims disseminated to the public is critical at all times, and especially so during this period of heightened sensitivity as a result of COVID-19. Members must remain vigilant about this aspect of their practice and are reminded they can submit advertising materials to the CCO’s Advertising Committee for review in advance of publication.
Outstanding Discipline Matters
CCO continues to address promptly any outstanding discipline referrals from the ICRC. Currently, there are 12 outstanding referrals to the discipline committee, many of which involve allegations (not findings) of sexual abuse of a patient. CCO has repeatedly emphasized that the legislation is absolutely clear – there cannot be a concurrent treating and sexual relationship with a patient. CCO is anticipating the passing of a spousal exemption regulation by government, but unless and until such a regulation is passed, there is no spousal exemption to the sexual abuse provisions of the Regulated Health Professions Act, 1991. Review the CCO website regularly for any regulatory updates.
CCO’s Registration Policy P-058: Policy on Considering Applications for Registration During the COVID-19 Pandemic
, has been well received. As of October 15, 2020, 79 new members have registered using the provisional certificate of registration. It is very heartening to see the number of existing CCO members who are prepared to serve as mentors and supervisors for these graduates, who otherwise would have to wait until at least mid-November 2020 to become registered. We are carefully monitoring this pilot project to evaluate its success, and potential future applicability in other circumstances.
I am also pleased to report that on October 8, 2020, 195 candidates wrote the first-ever online sitting of CCO’s Legislation and Ethics examination. Previously, on September 1, 2020, CCO conducted the first-ever online Record Keeping Workshop attended by 48 individuals. (Another online workshop
is scheduled for December 3, 2020.) CCO continues to adapt and find creative ways to complete College business in these unusual times.
Transitions on Council
In July 2020 CCO said goodbye to Ms Karoline Bourdeau, and in September 2020, to Ms Georgia Allan. On behalf of the College we thank them both and express our deep appreciation for their service. CCO is awaiting the appointment of new public members, which will ensure CCO is properly constituted. Under the Chiropractic Act, 1991, CCO requires at least six public members to be properly constituted, and currently we are benefitting from the very hard work and commitment of our four valued and experienced public members.
CCO’s Executive Committee remains properly constituted, however, and continues to address public interest priorities by leveraging video conferencing platforms. All meetings, including Council meetings and discipline hearings will continue to be conducted virtually at least until 2021. If you would like to attend a Council meeting or Discipline hearing, please contact Ms Rose Bustria at: email@example.com.
Ontario recently announced further restrictions on the size of indoor and outdoor gatherings, as well as on the operations of certain businesses. At this time there has not been any specific direction from the province that would impact the delivery of chiropractic care in Ontario. Rest assured CCO continues to liaise with the Ministry and will update members on any changes to the requirements under the emergency orders if, or when, they are introduced.
Members are encouraged to continue to review the most up-to-date guidance documents
from CCO, the Ministry of Health and Public Health Ontario for health and safety practices related to COVID-19. In accordance with Ministry of Health guidelines
, although the use of protective eyewear is not required for interactions with patients who screen negative for COVID-19, it should be considered and may prevent the member from being required to quarantine for 14 days if a patient who they have treated tests positive for COVID-19, in accordance with the direction of certain local public health units in Ontario. Members are encouraged to contact their local public health unit
with any specific questions regarding practices around being informed of a COVID-19 positive test result from a patient or staff.
While our primary focus remains on public and member safety during this ongoing pandemic response, CCO continues to work with stakeholders to advance ongoing regulatory initiatives, such as including access to diagnostic services so chiropractors can act within the full scope of the existing scope of practice.
Communications with and from CCO
“CCO encourages all stakeholders to forward inquiries relating to CCO to CCO directly. A great deal of information is readily available on the CCO website. Some information (including active investigations for example) is confidential under the RHPA. Please ensure all inquiries are respectful and professional. Please also note CCO may include both your inquiry and CCO’s response on the website or in public information packages to ensure all stakeholders get the same information in the same way and at the same time. Thank you.”
— Taken from CCO website
On an ongoing basis, CCO receives inquiries from members and stakeholders that may be of interest to the full membership, and which may require clarification through the lens of CCO’s public interest mandate.
During the pandemic, CCO’s communications have been predominantly electronic – offering short, timely guidance and highlighting new initiatives. CCO has a broad stakeholder list, in addition to communicating to all members. However, many of you will have received a paper copy of the 2019 Annual Report. This is the only document CCO (and all other regulated health colleges) must file with the Minister of Health. We received feedback from some members that they would appreciate continuing to receive a printed annual report, but that CCO should continue with short, timely electronic communications rather than producing printed newsletters.
CCO greatly values member and public feedback at all times, but especially in the context of the continuing pandemic response as we pivot to find new ways to connect and conduct College business.
I am mindful of how challenging the pandemic has been for everyone, especially for our patients and their trusted chiropractic professionals. Thank you for your ongoing diligence with respect to compliance and for putting patients first.
Dr. Dennis Mizel, President
Infection Prevention and Control Webinar – COVID-19 – Friday, June 26, 2020
Please see the following resources related to a webinar conducted by the Infection Prevention and Control team from Public Health Ontario
President’s Message #11 re: COVID-19 – Wednesday, June 17, 2020
Earlier this week, the province announced that as of 12:01 a.m. Friday, June 19, 2020, seven more public health regions in Ontario will be allowed to transition to Stage 2 of the government’s reopening framework. These regions are in addition to the 24 public health regions that entered Stage 2 on June 12. Stage 2 of the framework allows for the opening of additional businesses, services and activities – like personal care services, outdoor recreational facilities, bars and restaurants, weddings, funerals and similar gatherings with limits for social gatherings of up to 10 people.
It is a welcome sign of the continuing positive trend in the key public health indicators in these regions, including lower COVID-19 transmission rates and local hospital health system capacity.
Ontario’s chiropractors have been doing their part to support the Ministry’s efforts to mitigate the spread and impact of COVID-19 since the onset of the pandemic, by adhering to the provincial guidelines for essential workplaces and complying with CCO directives to ensure a safe, gradual return to practice. I am heartened by the accounts I have received about the gradual resumption of the full range of chiropractic services in Ontario, and the relief many practitioners have expressed at being able to meet the needs of their patients in a safe and ethical manner.
