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Hospitals Regulations

made under Section 17 of the

Hospitals Act

R.S.N.S. 1989, c. 208

O.I.C. 2015-77 (March 24, 2015), N.S. Reg. 53/2015



Citation

1     These regulations may be cited as the Hospitals Regulations.


Definitions

2     In these regulations,

 

“health authority” means a health authority as defined in, and as deemed to be a hospital in, the Health Authorities Act;

 

“hospital building” means a physical location that is or will be used by a health authority to provide health care services, but that is not necessarily owned by the health authority;

 

“qualified nurse practitioner” means a nurse practitioner as defined in the Registered Nurses Act who is an employee of a health authority;

 

“qualified registered nurse” means a registered nurse as defined in the Registered Nurses Act who is an employee of a health authority.


Hospital construction and renovation proposals

3     (1)    A health authority may make a proposal to the Minister to construct or alter a hospital building, or the Minister may request a health authority to make a proposal for constructing or altering a hospital building.

 

       (2)    A proposal to construct or alter a hospital building must be in writing and include any information the Minister requires, including all of the following:

 

                (a)    a description of any existing buildings at the site and their uses;

 

                (b)    the proposed construction or alterations;

 

                (c)    the health authority’s functions and services that will be affected;

 

                (d)    an estimate of the cost of the proposed construction or alterations;

 

                (e)    any reports or studies by consultants.

 

       (3)    The Minister may approve a proposal to construct or alter a hospital building in writing, subject to any conditions the Minister considers advisable and subject to a maximum budget that includes the cost of any item or service the Minister considers advisable, including the cost of all of the following, as appropriate:

 

                (a)    purchasing land or buildings;

 

                (b)    construction, repair or alterations;

 

                (d)    fees for consultants and architects;

[Clause lettering as in original.]

 

                (c)    interest on funds required for clauses (a) and (b);

[Clause lettering as in original.]

 

                (e)    equipment;

 

                (f)    land surveys and soil tests;

 

                (g)    necessary paving and landscaping;

 

                (h)    site preparation and servicing.


Emergency planning

4     (1)    A health authority must develop and maintain the following plans and procedures in writing, and submit them to the Minister:

 

                (a)    a plan for internal and external emergencies arising within the health authority, a management zone or a hospital building, including procedures for

 

                         (i)     preparing for emergencies,

 

                         (ii)    mitigating against emergencies,

 

                         (iii)   responding to emergencies,

 

                         (iv)   recovering from emergencies,

 

                         (v)    testing the procedures for subclauses (i) to (iv);

 

                (b)    a plan for health authority and management zone emergency operations centres that are capable of being activated during an emergency;

 

                (c)    business continuity plans and procedures to respond to loss of critical infrastructure and mission critical services;

 

                (d)    fire safety plans for preventing and controlling fire within a hospital building in accordance with the Office of the Fire Marshal’s requirements.

 

       (2)    Plans and procedures required by subsection (1) must be developed in collaboration with relevant local, provincial and federal authorities, as appropriate.

 

       (3)    The Minister may review any plans and procedures submitted under subsection (1) as the Minister considers necessary, and a health authority must revise and update its plans and procedures at the request of the Minister.


Records and reports regarding emergency planning to Minister

5     (1)    A health authority must retain a written record of each inspection, test and practice related to preventing and controlling fire or other emergencies, including events that threaten business continuity, for at least 2 years and make the records available to the Minister on request.

 

       (2)    A health authority must submit a copy of all reports received from the Office of the Fire Marshal or any fire department to the Minister.


Hospital accreditation report to Minister

6     A hospital must send the Minister a copy of any report made by Accreditation Canada regarding the hospital.


Ministerial approval of student training programs

7     A health authority must first obtain the written approval of the Minister before doing any of the following:

 

                (a)    developing a hospital-administered training program for medical, nursing, technical or other students;

 

                (b)    entering into an agreement with another institution to provide a training program for students of that institution, including approval of the terms and conditions of the agreement.


Drug dispensary pharmacist

8     A drug dispensary in a hospital must be under the direction or advice of a pharmacist licensed under the Pharmacy Act.


In-patient and out-patient medical records

9     (1)    A hospital must maintain a record of the diagnostic and treatment services provided for each hospital in-patient and out-patient.

