President’s Message: September 19, 2023 – Draft Amendments to Standard of Practice S-003: Professional Portfolio and By-laws for Circulation and Feedback

Update – Council Meeting September 8, 2023 and Strategic Planning Sessions September 9, 10, 2023

CCO Council and staff have just returned from a successful Council meeting and strategic planning sessions. Here is an update on some of our initiatives, and two opportunities for you to have input into items being considered by Council.

Potential Amendment to Standard of Practice S-003: Professional Portfolio

The Quality Assurance Committee recommended to Council circulation of amendments to S-003: Professional Portfolio to include five (5) hours of hands-on activity relating to spinal adjustment or manipulation to be completed once every three (3) CE cycles (or six years). Members will be aware that although there is a continuing education (CE) requirement for five (5) hours in diagnostic or therapeutic procedures related to controlled acts, peer assessors have observed that much of this requirement is being completed through remote learning related to communicating a diagnosis and/or ordering radiographs. Council approved the circulation of changes to require hands-on learning specific to members’ authority to perform the controlled act of moving the joints of the spine. The public interest rationale includes ensuring a basic level of competency in a fundamental skill that members are authorized to perform by governing legislation.

Please review the draft amendments to Standard of Practice S-003: Professional Portfolio, indicated in underline on page five (5), and provide any feedback through the portal by November 19, 2023.

By-law Amendments Being Considered

For several years now, CCO has been engaged in a process of systematically reviewing, consulting on, and amending its by-laws, in keeping with the College’s commitment to regulatory excellence in a diverse environment.

As President, helping to guide this work of carefully analyzing and amending by-laws to strengthen the College’s governance, all while building on the efforts of previous Councils, is a significant priority.

A leading expert on regulatory performance, Harvard Professor Malcolm Sparrow, observed that a regulatory system is not just supported by formal rules, but also by norms, best practices and, of equal importance, community expectations. This is why when examining our by-laws we should not just ask if something is technically permissible within the relevant governing statutes, but also whether it is the right thing to do.

The CCO’s ongoing by-law review has been informed by this spirit.

At the August 11, 2023 meeting of the CCO Executive Committee, several by-law amendments were approved to be brought forward to CCO Council. Most of these recent amendments make the language used more inclusive and gender neutral, such as replacing “his/her” with “their”, or “member”, as appropriate (11 by-laws were affected). A significant number of amendments were undertaken to make minor grammatical changes for sentence clarity, or to be consistent with related by-laws, or to correct small typographic errors (10 by-laws were affected).

In the remaining instances, the by-law amendments were designed to enhance the efficacy of CCO’s Council and committees, to ensure that the members who serve on them are the best equipped to do so. This has been done in accordance with the College’s published Competencies for Council and Committee members. For example, following a detailed review of best practices at 11 Ontario health regulatory colleges and three non-health regulatory bodies concerning the nomination of candidates to committees, an amendment was made to By-law 7 Elections Within Council. (The best practices review was undertaken by outside legal counsel engaged by CCO and governance experts at SML Law.) Specifically, By-law 7.11 was amended to include the CCO President on the Nomination Committee. The rationale being, in part, that the President likely has a great deal of experience of Council and its committees and is well versed in their various roles and mandates in terms of nominating suitable candidates. The details will be set out in policy.

Additional amendments pertained to eligibility for Council. These included amendments to by-law 6.9 which, in the interest of consistency, extend the ‘cooling off’ period from three to six years for any member seeking to be elected from when they had been last engaged with the leadership (as defined) of a chiropractic advocacy group, or chiropractic education organization, or had resigned from CCO Council before the completion of their term. The suggestion to harmonize the cooling off periods was first proposed by a former CCO President during the College’s recent consultations on amendments to By-law 6.