Still, now is not the time to become complacent. We must continue to fully comply with the strict protocols required by Ministry guidelines and CCO directives that I have sought to highlight in my ten previous President’s Messages
— especially those governing return to practice in Message #9 (May 26, 2020) and Message #10 (June 9, 2020).
Collectively, Ontario’s chiropractors are making a difference in helping to stem the growth of this very dangerous virus and public health threat, at the same time as providing safe, effective and compassionate health care to essential workers and chiropractic patients across the province. I thank you for your continued vigilance.
Update on Council Activities
As I mentioned in my last President’s Message (June 9, 2020) CCO has been optimizing the use of technology to facilitate its regulatory functions and enhance communications while adapting to the challenges of conducting normal business in the context of the pandemic.
On June 17, 2020 College Council met publically via a videoconferencing platform, and worked through a comprehensive agenda in fulfillment of its mandate to regulate chiropractic in the public interest. I look forward to being able to update you on the proceedings from the meeting in my next President’s Message.
In the interim, I am pleased to welcome two new Council members: Dr. Gerard Arbour, and Dr. Michael Staffen. Dr. Arbour and Dr. Staffen fill two recent vacancies created by the resignations of Dr. Janet D’Arcy and Dr. Kristina Peterson. CCO thanks Drs. D’Arcy and Peterson for their service, as well as Dr. David Starmer for his, upon his recent resignation from Council. Drs Arbour and Staffen submitted their candidacies and had received the next highest number of votes in their respective districts (Districts 4 and 1) in the last Council elections. CCO will be calling a by-election in District 7 (Academic) as soon as possible. When the vacancy in District 7 is filled, and Council is thereby properly constituted, internal elections will be conducted to compose all CCO committees. (If no candidates from CMCC faculty submit a candidacy, then CCO may select any eligible CCO member in good standing to fill the vacancy.)
As the weather warms and the days grow longer, I hope all CCO members are able to enjoy the company of family and friends within the safe limits outlined in the recent provincial guidance on social gatherings and creation of social circles.
On June 17, 2020, CCO conducted a virtual Council meeting using the Zoom platform. CCO is ready to conduct virtual elections using technology when the Elections meeting is scheduled. Physical distancing continues to be maintained within the premises.
Dr. Dennis Mizel, President
President’s Message #10 re: COVID-19 – Tuesday, June 9, 2020
There have been many important turning points throughout the province’s response to the unprecedented COVID-19 pandemic, perhaps none as significant for Ontario chiropractors as the May 26, 2020 Ministry of Health announcement that amended its previous Directive #2
to allow for all deferred and “non-essential” and elective services offered by health care practitioners to be gradually restarted.
We were well positioned to meet the stringent ministerial requirements
for the gradual resumption of full service, as CCO had earlier provided to members comprehensive and authoritative guidelines for a safe and compliant return to practice. (Please note
: these guidelines have now been updated to further reinforce Ontario health ministry directives and can be found here
. Members are advised to review these guidelines again and to implement the updated measures as required.)
In the wake of the May 26 announcement, licensed practitioners across Ontario have begun providing the full range of chiropractic services to the public – while following strict COVID-19 protocols to ensure pubic and workplace safety. Members must adhere to these protocols and remain vigilant in mitigating the risk of transmission as they re-open their practices.
Optimizing technology in support of openness and accountability
One of CCO’s strategic objectives is to optimize the use of technology to facilitate regulatory functions and communications. I am proud to say that the College has demonstrated its commitment to this objective through its adaptive and accountable response to managing remotely CCO’s core business during the pandemic.
The CCO Discipline Committee’s virtual hearings held on May 14, 2020 are but one example. As a result of the temporary suspension of in-house hearings due to pandemic concerns, the Committee held two virtual hearings, respecting the values of openness, transparency, accountability and fairness. Conducted over a videoconferencing platform, the hearings were attended by more than 100 members of the public, while the confidentiality of the complainants was maintained by orders from the Committee panel that prohibited the sharing of any identifying information during the hearing.
“Administrative tribunals have already conducted videoconference hearings. The College of Chiropractors of Ontario was the first regulated health profession to hold discipline hearings using Zoom videoconferencing.”
This was indeed a first, but it will definitely not be the last instance of CCO striving to be at the forefront of using technology wisely to support its core business – pandemic or not. (In fact, CCO is scheduled to have the its first virtual internal elections on June 17, 2020.)
Flexibility and scrutiny in licensing new registrants
The CCO Registration Committee met on June 2, 2020 to consider the best way to ensure a transparent, fair and impartial registration of applicants who are unable to complete the Canadian Chiropractic Examining Board (CCEB) examinations cancelled because of COVID-19. The Committee expects to have a recommendation for CCO Council shortly about addressing the impact of the cancellation. I should point out, though, that the situation is not unique to the CCO, and we have had discussions with other health regulators in Ontario and other chiropractic regulators across Canada to consider and share best practices.
The Registration Committee understands that there are compelling public interest reasons for accommodating applicants for registration who cannot attempt the examinations. At the same time, it recognizes that exempting applicants from having to successfully pass the examinations, even temporarily, is a major concession that requires adequate alternative safeguards. As soon as is practical, applicants who have been temporarily exempted will have to complete the examinations. Moreover, holders of provisional licenses will only be able to practise under a stringent set of terms, conditions and limitations designed to ensure the safety and well-being of the public.
I look forward to being able, along with my fellow members of CCO Council, to evaluate the Registration Committee’s proposed recommendations and communicate the Council’s decision in the future.
And let me thank once again all members who have closely followed and adhered to Ministry of Health and CCO directives over the past few weeks and who continue to maintain the highest standards of practice in serving the public interest. COVID-19 remains a persistent concern and we are reminded daily by the province that we must all continue to work to minimize its spread.
But before I close – a bit of good news. CCO would like to thank Dr. Colleen Patrick, CCO member since 1975, and artist, for her painting entitled Sustenance, which was unveiled on March 10, 2020 and will be hung in the CCO’s Members’ Lounge for everyone to enjoy when CCO reopens its premises.