 

       (2)    An in-patient record maintained under subsection (1) must include any information the hospital considers necessary, including all of the following for the patient:

 

                (a)    name, including all previous surnames;

 

                (b)    health card number assigned under the Health Services Insurance Act;

 

                (c)    date of birth;

 

                (d)    history of present illness;

 

                (e)    history of previous illness;

 

                (f)    family history;

 

                (g)    physical examination;

 

                (h)    provisional diagnosis;

 

                (i)     orders for treatment;

 

                (j)     medical, nursing and other notes on the progress of the patient;

 

                (k)    condition on discharge;

 

                (l)     all reports of

 

                         (i)     consultations,

 

                         (ii)    follow-up care,

 

                         (iii)   laboratory, radiological, and other diagnostic examinations,

 

                         (iv)   medical, surgical, obstetrical and other therapeutic treatment, including renal dialysis treatment,

 

                         (v)    operations and anaesthesia,

 

                         (vi)   hospital autopsy;

 

                (m)   final diagnosis;

 

                (n)    on the death of the patient in hospital, a copy of the death certificate under the Vital Statistics Act.


Destruction and examination of tissues

10   (1)    In this Section, “tissue” means tissues removed from a patient during an operation or by curettage.

 

       (2)    A qualified medical practitioner, qualified dental practitioner or employee of a hospital must not destroy tissue.

 

       (3)    Tissue must be sent to a laboratory, together with a short history of the case and a statement of the findings of the operation or curettage, where a pathologist must carry out a gross examination of the tissue.

 

       (4)    A histological examination of tissue must be carried out if

 

                (a)    a qualified medical practitioner or qualified dental practitioner requests the examination; or

 

                (b)    the gross examination suggests a pathological condition that can be confirmed only by a histological examination.

 

       (5)    A laboratory report on any tissue examination must be sent to the hospital in which the operation or curettage took place.


Tissues not requiring pathological examination

11   (1)    On the recommendation of its medical staff, a hospital may authorize exceptions to Section 10 for certain tissues or specimens or classes of tissues or specimens that the hospital considers do not to require pathological examination.

 

       (2)    A hospital must maintain a list of tissues that do not require examination under subsection (1), and must send the Minister a copy of the list and any subsequently updated lists.


Discharging patient from health authority

12   (1)    Subject to any conditions established under a health authority’s by-laws, if a patient is no longer in need of treatment in the health authority, any of the following may authorize the discharge of the patient from the health authority:

 

                (a)    a qualified medical practitioner;

 

                (b)    a qualified midwife;

 

                (c)    a qualified dental practitioner;

                 

                (d)    a qualified nurse practitioner.

 

       (2)    A qualified medical practitioner may authorize a qualified registered nurse to discharge a patient from a health authority in accordance with conditions established under the health authority’s by-laws.


Release from an emergency department or collaborative emergency centre

13   (1)    In this Section,

 

“collaborative emergency centre” means a service delivery centre, facility or program approved by the Minister and operated by a health authority to provide access to or delivery of any of the following:

 

                         (i)     primary care services,

 

                         (ii)    urgent care services;

 

                         (iii)   emergency care services;

 

“release” means the release of a patient from a health authority’s emergency department or a collaborative emergency centre after a qualified registered nurse has conducted a nursing assessment and provided nursing care.

 

       (2)    A qualified registered nurse may release a patient from a health authority’s emergency department or a collaborative emergency centre in accordance with conditions established by a health authority.


Forms

14   The forms listed in the following table are prescribed to be used in the administration of the Act for the purposes stated:


Form Letter

Title/purpose

A

Declaration of Capacity to Consent to Treatment form for use under Section 53 of the Act

B

Revocation of Declaration of Capacity to Consent to Treatment form for use under Section 57 of the Act

C

Declaration of Competency form for use under Section 53 of the Act

D

Revocation of Declaration of Competency form for use under Section 57 of the Act

E

Notice to Public Trustee form for use under subsection 59(1) of the Act


 ________________________________________________________________ 

Schedule A—Approved Hospitals


The following are approved as hospitals under clause 4(1)(a) of the Act:


Hospital

Location

Scotia Surgery Inc.

18 Acadia Drive, Dartmouth


 ________________________________________________________________ 

Schedule B—Forms


Form A—Declaration of Capacity to Consent to Treatment

(Section 53, Hospitals Act)



I, ____________________________________ (full name), a ______________________ (title) on the staff of _______________________________________ (name of hospital or psychiatric facility), personally examined _________________________________ (full name of person) of _________________________________ (address of person) on ___/___/______ (dd/mm/yyyy) at _____________a.m./p.m. at ____________________ (location of examination).


It is my opinion that the person (check one)

 

                [  ]    is capable of consenting to the proposed treatment or treatments

                [  ]    is not capable of consenting to the proposed treatment or treatments

 

 

 

 

 

 

 

 


In arriving at this opinion I have considered all of the following:

 

              whether the person understands the condition for which the specific treatment is proposed;

              the nature and purpose of the specific treatment;

              the risks and benefits involved in undergoing the specific treatment; and

              the risks and benefits involved in not undergoing the specific treatment.