Other amendments to by-law 6.9 address a member’s ineligibility to become a candidate for Council. These require that a member is not, and has not been within the preceding six years, an adverse party in litigation against CCO 6.9(q); that the member is not an accused currently charged with a criminal offence under the Criminal Code of Canada 6.9(r); and that the member has not been convicted of a criminal offence for which the member has not received a pardon pursuant to the Criminal Code of Canada 6.9(s). The clear public interest rationale for these three amendments (q), (r), (s) is that the member is ineligible as a result being in a conflict of interest – in 6.9 (q) with CCO itself, and in the case of 6.9 (r) and (s), the conflict of interest is with the duty to serve and protect the public interest as a member of CCO Council.

In addition to meeting eligibility criteria, the competencies expected of candidates for, or members of, Council and Committee also include a deep understanding of the fiduciary responsibilities of Council members as stewards of CCO. Fiduciary responsibilities extend beyond a narrow reading of financial accountability, to include due diligence, respect, ethics, confidentiality, loyalty and of course conflict of interest.

To be fair, it is not assumed that all prospective candidates or Council members are already experts in all the competencies and responsibilities. CCO provides many orientation sessions, modules and ongoing training and support for Council members that I and many other Council colleagues have found invaluable. This training, alongside the formal articulation of core competencies for Council members, are a key component of CCO’s (and other leading health regulatory colleges’) efforts to strengthen college leadership, and to align with the goals and benchmarks of the Ministry of Health and Long-Term Care’s College Performance Measurement Framework.

A review and opinion were also sought on related governance matters with respect to voting on amendments (and other business), and specifically the role of the Chair. CCO’s existing by-law stipulates that the Council Chair votes only in the event of a tie, although that is not a universal practice within other colleges or organizations generally. For example, while the Ontario College of Pharmacists mirrors CCO’s approach, the College of Nurses of Ontario does not require the Chair to vote regardless of the outcome, though they may vote if they wish. In the event of a tie, the motion is considered to be defeated. The Royal College of Dental Surgeons of Ontario and the College of Physicians and Surgeons of Ontario likewise have the by-law provision that a tied vote defeats the motion, although in both colleges the vote of the Chair is counted along with every other council member. Council agreed to include a right to vote for the Chair to vote as part of the by-law amendments, with the proviso that the Chair votes last on any matter before Council. There are other by-law amendments under active consideration including, for example, requiring a 2/3 majority vote to amend a by-law. The Executive Committee will be considering these and other amendments with further recommendations going to Council.

Proposed amendments to By-law 12: Appointment of Non-Council Members include applying the same criteria for the election of Council members to the appointment of non-Council committee members to help ensure consistent practices are applied. As well, proposed amendments to By-law 13: Fees include the addition of certificate and application fees to the new Emergency class of registration certificate (approved by the Ministry of Health on August 31, 2023), and the exemption of additional registration fees for those members moving from the Emergency class to the General class of registration. Proposed new By-laws 13.14 and 13.26 codify fees payable by a member for a Specified Continuing Education or Remediation Program (SCERP) or reinstatement application.

I realize that in the course of our busy lives, some of these amendments and considerations may seem like minutiae, and that for many people the world of by-laws and governance can be obscure and complex at best—and cause their eyes to glaze over at worst. 

What I have attempted to share with you in this message is but a glimpse of the breadth and depth of the ongoing by-law review and reform at CCO, spurred on by our commitment to exceed expectations. There will be further communication to all stakeholders, including members, on the topics discussed during strategic planning, including evaluating Council effectiveness, the College Performance Measurement Framework, and effective communications. Stay tuned for further updates.

Please review the proposed by-law amendments, summarized in the following chart and provide any feedback through the portal by November 19, 2023.

Feedback from all stakeholders, including members will be reviewed by the Quality Assurance Committee and the Executive Committee with further recommendations, informed by the feedback, to be considered by the full Council. Thank you for participating in CCO’s ongoing efforts in delivering competent, diligent and ethical regulation of chiropractic in the public interest in Ontario! 

Sincerely,

Dr. Sarah Green

CCO President

Council and staff at Strategic Planning September 9, 10, 2023