Dr. Dennis Mizel, President
President’s Message #9 re: COVID-19 – Tuesday, May 26, 2020
The Ministry of Health today announced that, after approximately 2 1/2 months in which health professionals were limited to providing urgent/emergency and telehealth services only to patients, it has amended Directive #2
to allow for “all deferred and non-essential and elective services carried out by Health Care Providers” to be gradually restarted, subject to a number of requirements contained in the amended Directive.
In other words, Ontario chiropractors can, under certain conditions, start the process of getting back to our work and our driving passion – providing the highest quality care for all our patients!
The documents detail what all health care professionals MUST consider in deciding which services can safely resume in-person, guided by the best clinical evidence and with appropriate hazard controls and sufficient PPE for practitioners and staff alike-and which services should continue to be provided remotely.
The amended directive also makes clear that all health care professionals must follow the restart guidance provided by their health regulatory college.
As a reminder, in my previous message I recommended that you prepare for today’s announcement by reviewing CCO’s ‘Guidance for Return to Practice for CCO Members when Authorized by Government’, which details the actions to be followed when the go-ahead is given to restart your practices.
You also received two infographics summarizing these guidelines: one for members and the other for patients. As I wrote then, “This information provides authoritative direction and support for Ontario’s chiropractors in
prioritizing the safety of their patients, staff, colleagues and others visiting their practice.”
I will stress, though, that the CCO will be looking into any concerns about a practice not following any of these requirements, including, for example, the use of appropriate hazard controls and availability of sufficient PPE.
As we begin a cautious, careful and steady restart process, I know I can count on all of you to adhere to the highest standards of professional conduct in your practices and in your service to your patients and the public.
And let me close by thanking you for your efforts and sacrifices so far. Your commitment to the health and safety of your patients, staff, and the public of Ontario has helped us get to this point where we can begin again to practise our profession in safe and caring clinics and workplaces. Thank you!
Dr. Dennis Mizel, President
President’s Message #8 re: COVID-19 – Friday, May 15, 2020
There are no immediate changes to the previous directives and guidelines provided by CCO to members as a result of the Ontario government’s announcement.
However, this measured approach to reopening allows time for health service providers and business owners to prepare for an eventual reopening, and to ensure that their clinics and workplaces are safe for staff, patients, practitioners and the general public alike.
In addition to the included guidance, CCO has prepared two infographics summarizing the guidance: one for members
and the other for patients
. Taken together, this information provides authoritative direction and support for Ontario’s chiropractors in prioritizing the safety of their patients, staff, colleagues and others visiting their practice. The documents are meant to ensure you are ready and able to practice as soon as the Ontario government makes the announcement that health professionals may reopen their practices.
CCO continues to work diligently with other Canadian chiropractic regulators, and other health regulators in Ontario, to ensure it is adhering to best practices in its guidance to members and the public about how to safely return to practice.
But let me stress again that these guidelines do not supersede directives from Ministry of Health, Public Health Ontario, or the Chief Medical Officer of Health for Ontario and other authoritative bodies with respect to required measures in response to COVID-19. As regulated health professionals, members are required to review and comply with all these directives and to adhere to the highest standards of professional conduct in their practices and in their service to the public.
I would ask you to continue to monitor the CCO website for further updates and announcements as we work together to ensure CCO members are ready and able to return to full practice as soon as they are authorized to do so by the provincial government. Please use this time, and the attached guidance, to prepare yourselves and your practices accordingly.
And, again, thank you for your ongoing commitment to the health and safety of your patients, staff, and the public of Ontario.
Dr. Dennis Mizel, President
Ontario Government News Release: Reopening Ontario after COVID-19 – Thursday,May 14, 2020
Please see the following news releases from the Ontario Government for Stage 1 of the reopening of Ontario after COVID-19:
Ontario Government News Release: Ontario Providing Employers with Workplace Safety Guidelines – Thursday, April 30, 2020
The Ontario Government has provided guidelines to help businesses adhere to safety guidelines they need to protect workers, customers and the general public from COVID-19 as it prepares for a gradual reopening of the provincial economy.
As of April 30, 2020, the Ontario government has not made any changes to its list of essential workplaces as it applies to chiropractic care. Please regularly visit the CCO website and keep an eye for President’s messages for any updates from the Ontario Government and further guidance from CCO.
Please see the following resources:
President’s Message #7 re: COVID-19 – Monday, April 27, 2020
I heard it said recently that the extraordinary nature of this past month has made it feel more like a year. I can certainly appreciate the sentiment. There have been at least a year’s worth of challenges and changes as a result of the COVID-19 pandemic, and it remains an evolving situation with no immediate end in sight.
One thing that will not change, however, is the expectation that members adhere to the highest standards of professional conduct in their practices and in their service to the public. CCO has both the statutory obligation – and the complaints reporting, investigation and discipline processes – to ensure compliance with these standards and to regulate in the public interest.
The CCO acts quickly and decisively when it becomes aware of advertising or social media posts that are not in compliance with the standards identified above. In fact, beginning March 2, 2020 without any complaint having been filed, CCO delivered 74 cease and desist letters in response to inquiries relating to inappropriate advertising and social media posts. These letters resulted in all identified website, advertisements and social media posts being subsequently removed.
Of course, the CCO’s central compliance assurance process is the work of the Inquiries Complaints and Reports Committee (ICRC), whose recent deliberations I would like to highlight here.
As you can see in the accompanying table, in the past month alone (or more accurately in the period from March 20 to April 20, 2020) the ICRC received 158 complaints pertaining to inappropriate advertising and social media posts. As you will also note, that is considerably more than were received throughout the entire year in either 2019 or 2018. To what should we attribute this increase, and in such short a time span?
At the risk of oversimplification, I believe a few factors were in play. First, during this global health crisis there is a heightened sense of awareness regarding any claims made in advertising or social media in conjunction with COVID-19. Given the seriousness of the pandemic, this increased scrutiny is without question both appropriate and welcome.
The overwhelming majority of recent complaints pertain to claims made for chiropractic’s benefits for the immune system, and by extension, as a deterrent to contracting or managing the coronavirus. As I stated clearly in my messages of on March 16th and 22nd, “members should not make any unsubstantiated claims concerning chiropractic care and COVID-19.”
Second, it is helpful to consider from where the complaints are originating*. Two-thirds came from CCO member chiropractors, who expressed a concern about claims made by a fellow College member. The remaining third was made up of complaints from the public (26% of total) and one student (8% of total). Of the 35 complaints received from the public, all were submitted by one individual, who has indicated that they do not use chiropractic services.