 

The following information supports my opinion:

1)

Observations from my examination of the patient:

 

 

 

 

 

 

 

 

2)

Information from other sources:

 

 

 

 

 

 

 

 

 

 

 

Sources of above information (identify specific sources):

 

 

 

 


 

 

 

(date of signature)

(signature)

 

 

 

(printed name)



Notes:

1)     Section 2A of the Hospitals Act states:

        2A      For the purpose of this Act, any reference to a psychiatrist carrying out a capacity or competency assessment means

                 (a)     for the purpose of a person in a psychiatric facility, a psychiatrist as defined in clause (r) of Section 2; and

                 (b)     for the purpose of a person in a hospital, the attending physician or other suitable health professional determined by the hospital.

2)     Sections 54(2) to 54D of the Hospitals Act state:

        54      (2)     Where a patient in a hospital or a psychiatric facility is found by declaration of capacity to be incapable of consenting to treatment, consent may be given or refused on behalf of the patient by a substitute decision-maker who has capacity and is willing to make the decision to give or refuse the consent from the following in descending order:

                           (a)     a person who has been authorized to give consent under the Medical Consent Act or a delegate authorized under the Personal Directives Act;

                           (b)     the patient’s guardian appointed by a court of competent jurisdiction;

                           (c)     the spouse of the patient;

                           (d)     an adult child of the patient;

                           (e)     a parent of the patient;

                           (f)      a person who stands in loco parentis to the patient;

                           (fa)    an adult sibling of the patient;

                           (fb)    a grandparent of the patient;

                           (fc)    an adult grandchild of the patient;

                           (fd)    an adult aunt or uncle of the patient;

                           (fe)    an adult niece or nephew of the patient;

                           (g)     any other adult next of kin of the patient; or

                           (h)     the Public Trustee.

                 (3)     Where a person in a category in subsection (2) fulfils the criteria for a substitute decision-maker as outlined in subsection (5) but refuses to consent to treatment on the patient’s behalf, the consent of a person in a subsequent category is not valid.

                 (4)     Where two or more persons who are not described in the same clause of subsection (2) claim the authority to give or refuse consent under that subsection, the one under the clause occurring first in that subsection prevails.

                 (5)     A person referred to in clauses (c) to (g) of subsection (2) shall not exercise the authority given by that subsection unless the person

                           (a)     excepting a spouse, has been in personal contact with the patient over the preceding twelve-month period or has been granted a court order to shorten or waive the twelve-month period;

                           (b)     is willing to assume the responsibility for consenting or refusing consent;

                           (c)     knows of no person of a higher category who is able and willing to make the decision; and

                           (d)     makes a statement in writing certifying the person’s relationship to the patient and the facts and beliefs set out in clauses (a) to (c).

                 (6)     The attending physician is responsible for obtaining consent from the appropriate person referred to in subsection (2).

        54A    The substitute decision-maker shall make the decision in relation to specified medical treatment

                 (a)     in accordance with the patient’s prior capable informed expressed wishes unless

                         (i)      technological changes or medical advances make the prior expressed wishes inappropriate in a way that is contrary to the intentions of the patient, or

                           (ii)     circumstances exist that would have caused the patient to set out different instructions had the circumstances been known based on what the substitute decision-maker knows of the values and beliefs of the patient and from any other written or oral instructions;

                 (b)     in the absence of awareness of a prior capable informed expressed wish, in accordance with what the substitute decision-maker believes the wishes of the patient would be based on what the substitute decision-maker knows of the values and beliefs of the patient and from any other written or oral instructions; and

                 (c)     if the substitute decision-maker does not know the wishes, values and beliefs of the patient, in accordance with what the substitute decision-maker believes to be in the best interest of the patient.

        54B    In order to determine the best interest of the patient for the purpose of clause (b) of Section 54A, regard shall be had to

                 (a)     whether the condition of the patient will be or is likely to be improved by the specified medical treatment;

                 (b)     whether the condition of the patient will improve or is likely to improve without the specified medical treatment;

                 (c)     whether the anticipated benefit to the patient from the specified medical treatment outweighs the risk of harm to the patient; and

                 (d)     whether the specified medical treatment is the least restrictive and least intrusive treatment that meets the requirements of clauses (a), (b) and (c).

        54C    Whoever seeks a person’s consent on a patient’s behalf is entitled to rely on that person’s statement in writing as to the person’s relationship with the patient and as to the facts and beliefs mentioned in clauses (a) to (c) of subsection (5) of Section 54, unless it is not reasonable to believe the statement.

        54D    (1)     Where a substitute decision-maker approves or refuses treatment on behalf of a patient pursuant to subsection (2) of Section 54, the Supreme Court of Nova Scotia (Family Division) or the Family Court where there is no Supreme Court (Family Division) may review the provision or refusal of consent when requested to do so by the psychiatrist or the patient to determine whether the substitute decision-maker has rendered a capable informed consent.