Significantly, not one complaint was received from a chiropractic patient in Ontario during this period.
But let me be clear: CCO takes every complaint very seriously, regardless of where – or from whom – it originates. The work of the ICRC is completely agnostic as to origin and focused only on the matter of the complaint before it. Each complaint is subject to an exacting review and due diligence process by a committee comprised of two public members, one non-Council CCO member and two elected members, and is also supported by legal counsel. The ICRC is empowered to make decisions concerning the appropriate action to take regarding a complaint. The ICRC may refer to the Discipline Committee specified allegations of professional misconduct, require the member to appear before the ICRC to be cautioned or take other remedial action, or take no further action. Its work is legal in nature and is undertaken accordingly, including providing an opportunity for the referenced chiropractor to reply to the complaint.
The ICRC meets monthly. As you can see in the accompanying pie chart, on April 14, 2020 the Committee managed to review and render decisions on 64 investigations arising from the complaints received. Again, this number of decisions is equivalent to two-thirds of the complaints received annually over the last two years, and they were received and rendered in just over three weeks. My sincere thanks to the members of the ICRC, for tackling the urgency and volume of these complaints head on in the time available and given the restrictions of working remotely. It remains a top priority for the CCO to deal with these complaints thoroughly, and as expeditiously as possible. The outstanding complaints will be addressed in subsequent sittings of the Committee.
Of the 64 dispositions rendered, 39 resulted in ‘reminders’, 16 resulted in ‘advice’, three resulted in an ‘oral caution’, five were deemed not to require any further action, and one was sent back for further investigation.
‘Reminders’ and ‘advice’ are written notices to members whose actions were the subject of the complaint, issued when the ICRC is of the view there has been a breach of the applicable standards but the Committee believes the member in question will remediate their practice and not commit a similar breach in the future. They are instructive and educational measures that differ in degree. ‘Oral cautions’ are another form of instructive measure, but are recorded on the public register. As implied, an oral caution is one the ICRC communicates to the member by discussing the finding with him or her directly.
In making its determinations, the ICRC looks at a number of factors including how false or misleading the content was, how likely it was to put the public at risk, whether the member could recognize the breach, had a history of breaching the advertising or scope of practice standards in the past, was co-operative, and/or took down the posting or remediated the content; and whether the member could demonstrate they were taking steps to ensure it would not happen in the future.
In a number of cases, the investigations were complicated by the fact that the social media postings in questions were taken down before the complaints were addressed, the complaints didn’t include the entire content of the post, or the content was illegible or partially legible, and /or it was difficult to obtain the original post.
In closing, I urge all members to carefully review their own social media posts and advertising materials to ensure there are no breaches of the relevant CCO standards and guidelines I’ve just specified. If you have any questions about the suitability of any post or advertising, ask the Advertising Committee to review them prior to publishing. And I remind members not to rely on third parties for social media or advertising content, especially as those parties may not be familiar with CCO legislation, standards, policies and guidelines to which all members are required to adhere. Please continue to be safe, remain healthy, and watch for further announcements as CCO provides guidance on members’ safe and gradual return to practice to coincide and be consistent with directives from the provincial government.
Dr. Dennis Mizel, President
*while 158 complaints were received in total, for the purposes of understanding where these complaints originated the total number depicted on this pie chart is 134, as some complainants may have complained about more than one chiropractor, or different people may have complained about the same chiropractor.
President’s Message #6 re: COVID-19 – Friday, April 17, 2020
On Tuesday, April 14, 2020 the Ontario legislature extended its emergency order
until May 12, 2020 as it attempts to manage the impact of COVID-19. While this action may not have come as a surprise to any of you, it nonetheless means that the extraordinary conditions under which we have all been living and working will continue for several more weeks at the very least.
I recognize how challenging this period is for all CCO members, and I thank you for your commitment to adhering to the highest standards of professional conduct in serving the public, and in maintaining the health of your patients and well-being of your communities. I would also like to acknowledge the resilience and tireless efforts of CCO staff and committee members as we continue to confront what has become a global health crisis.
Changes at Council
In my last message, I welcomed three newly elected members to CCO’s Council. This week I am pleased to welcome CCO’s newest public member, Gagandeep Dhanda, who was appointed by Ontario Order in Council. Public members play a vital role in the deliberations and functioning of provincial health care regulatory bodies like CCO. Mr. Dhanda joins the College at an unusual time, and we very much look forward to his insights and contributions to the business of Council.
At the same time, I wish to thank the outgoing members of the CCO Executive and Council. Dr. Cliff Hardick has served the College in many capacities over the years including as President, Vice President and most recently as Treasurer. He was also Chair of the Office Development Project, which was instrumental in CCO’s acquisition of its new permanent office headquarters at 59 Hayden Street in Toronto, and he has agreed to stay on in that capacity.
Likewise, Dr. Peter Amlinger leaves Council after years of leadership and service, most recently as a member of the Executive and Inquiries, Complaints and Reports Committees, and as former Chair of the Advertising Committee and former member of the Quality Assurance Committee. Dr. Amlinger had also served as President and Vice President during his previous term on CCO. Thank you also to outgoing public member Ms. Sheryn Posen, who has left us to take up residence in another province. Please note that during the March 29 meeting of the CCO Executive (convened via teleconference), a motion to defer the scheduled April 16, 2020 internal Council elections and appointment of non-Council committee members was approved, until such time that they can be safely held in person or conducted on a virtual platform, consistent with CCO’s by-laws. If you are interested in participating as a non-Council committee member on CCO’s committees, please forward your expression of interest to CCO at the earliest opportunity. Any new information will be posted on CCO’s website.
Guidance on Telecare
In my March 24, 2020 message in response to the Ontario emergency order shutting down non-essential workplaces, I provided a series of protocols for CCO members to follow in contemplating or providing remote services (via telecare or tele-portal), as permitted under the order. The updated Ontario emergency order which listed essential services advised health care providers that only urgent care can be provided in-person but that telecare is not impacted.
The Ontario emergency order is to be read in concert with the recent Directive from the Chief Medical Officer of Health. As you recall, the Directive required all health care providers to stop or reduce all non-essential or elective services subject to certain exceptions (i.e. time sensitive situations or to avoid adverse patient outcomes). We are seeking clarification about the impact of the Directive from the Chief Medical Officer of Health on provision of non-urgent telecare. Pending that clarification, telecare should be restricted to what is essential care as outlined in the protocols below. We also recognize that new patients may require urgent care and the following provides guidance until further notice.
I want to remind members, as I did then, that they must comply with all CCO regulations, standards of practice, policies and guidelines – regardless of whether care is provided through telecare or in person.
Today, in addition to the earlier guidance, CCO issues the following detailed directives with respect to the provision of remote chiropractic services, or telecare.
As of April 17, 2020, CCO members may provide telecare services to new patients – meaning an individual who does not have a pre-existing, in-person doctor/patient relationship with the member – as this is deemed to be essential. Without obtaining initial information from the patient, members cannot be in a position to advise if the patient requires urgent/emergency in-person treatment.
To be very clear, these protocols governing telecare are temporary (during the period of the Ontario emergency order). CCO will review and provide further guidance following the lifting of this order.
CCO members may use an initial telecare screening consultation to determine:
- If the new patient is in need of urgent/emergency care that requires in-person chiropractic treatment.
- If it is determined that in-person treatment is required, members must comply with the screening, practice, hygiene and protective equipment protocols for in-person urgent/emergency care.
- If the new patient requires urgent/emergency care that is outside the chiropractic scope of practice, the member must make a referral to the appropriate health professional.
If, however, it is determined that the new patient does not require urgent/emergency in-person care but is in need of essential chiropractic services that could be offered remotely through telecare (i.e. time sensitive situation or to avoid adverse patient outcomes as per the Chief Medical Officer Directive), CCO members may now provide telecare services to that patient with the following protocols:
- The member must be registered in the General class of registration and ensure they have appropriate malpractice insurance or protection for telecare services.
- Both the member and patient must reside in the province of Ontario.
- The member must ensure they have achieved, maintain and can demonstrate clinical competency in providing telecare (as required of CCO members for every diagnostic and therapeutic procedure).
- The member must ensure a safe, secure and confidential platform is being used for telecare, and is used with the patient’s authorization.
- The member is required to maintain the privacy of personal health information in accordance with the Personal Health Information Protection Act, 2004 and CCO standards of practice, policies and guidelines, including the use of technological safeguards, such as secure transmission systems and storage mechanisms, password protection for any devices used for telecare services, and physical safeguards to prevent unauthorized use.
- The member must communicate to the patient, in advance, if any fee is to be charged for telecare services.
- The member must maintain records and billing practices consistent with CCO standards of practice, policies and guidelines that explicitly indicate that the services provided are telecare in nature.
In addition, members must use their professional judgement to determine whether:
- Telecare is appropriate for that patient without an in-person examination;
- The patient has the physical, cognitive, language and technological capabilities to be able to participate in telecare services; and
- There are risks, contra-indications or limitations to performing telecare services that outweigh the benefits for that patient.
To summarize – CCO members may now offer consultation, obtain informed consent, conduct modified assessment/examination, and provide diagnosis/clinical impression, plan of care recommendations, and other telecare services within the chiropractic scope of practice to new patients via telecare. These services include recommending and monitoring of appropriate exercises, recommending appropriate devices or supports, advice on ergonomics, nutrition, hot/cold therapies, lifestyle and home care.
In providing telecare services members must understand and acknowledge the limitations of telecare, specifically with respect to: care and communication with patients, including limitations to the performance ofcertain orthopedic, neurological and chiropractic assessments; limitations to providing a definitive diagnosis (in which case a clinical impression may be more appropriate), and recognition that no hands–on assessment or care will be provided through telecare.
Consistent with CCO requirements for periodic assessment and treatment review, members providing telecare must evaluate the new patient’s progress no later than two-weeks after the onset of treatment (and thereafter according to CCO guidelines on assessment/reassessment).
If, after the initial two-week period the patient’s condition worsens or does not improve, the member must take the appropriate next steps either to refer the patient to another qualified healthcare professional, to terminate care, or if it is established that the patient is now in need of urgent/emergency care, to follow CCO protocols for the provision of urgent/emergency in-person care under the Ontario legislature’s emergency order.
In these extraordinary times, and for the duration of the Ontario emergency order, CCO has provided these enhanced protocols for telecare in the public interest; to allow individual Ontarians to receive ethical and competent chiropractic care that could forestall an escalation of their condition to that requiring urgent/emergency care, and through these measures to divert additional strain on front line health resources in our province in support of the Ministry’s effort to ensure we have the necessary capacity to successfully manage the impacts of COVID-19.
Please note that the situation remains very fluid and that further practice directives may be necessary as events require. I thank you for your patience and understanding.
I would like to conclude by thanking all former Presidents who have helped to steer CCO and the former Board of Directors over many years. I particularly would like to acknowledge the efforts of recently passed Dr. Leo Rosenberg who will be sadly missed at our annual Presidents’ luncheons. We are all sharing fond memories about Leo and we express condolences to his family during what is already a challenging time. We are all reminded of the importance of celebrating life and health, and of remembering the importance of family, friends, and colleagues.
Presidents’ Luncheon and Tour of New Premises – June 2019
Dr. Dennis Mizel, President
News Release from the Government of Ontario: Ontario Calls on all Health Care Workers to Help Fight COVID-19 – Province Launches Online Portal to Match Available Health Care Workers with Employers – Tuesday, April 7, 2020
Please see the following information on the Government of Ontario launching the online portal to match available health care workers and employers:
**NOTE**: Some regulated health professionals are having difficulty in entering their registration numbers when creating a profile. The Ministry of Health is working to fix the issue. Members who are experiencing this issue should select “Other Health Professional”. Once they log into the portal, they can click on Account Information and then update their registration number.
For other technical support members should contact the Ontario Public Service (OPS) IT Service Desk at 1-888-677-4873 or 416-246-7171. Once they hear “You have reached the OPS IT Service Desk” members should enter prompt code 011 on their telephone.
Public Health Ontario Technical Brief: Infection Prevention and Control (IPAC) Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 – Monday, April 6, 2020
Please see the following technical brief from Public Health Ontario: Infection Prevention and Control (IPAC) Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19.