                 (2)     Where the court finds that a substitute decision-maker has not rendered a capable informed consent, the next suitable decision-maker in the hierarchy in subsection (2) of Section 54 becomes the substitute decision-maker.


Form B—Revocation of Declaration of Capacity

(Section 57, Hospitals Act )


I, _______________________________ (full name), a _____________________ (title) on the staff of _____________________________________ (name of hospital or psychiatric facility), personally examined ___________________________ (full name of person) on ___/___/____ (dd/mm/yyyy) at __________ a.m./p.m. at _____________________ (location of examination).


I declare that in my opinion the person is capable of consenting to the following treatment or treatments:

 

 

 


Therefore I am revoking the Declaration of Capacity dated ___/___/____ (dd/mm/yyyy) respecting this person.


 

 

 

(date of signature)

(signature)

 

 

 

(printed name)



Note:

Section 2A of the Hospitals Act states:

                 2A     For the purpose of this Act, any reference to a psychiatrist carrying out a capacity or competency assessment means

                           (a)     for the purpose of a person in a psychiatric facility, a psychiatrist as defined in clause (r) of Section 2; and

                           (b)     for the purpose of a person in a hospital, the attending physician or other suitable health professional determined by the hospital.


Form C—Declaration of Competency

(Section 53, Hospitals Act)


I, _________________________________ (full name), a ______________________ (title) on the staff of _______________________________________ (name of hospital or psychiatric facility), personally examined _______________________________ (full name of person) on ___/___/____ (dd/mm/yyyy) at __________a.m./p.m. at ___________________________ (location of examination).


I declare that in my opinion the person (check one)

 

                [  ]    is competent to administer their estate.

                [  ]    is not competent to administer their estate.


In arriving at this opinion I have considered all of the following:

 

                       the nature and degree of the person’s condition

                       the complexity of the estate

                       the effect of the condition of the person upon their conduct in administering the estate

                       any other circumstances that I consider relevant to the estate and the person and their condition.


The following information supports my opinion:

1)

Observations from my examination of the patient:

 

 

 

 

 

 

 

 

2)

Information from other sources:

 

 

 

 

 

 

 

 

 

 

 

Sources of above information (identify specific sources):

 

 

 

 



Date of admission to hospital or psychiatric facility: ___/___/_____ (dd/mm/yyyy).


 

 

 

(date of signature)

(signature)

 

 

 

(printed name)



Note:

Section 2A of the Hospitals Act states:

                 2A     For the purpose of this Act, any reference to a psychiatrist carrying out a capacity or competency assessment means

                           (a)     for the purpose of a person in a psychiatric facility, a psychiatrist as defined in clause (r) of Section 2; and

                           (b)     for the purpose of a person in a hospital, the attending physician or other suitable health professional determined by the hospital.


Form D—Revocation of Declaration of Competency

(Section 57, Hospitals Act)


I, _________________________________ (full name), a ______________________ (title) on the staff of _______________________________________ (name of hospital or psychiatric facility), personally examined ___________________________ (full name of person) on ___/___/____ (dd/mm/yyyy) at _________ a.m./p.m. at ___________________________ (location of examination).


I declare that in my opinion the person is competent to administer their estate.


Therefore I am revoking the Declaration of Competency dated ___/___/_____ (dd/mm/yyyy) respecting this person.


 

 

 

(date of signature)

(signature)

 

 

 

(printed name)



Note:

Section 2A of the Hospitals Act states:

                 2A     For the purpose of this Act, any reference to a psychiatrist carrying out a capacity or competency assessment means

                           (a)     for the purpose of a person in a psychiatric facility, a psychiatrist as defined in clause (r) of Section 2; and

                           (b)     for the purpose of a person in a hospital, the attending physician or other suitable health professional determined by the hospital.


Form E—Notice to Public Trustee

(Subsection 59(1), Hospitals Act)



I, _____________________________ (full name), am the administrator/chief executive officer (circle one) of _____________________________ (name of hospital or psychiatric facility).


___________________________________ (full name of patient), a patient at the hospital/psychiatric facility, has been examined by a psychiatrist and found to be unable to administer their estate.


I hereby advise you that circumstances are such that the Public Trustee should consider immediately assuming management of their estate.

 

 

 

(date of signature)

(signature)

 

 

 

(witness’s name—printed)

(printed name)

 

 

 

 

 

(title)



Note:

Section 2A of the Hospitals Act states:

                 2A     For the purpose of this Act, any reference to a psychiatrist carrying out a capacity or competency assessment means

                           (a)     for the purpose of a person in a psychiatric facility, a psychiatrist as defined in clause (r) of Section 2; and

                           (b)     for the purpose of a person in a hospital, the attending physician or other suitable health professional determined by the hospital.