News Release from the Government of Ontario: Ontario Extends Business Closures to Stop Spread of COVID-19 – Friday, April 3, 2020
Please see the following news release on updated business closures to stop the spread of COVID-19 and updated list of essential businesses from the Government of Ontario.
President’s Message #5 re: COVID-19 – Thursday, April 2, 2020
Notwithstanding the incredibly challenging situation we find ourselves in as a result of the COVID-19 pandemic, it is a welcome departure to be able to write today about the results of the District 1, 5 and 6 elections. They are a reminder of normal College business in these anything but ‘normal’ times. Congratulations to Dr. Kristina Peterson (District 1), Dr. Sarah Green (District 5), and Dr. Colin Goudreau (District 6) for their recent election to CCO council, and Dr. David Starmer for his recent acclamation as the first academic representative (District 7).
Congratulations also to Dr. Michael Staffen, Dr. Dwight Chapin and Dr. Michelle Campbell who put their names forward as candidates. Your candidacy was critical in ensuring that members had an important choice to make. Despite the obvious distractions of the pandemic, more than 1,300 CCO members in these districts exercised their votes. It goes without saying that whether as candidates or electors, your participation in this essential CCO governance process is the foundation on which a thriving, responsive and accountable self-regulatory body rests.
Profound thanks are due also to the more than 150 Ontario chiropractors who have indicated to the Ministry of Health their willingness to assist in whatever capacity they may be called upon, as the Ministry prepares for a surge in demand on Ontario’s health care system. This is a testament to the role chiropractors can and do play in improving public health in our province, and also to the values that drew us to the profession in the first place.
My sincere appreciation goes out to these practitioners, and to all CCO members who in ways both big and small are quietly helping their patients, colleagues and neighbours manage through this difficult time. Through this spirit of generosity, compassion and resilience, chiropractors in Ontario are making a significant impact as we navigate the uncertain road ahead.
CCO staff have not surprisingly been in very close contact with the Ministry during this tumultuous time. (Virtual contact, of course.) Staff have participated on province-wide conference calls to facilitate surge planning and information sharing with other health regulators. I have personally written to the Minster and the Opposition health critic to inform them of our communications to members outlining, and urging compliance with, provincial directives.
The College has also shared with the Ministry our ongoing efforts to reinforce CCO guidelines with respect to inappropriate claims about COVID-19 made for chiropractic in social media and advertising. Where it was required, CCO acted quickly and forcefully in reaching out to members whose posts may have crossed the line. Equally, many of the members CCO contacted immediately took down potentially problematic posts.
It is tremendously important at this moment of heightened global health concern and awareness that CCO members continue to adhere to the highest standards of professional conduct and personal responsibility. I am proud to see the contributions members continue to make to improve the health and well-being of Ontarians.
Thank you again for your patience and forbearance during this unprecedented time.
Dr. Dennis Mizel, President
Statement from the Ontario Chief Medical Officer of Health – Monday, March 30, 2020
Please see the following statement from the Ontario Chief Medical Officer of Health.
Government of Canada’s COVID-19 Economic Response Plan – Monday, March 30, 2020
Please see the following link for information and resources on the Government of Canada’s COVID-19 Economic Response Plan, which includes support for individuals and businesses.
Government of Canada News Release: New Order Makes Self-Isolation Mandatory for Individuals Entering Canada – Thursday, March 26, 2020
Please see the News Release from the Government of Canada making self-isolation mandatory for individuals entering Canada.
Ontario Ministry of Health COVID-19 Information and Resources – Thursday, March 26, 2020
Members should continue to review the Ontario Ministry of Health Information on COVID-19 and Guidance for the Health Sector documents.
This information continues to be updated, so please review regularly.
Ontario Action Plan: Responding to COVID-19 – Wednesday, March 25, 2020
Please see the following link for a news release from the Government of Ontario for Ontario’s Action Plan: Responding to COVID-19.
President’s Message #4 re: COVID-19 – Tuesday, March 24, 2020
Recently, the Ontario government’s list
of what it is defining as “essential” workplaces was released. The government has ordered the closing down of non-essential workplaces
as of March 24, 2020 at 11:59 p.m. As many of you will have already noted, Section 58 of the list refers to “Health care professionals providing emergency care including dentists, optometrists and physiotherapists.”
While chiropractors are not explicitly mentioned in this list, the term ‘including’ is non-exclusive. Let me be clear: It is our understanding as regulated health care professionals in the province of Ontario that chiropractors constitute an important segment of the unnamed, but included, health professionals referred to in Section 58 of the list. Chiropractors play an important and vital role in maintaining the health of Ontarians, including those working on the front lines.
Following on from the CCO directives contained in my previous communications outlining essential versus non-essential services, let me offer the following with respect to the “emergency care” directive in today’s announcement.
Consistent with many other health regulatory college positions on this matter, what constitutes emergency care is largely dependent on the individual practitioner’s knowledge, skill and judgment. Please note, members need to weigh the value of treatment against the risk when seeing a patient. However, for chiropractic, emergency care would include:
- Care for patients experiencing a sudden and debilitating change in functional abilities (understood as walking, standing, sitting, lifting floor-to-waist or waist-to-shoulder, stair climbing, ladder climbing) or significant restrictions (experienced during bending/twisting, repetitive movement, pushing/pulling with right/left arm) as well as injury to head/neck/back and extremities.
- Treatment aimed at alleviating significant pain, understood as pain that is incapacitating for the patient and interferes with their ability to carry out normal functioning.
Therefore, and in line with this most recent directive from the Province of Ontario, chiropractors must until further notice practise only emergency care as described above.
Note that the Ontario Government’s order does not preclude the provision of work and services either online by telephone or by mail/delivery. CCO is currently developing further guidelines on this topic, however members intending to provide virtual or remote services may act in accordance with the following protocols:
- A member must have a pre-existing relationship with the patient which would have included an in-person examination, plan of care and informed consent with that patient.
- As part of that plan of care, a member may communicate certain information, advice and recommendations to the patient that are within the chiropractic scope of practice and in the public domain.
- A member must ensure they are competent to perform remote services, have appropriate malpractice insurance or protection for providing remote services and consider the benefits and risks for any information, advice and recommendations that are provided remotely.
- A member must obtain informed consent from the patient relevant to any services that are provided remotely. This may be obtained verbally and documented in the patient health record.
- A member must document any services that are offered remotely in the patient health record, financial record and invoice.
- A member must communicate any fee to a patient that is to be charged for any remote services.
- A member must comply with all CCO regulations, standards of practice, policies and guidelines.
CCO recognizes the important role chiropractors – practising emergency care within the chiropractic scope of practice and respecting all CCO standards of practice, policies and guidelines – can play in helping to mitigate the anticipated demand on hospital and clinic resources bracing for the surge in COVID-19 related illnesses.
Treating patients who are presenting with urgent neuromusculoskeletal pain and disability within our own clinical practices, respecting physical distancing and with the highest level of hygiene protocols, and honouring the prohibition on non-essential travel outside our professional roles, will assist in the province’s efforts to manage the impact of this serious pandemic.
Continue to watch the CCO website for updates as the situation is changing rapidly.
Dr. Dennis Mizel, President
Please see the following links for information on the order from the Ontario Government closing all non-essential workplaces to fight the spread of COVID-19 and a list of essential workplaces from the Ontario Government.
CCO will be communicating to members and posting updated information on its website related to this order shortly.
Government of Ontario COVID-19 Self-Assessment – Monday, March 23, 2020
If you think you have coronavirus (COVID-19) symptoms or have been in close contact with someone who has it, use this self-assessment to help determine how to seek further care.
Request from the Ontario Medical Association – Monday, March 23, 2020
The Ontario Medical Association (OMA) is requesting the sharing of Personal Protective Equipment (PPE) with front line health care providers, as the efforts to address COVID-19 ramp up.
Please contact Ms Christine Poopalapillai, Manager, Stakeholder Relations, Change Management & Implementation at the OMA at Christine.Poopalapillai@oma.org, who is coordinating these efforts.
President’s Message – Sunday, March 22, 2020
Let me start with thanking all of you for your extraordinary efforts during an extremely difficult time for everyone – patients, members, families and communities. I know some members have expressed an interest in knowing how they can help. The following are links in English and French to the Ministry of Health’s website which asks health professionals to provide information which will assist the Ministry with determining how to mobilize capacity in the health care system:
Please make sure to review the CCO website
often as updated information will continue to be posted there. There is some misinformation being circulated. CCO’s recommendation to suspend non-essential chiropractic services was consistent with the direction of the majority of other health regulators in Ontario, as well as the direction of other chiropractic regulators in Canada.
The Ontario Chief Medical Officer of Health has since released a directive
to regulated health professionals or persons who operate a group practice of regulated health professionals, directing that “all non-essential and elective services should be ceased or reduced to minimal levels, subject to allowable exceptions, until further notice. Allowable exceptions can be made for time sensitive circumstances to avert or avoid negative patient outcomes or to avert or avoid a situation that would have a direct impact on the safety of patients.” Please see the full directive
for further details and considerations for health care providers. CCO strongly encourages members to review the request made by the Ministry of Health in the links provided.
Everyone must continue to comply with the Ministry of Health directives which are linked on the website
. New directives are posted as soon as they are received.
In the interim, I reiterate the previous message to make sure you comply with CCO’s standards of practice, policies and guidelines relating to social media, namely:
CCO has communicated with many members directly about removing any potentially inappropriate postings or comments, and we will continue to monitor social media for that purpose. Members should not make any unsubstantiated claims concerning chiropractic care and COVID-19. Thank you to the organizations who have reinforced CCO’s messaging to ensure compliance with all relevant provisions, and the need to maintain professional, respectful discourse. CCO will continue to take appropriate regulatory action to protect the public when evidence is provided of comments, claims or behaviour that fall outside a chiropractor’s scope of practice as defined in the Chiropractic Act, 1991
and Standard of Practice S-001: Chiropractic Scope of Practice
In the interim, if you see anything inappropriate, here are some positive, constructive and effective courses of action:
- Pick up the phone and contact your colleague to give him/her a heads up that his/her postings may be off side;
- Contact Dr. Bruce Walton, Director of Professional Practice at firstname.lastname@example.org and ask if the posting is generally consistent with CCO’s standards of practise;
- Submit the posting to the Advertising Committee and ask if it complies; or
- Send the posting to CCO so we are aware of it and can take action as appropriate.
CCO’s role and mandate is to focus on public interest protection. There are many very serious matters for CCO to address at all times, including now. I am cognizant of the importance of “proportionality” in the exercise of regulatory action, and that means focusing approximately 80% of CCO’s actions on matters directly related to CCO’s statutory mandate. I have throughout my presidency emphasized the importance of respectful, professional communications. I am honored, humbled and restored by the passion of chiropractors and I have confidence that CCO members will bring their skills and experience to assist with all of our efforts to effectively manage and overcome the current health care crisis.
Dr. Dennis Mizel, President
Ministry of Health COVID-19 Health Care Provider Recruitment – Sunday, March 22, 2020
Please see the following link to the Ontario Ministry of Health’s page on the recruitment of COVID-19 health care providers. The Ministry of Health is looking for health care providers who may be working part-time and want to and are prepared to increase their work hours or former healthcare providers who are retired, or on inactive status with their regulatory college; and are prepared to return to employment.
Please see the links below for further information in English and French.
Information from the Government of Canada – COVID-19 Benefits and Services – Saturday, March 21, 2020
Please see the following link for information on COVID-19 Benefits and Services available from the Government of Canada .
News Release from the Government of Ontario – Saturday, March 21, 2020
Please see the following link to the a news release from the Government of Ontario: Ontario Takes Extraordinary Steps to Ensure Health Care Resources Available to Contain COVID-19 – Saturday, March 22, 2020
Directive from Ontario Chief Medical Officer of Health: Directive #2 for Health Care Providers – Friday, March 20, 2020
Please see the following directive from the Ontario Chief Medical Officer of Health for regulated health professionals or persons who operate a group practice.
Ministry of Health Letter: Managing Health Worker Illness and Return to Work COVID-19 – Thursday, March 19, 2020
Please the following letter from the Ontario Ministry of Health concerning managing health worker illness and return to work.
President’s Message – Tuesday, March 17, 2020
An update to all chiropractors in Ontario – COVID-19
The situation regarding the coronavirus/COVID-19 in Ontario continues to evolve rapidly and remains a prime concern for the CCO. I appreciate how disruptive and disorienting this moment has become for the public and CCO members alike.
Since my last message with respect to COVID-19 a mere 24 hours ago, we have heard from both the Premier of Ontario and the Prime Minister on measures their governments are taking, as well as from many senior health officers at both the provincial and federal and levels. In fact, Ontario has declared a state of emergency as of this morning.
These are extraordinary and unsettling times for chiropractors and other specialized health care practitioners in Ontario. I recognize that there remain unanswered questions about how best to operationalize in the clinical setting the recommendations from both the CCO and the Ministry of Health seeking to mitigate the impact of the pandemic on our most vulnerable populations. As well, there are many questions pertaining to the very real and related financial implications for practice management. I thank all those members who have emailed to date with their concerns and questions, and I assure you they will continue to be considered with utmost seriousness as we navigate the uncharted territory of this global health crisis in the best interests of the public.
With regard to the CCO’s recommendation that all non-essential (except for emergency/acute) chiropractic services be suspended immediately, it is incumbent on the individual practitioner to exercise their best professional judgement to determine what constitutes emergency/acute care, as has always been the expectation for CCO members when providing safe, effective and ethical care. This will necessarily include consideration of the different needs of urban and rural or remote communities. (At this time, we are not in a position to put a timeframe to this recommendation. But rest assured that we will be assessing the situation on a daily basis.)
Specifically, chiropractors may receive patients who have suffered a musculoskeletal trauma, or those dealing with incapacitating neuromusculoskeletal problems or pain, in order to offer an effective therapeutic option for these patients.
Additionally, many patients in chiropractic care have some form of ongoing pain (chronic pain) and seek regular treatment to manage their condition and to prevent a flare-up or augmentation of their symptoms. In the professional judgement of qualified, skilled and compassionate practitioners these patients can be considered as emergency/acute cases, as the withdrawal of care would lead to an unacceptable deterioration in their condition, which makes the care provided to them an essential chiropractic service.
On the other hand, all care deemed to be maintenance or preventive should be postponed in order to avoid non-essential patient contact, and to reduce the potential spread of Covid-19 as much as possible. Maintenance or preventive care may be considered treatment that, if not provided for a period of two months, would cause the patient to experience a flare-up or deterioration in condition.
Chiropractors are reminded that the practice of social distancing is to be followed at all times and in all environments where it is feasible, such as in waiting rooms and larger treatment settings. Enhanced cleaning and sanitizing of ‘touch surfaces’ and equipment is also critically important to protect the health of the public and clinical staff. These measures should include spacing of seating areas in waiting rooms to ensure social distancing and removal of ‘soft’ items that cannot be cleaned effectively (books, magazines, plush toys etc.)
Similarly, chiropractors are reminded to observe federal regulations to immediately self-isolate for a period of 14 days upon returning to Canada from other countries, or upon coming in contact with an individual who has been diagnosed with, or deemed to be a presumptive case of, COVID-19. And obviously to stay home and to seek appropriate medical advice if experiencing any flu-like symptoms themselves.
In addition, and in support of the Ministry of Health’s ongoing efforts to mitigate the spread of COVID-19, all members should perform active screening before commencing treatment. Active screening consists of asking the following questions: Do you have a FEVER and/or NEW ONSET OF COUGH or DIFFICULTY BREATHING? Have you just returned from international travel within the last two weeks? Have you had any close contact with a confirmed or probable case of COVID-19? Have you had close contact with a person with acute respiratory illness who has been to an impacted area
At this time of great uncertainty with respect to the impact of COVID-19, CCO members must play their role as primary health care providers expertly and conscientiously, to help reduce the spread of this potentially fatal virus. In keeping with its mandate to regulate chiropractic in the public interest, CCO will continue to monitor this unfolding health crisis closely and will provide updates as developments warrant.
Dr. Dennis Mizel, President
President’s Message – Monday, March 16, 2020
A message to all chiropractors in Ontario – COVID-19
The College of Chiropractors of Ontario (CCO) has a mandate to regulate chiropractic in the public interest. CCO acknowledges and supports the Ontario Ministry of Health’s efforts relating to COVID-19 including the important public health initiatives being taken. The Ministry of Health should be considered the appropriate source for up-to-date, accurate information and resources.
The situation involving COVID-19 is being monitored on an ongoing basis and the measures and guidelines noted below will be revisited regularly as new information becomes available.
Please note the following:
- Members should review and comply with the Ministry of Health’s bulletins and directives relating to COVID-19 which are linked here:
- Members should not make any unsubstantiated claims concerning chiropractic care and COVID-19. CCO will be monitoring social media to ensure compliance with the advertising provisions.
- CCO is extending the time period to complete the continuing education (CE) requirements for the current CE cycle (July 1, 2018 – June 30, 2020) until December 31, 2020. Members may continue to log and report their hours through the member portal. Members should choose online CE activities or virtual events and should not feel compelled to attend live events in order to fulfill CE requirements.
- Peer assessments have been suspended pending a consideration of how or if they may be conducted virtually.
- CCO recommends that all non-essential (except for emergency/acute) chiropractic services be suspended immediately.
- All in-person meetings at CCO have been suspended until further notice. Virtual meetings will be organized as needed.
- All speaking engagements and presentations including business travel for staff and Council members have been cancelled.
- CCO staff will be working remotely wherever possible. There may be a delay in responding to inquiries although we will respond as quickly as we can.
- CCO is working in conjunction with other stakeholders to ensure consistent messaging and leadership in addressing the current health crisis responsibly.
- If you have an urgent matter involving CCO, please communicate via e-mail: email@example.com.
CCO will continue to post information and a link to the Ministry’s bulletins on the CCO website: www.cco.on.ca.
Dr. Dennis Mizel, President
Ministry of Health Resources – Novel Coronavirus – Wednesday, March 11, 2020
The College of Chiropractors of Ontario acknowledges and supports the Ontario Ministry of Health’s efforts relating to the Novel Coronavirus. The Ministry of Health should be considered the appropriate source for up-to-date accurate information and resources.
The Ministry of Health has a number of resources concerning the Novel Coronavirus. Please review the information in the following links to access up-to-date information and guidelines for health care professionals and the public: