TABLE OF CONTENTS

REPORTS OF THE STANDING COMMITTEES

AND OTHER COMMITTEES

As Considered by

The Council of the City of Toronto

on February 2, 3 and 4, 1999

EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

REPORT No. 1

1Cardio Pulmonary Resuscitation and First Aid Training Contract

2Continuing Evolution of the Ambulance Act of Ontario and Identified Potential Financial Implications.

3Legal Validity of Toronto Licensing Obtaining Personal Information in the Possession of the Toronto Police Service.

4Other Items Considered by the Committee.

City of Toronto

REPORT No. 1

OF THE EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

(from its meeting on January 12, 1999,

submitted by Councillor Dennis Fotinos, Chair)

As Considered by

The Council of the City of Toronto

on February 2, 3 and 4, 1999

1

Cardio Pulmonary Resuscitation and

First Aid Training Contract

(City Council on February 2, 3 and 4, 1999, adopted this Clause, without amendment.)

The Emergency and Protective Services Committee recommends the adoption of the report dated November 23, 1998, from the Commissioner of Works and Emergency Services.

The Emergency and Protective Services Committee reports, for the information of Council, having:

(a)requested the Commissioner of Works and Emergency Services to report to the Emergency and Protective Services Committee providing:

(i)the current status of the Corporate Safety First Aid and CPR training group;

(ii)the number of staff who are currently trained in First Aid and CPR; and

(iii)recommendations, if necessary, on how the First Aid/CPR Programs should be enhanced in the future; and

(b)referred to the Budget Committee for review and approval the following motion:

"That all revenues that accrue from First Aid/CPR Programs be utilized to fund initiatives, including the Public Access Defibrillation Program, that contribute to City Council's commitment to being a 'Cardiac Safe City'."

The Emergency and Protective Services Committee submits the following report (November23, 1998) from the Commissioner of Works and Emergency Services:

Purpose:

To seek the approval of Council to enter into a contract with the Toronto District School Board for the provision of First Aid/CPR programs. This report also identifies the community benefits of providing First Aid/CPR programs to the students and staff within the Toronto District School Board.

Funding Sources, Financial Implications and Impact Statement:

This initiative is intended to be revenue-neutral to marginally revenue-positive. Fees for courses will be paid on a per-student basis, and there will be full cost-recovery of all program expenses. It is estimated that the net revenues arising from the program may amount to approximately $45,000.00 This will be paid to the City of Toronto.

Recommendations:

It is recommended that:

(1) City Council give approval for Toronto Ambulance to enter into a contract with the Toronto District School Board for the purposes of providing training in Emergency First Aid, Standard First Aid, Cardio Pulmonary Resuscitation (CPR) and safety related training programs;

(2) City Council endorse Toronto Ambulance's pursuit of other First Aid/CPR revenue generating opportunities;

(3) City Council endorse Toronto Ambulance's promotion of public awareness and training in First Aid and CPR; and

(4) the appropriate City officials be authorized and directed to take the necessary action to give effect thereto.

Background:

In 1988, Toronto Ambulance established the Corporate Safety First Aid and CPR training group. The mandate of this unit is to deliver First Aid/CPR programs to employees of Toronto, and its Agencies, Boards Commissions and Departments. This group was, and continues to be, staffed with permanently partially disabled paramedics, individuals who have suffered work related injuries and are unable to continue with their pre-injury roles.

Over the years the expertise of the unit and the reputation of each of its programs has become very well known, both within Toronto and to a number of outside organizations. Many agencies continue to solicit the services of the Safety First Aid and CPR group in order to provide their Workplace Safety and First Aid/CPR programs. Organizations for whom programs have been delivered include the City of North York, the North York Board of Education, the Ontario Association of Hostels and De Havilland.

The Toronto Safety First Aid and Training program has been recognized by the Workplace Safety and Insurance Board (WSIB) as being able to provide the equivalent of the First Aid requirements legislated under Regulation 1101. As well, CPR training meets all of the standards and guidelines set out by the Heart and Stroke Foundation of Ontario.

Although the program is mainly delivered on a cost-recovery basis, overall benefits are recognized through contribution to Emergency Medical Services (EMS) public awareness and, by extension, through contribution to increased citizen survival from cardiac arrest.

Potential for additional revenues exist through the establishment of organizational instructor pools and by the sale of First Aid/CPR course books and materials.

Comments and/or Discussion and/or Justification:

Toronto Ambulance has promoted a number of public awareness, safety and first aid and health awareness programs within the community. Recently Council recommended that Toronto become a "Cardiac Safe City", through the promotion of CPR and Public Access Defibrillation training. A recent review of statistics from the Toronto Ambulance database indicates that in order to positively influence survival from cardiac arrest - and to become a Cardiac Safe City - greater public awareness, education and involvement is required. One of the ways of meeting this need is through the provision of training and public awareness programs to the youth in our school systems. In many parts of Canada and the United States this type of training is a standard part of school curriculum, and helps ingrain the need for vigilance and responsiveness in the face of unexpected medical emergencies. Truly, the overall effectiveness of the health care system begins at the first responder level, and early training helps foster that practice.

Toronto Ambulance has supported the Acute Coronary Treatment (ACT) Foundation in its efforts to make CPR training a mandatory component of grade nine curriculum in all schools. The Toronto District School Board has made a request for proposals for such training. The opportunity to participate in this contract will allow Toronto Ambulance to enhance its commitment to the City of Toronto's goal of becoming a "Cardiac Safe City".

In order to support the school board in this initiative, instructors from the Toronto Safety First Aid and CPR program will be utilized. Once programs are established, instructors will be identified from within the school board itself, and they in turn will be able to continue training staff and students.

Initial training will include 1,800 participants for Emergency First Aid and CPR, 600 participants for Standard First Aid and CPR, and 200 participants for CPR alone. The contract for training represents an amount of $78,000.00. The cost to Toronto Ambulance to provide the training - inclusive of instructor wages and course materials - will be approximately $33,500.00 dollars, leaving a net profit of approximately $45,000.00.

Conclusions:

Toronto Ambulance's participation in first aid and CPR training in schools will further contribute to Toronto's commitment to being a "Cardiac Safe City". This, along with other initiatives, such as Public Access Defibrillation, will help the public better appreciate the important role they can play within the Emergency Medical Services system in Toronto. This strengthening of the first link in the "chain of survival" will enhance the medical chances of those citizens who suffer from an unexpected cardiac illness or, worse, a cardiac arrest.

Through opportunities such as the contract with the Toronto District School Board, Toronto Ambulance can ensure appropriate training is provided, and that activities related to public awareness are optimized.

Contact Name:

Norm Lambert,

Manager, EMS Education and Development Unit

Tel: 392-2061/Fax: 392-2149

2

Continuing Evolution of the Ambulance Act

of Ontario and Identified Potential Financial

Implications.

(City Council on February 2, 3 and 4, 1999, amended this Clause by adding thereto the following:

"It is further recommended that a copy of this Clause be forwarded to the Premier of Ontario and the Provincial Minister of Health.")

The Emergency and Protective Services Committee recommends that the new provincial Ambulance legislation and the issue of the Ambulance fee charged be referred to the Toronto Caucus of the Association of Municipalities of Ontario and that of the Greater Toronto Services Board for discussion.

The Emergency and Protective Services Committee reports, for the information of Council, having requested the Commissioner of Works and Emergency Services to review the following and report thereon to the Committee:

(a)the possibility of billing the hospitals for the administration of the paperwork provided by Toronto Ambulance; and

(b)the new Ambulance Act of Ontario and its Regulations as they relate to the issue of co-payments.

The Emergency and Protective Services Committee submits the following report (December2, 1998) from the Commissioner of Works and Emergency Services:

Purpose:

To update the Committee and Council on the status of the Ambulance Act of Ontario and its Regulations and to bring to the Committee's and Council's attention to potential financial implications within the current Act.

Funding Sources, Financial Implications and Impact Statement:

There are no immediate funding considerations associated with this report, however, there are potential financial implications.

Recommendations:

It is recommended that this report be received for information and that appropriate consultation and further assessment be undertaken.

Council Reference/Background/History:

As of January 1, 1998, under the Services Improvement Act (Bill 152), the funding responsibility for land ambulance services in Ontario has been downloaded to the upper tier municipalities.

The management and operation of the ambulance service is governed and regulated by the Ambulance Act of Ontario and its Regulations and was originally brought to the attention of the Emergency and Protection Services Committee in a report dated April 1, 1998.

The Ministry of Health has been working with the Land Ambulance Transition Task Force to review and reform the legislative framework for ambulance service in Ontario. Toronto Ambulance has made presentations to this Task Force and we await the results of their deliberations. The current Ambulance Act has been extended through to March 31, 1999, and, as of yet, we do not know what its final form will be.

There are a number of areas in the current Ambulance Act which we feel must be assessed in greater depth as they may result in financial implications not only to the Ambulance Services Division but to other departments within the City of Toronto.

Comments and/or Discussion and/or Justification:

A copy of the general overview of the initial changes to the Ambulance Act and Regulations originally submitted to the Emergency and Protective Services Committee is attached for reference.

The following are the sections of concern:

Part 1: Definitions:

The "old" Act defined ambulance as "a conveyance used or intended to be used in an ambulance service for the transportation of persons requiring medical attention or under medical care."

The current definition is "a conveyance used or intended to be used for the transportation of persons who (a) have suffered a trauma or an acute onset of illness ... or (b) have been judged by a physician to be in an unstable medical condition and to require, while being transported, the care of a physician, nurse ... and the use of a stretcher".

The section referred to under part (a) refers to emergency calls but our concern is that part (b) may not reference non-emergency calls.

Toronto Ambulance transports approximately 176,000 patients annually of which approximately 40percent or 70,000 patients fall into the broad category of non-emergency. These patients are today transported without charge to the patient as per OHIP regulation as the majority of these calls involve a medical institution.

There is in the community a number of patient transportation services which transport non-emergency patients but charge the patient a fee of up to $65.00 per call. This sector of the industry is both unregulated and unlicensed but discussions with Licensing have been undertaken.

Our concern is that should we be excluded from providing service to patients deemed to be in a "stable" medical condition, this group of patients may be charged a fee for service previously non-existent and may be interpreted as a "user fee" by the general public.

Part VI: General:

The current Ambulance Act provided "If a person who is transported in an ambulance is receiving general assistance from a municipality under the General Welfare Assistance Act or assistance under the Ontario Works Act 1997 or is a dependent of a person receiving such assistance, the municipality or the delivery agent is also liable for and shall pay the person's share of the ambulance service operator's fee as established under subsection 22 1 (s)."

There is currently a co-payment of $45.00 charged to a patient transported by ambulance by the receiving hospital.

In discussion with Community Services, we have estimated that approximately 81,920 persons receive assistance in a month; from this population we anticipate transporting 6,500 patients of which 4,000 would be emergency calls and subject to the $45.00 co-payment. This could result in a bill to the municipality of about $180,000.00 per annum, payable to the receiving hospitals; should Toronto Ambulance be excluded from the non-emergency sector, the 2,500 non-emergency patients would cost the municipality $162,500.00 per annum.

It is interesting to note that of the $45.00 co-payment collected by the receiving hospitals, they are required to submit $15.00 to the provincial government; from the figures we have presented, this would translate into $60,000.00 per annum.

The figures we have presented, represent City of Toronto residents; it is our understanding that there are approximately 3,900 non-resident persons receiving assistance in a month. This Division could transport 308 in a year of which 184 would be emergencies, costing approximately $8,280.00 to be paid to the receiving hospitals and $8,060.00 for non-emergency calls.

Regulations, Part II, Licences:

There is a requirement that the municipality apply for a licence to operate and/or provide ambulance service and there have been discussions concerning a certification process to maintain the credential. The current licensing fee is negligible, however, our research has shown that certification could amount up to $25,000.00.

Part III: Qualifications:

There is a new qualification in the Regulation which prohibits any one with six or more demerit points on their driver's licence from being employed as a paramedic.

We are currently determining how many of our staff could be affected by this requirement. Toronto Ambulance may incur employment separation/settlement costs and must incur replacement costs.

There are also Regulations which outline mandatory training requirements for both operations and communications personnel.

Should the Regulations stay as they are, there may be additional costs incurred should this required training exceed that which we currently provide.

Conclusions:

Toronto Ambulance will continue to monitor the evolution of the Ambulance Act and Regulations and will continue to assess the potential impacts and implications and will advise the Emergency and Protective Services Committee and Council of the final outcome of this process.

Contact Name:

Ronald L. Kelusky, Tel: 397-9240/Fax: 392-2115

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Appendix A

Toronto Ambulance

Summary of Changes to the Ambulance Act of Ontario

Part I:Definitions:

The definition of an ambulance has been narrowed and is more specific than previously, and may have significant implications for service delivery. The definitions have been expanded to include air ambulance services, delivery agent, designated area and upper-tier municipality which are dealt with in the Act. More specific definitions of emergency medical attendant and paramedic are included, which encompass both employees and volunteers.

Part II: Provincial Responsibilities:

This part details the functions and powers of the Minister. Significant changes have been made related to the training of personnel for ambulance services and communications services, the establishment of regions and districts, and the designation of base hospitals. The Minister can establish and operate, alone or co-operatively, institutes and centres for training. This may have implications for the well developed and accredited educational activities of Toronto Ambulance.

Part III: Responsibilities of Upper-Tier Municipalities:

This part deals extensively with the responsibilities of upper-tier municipalities, including Toronto, and provides details regarding the two-year protection period, operator selection, licensing by the Ministry, authority of the municipality to pass by-laws related to ambulance services and the responsibility for payment. Upper-tier municipalities may assume responsibility for the provision of land ambulance services in the municipality during and following the protection period.

Part IV: Delivery Agents:

Delivery agents may be designated by the Minister in areas which do not form part of an upper-tier municipality. Such a municipality can itself be designated as a delivery agent for other areas and may present an opportunity for Toronto Ambulance. This part also details the roles of the Minister and the responsibilities for and payment of the delivery agent.

Part V: Licences.

This part identifies the requirement for a licence to operate an ambulance service, the grounds for refusal to issue a licence and the grounds for revocation. As well the role, responsibilities and function of the Health Facilities Appeal Board related to ambulance services are described.

Part VI: General:

This part addresses the appointment and powers of inspectors, confidentiality, and the prohibition of user fees. The authority and expanded scope of the regulations which can be made by the Minister in relation to ambulance services is detailed. Also included in this part are sections related to the apportionment of costs in upper-tier municipalities. The authority to create different classes of ambulances, ambulance services and operators with different requirements, standards or conditions is broad and may have implications for the level of service and care to be provided to the citizens of Toronto.

Summary of the Changes to the Regulations

under the Ambulance Act

Introduction:

The regulations under the Ambulance Act have not been substantially revised in almost twenty years. Therefore, a number of antiquated sections have been updated and existing standards and components of the ambulance system not currently provided for in the regulations have been incorporated into the regulations (for example, air ambulance services and first response teams). Also, a number of regulations have been deleted in order to provide municipalities with more flexibility and decision-making power, and to eliminate red tape. Most importantly, the regulations have been revised to reflect the 'Who Does What' decisions respecting ambulance services.

The following is a summary of the changes made under each Part of old Regulation 19 under the Ambulance Act:

Part I: Definitions:

Definitions for programs, persons and vehicles that currently exist in the system have been added (i.e.,"aeromedical transportation", "air ambulance", "first response team members", "midwife", "registered nurse in the extended class" and "emergency response vehicles").

Three classes of paramedic are defined, each with a different scope of practice: primary care paramedic, advanced care paramedic and critical care paramedic. The primary care paramedic is equivalent to the Toronto Ambulance Level I paramedic. The Department's Level III paramedic, however, has a skill set beyond the scope of the advanced care paramedic and less than the critical care paramedic, as defined in the regulations. The difference in scope of practice may have significant implications for the type of licence applicable to Toronto Ambulance, as well as for its ability to meet the requirements of the regulations for staffing of ambulances.

The definition of a communications officer has been expanded to permit the receipt of calls and the dispatch of other emergency and non-emergency services. This has implications for the ability of the Department's control centre to receive requests for, and to dispatch to, such services as home-care.

Among the new definitions, the addition of the 'first response' vehicle has significance for the Department. This validates the operation of such services as the emergency response units, and may provide an opportunity for an expanded role for single paramedic response services. This parallels the revised definition of a 'patient' which permits first aid, emergency and other medical care to be provided without the requirement for transport.

Finally, definitions have been updated to improve the language or to make the language consistent with Bill 152 and other legislation.

Part II: Ambulance Service Licences:

Four classes of licences are created by this regulation. They reflect the level of care to be provided and the level of the scope of practice of the providers in each class - emergency medical attendant, primary care paramedic, advanced care paramedic and critical care paramedic. The requirements for each licence are detailed, including the application process and the conditions of licensure.

A regulation was added requiring that land ambulance service operators present proof of an agreement with a municipality before the operator is issued a licence or an operator's licence is renewed. This lets the Ministry know that the municipality has evaluated that operator and that the two parties have made decisions respecting the proper management, operation and use of ambulance services. Where the municipality is the operator, such agreement is not required.

Part III: Qualifications of Persons Employed in Ambulance and Communication Services:

The basic qualifications required of emergency medical attendants and paramedic are detailed. Specific additional requirements for full-time employees, part-time employees and volunteers are detailed for emergency care attendants, primary care, advanced care and critical care paramedics. The paramedic levels all require documentation regarding authorization from the base hospital medical director to perform controlled acts as listed in the schedules appended to the regulations. This requirement raises issues related to scope of practice of the different levels of paramedics as defined by the schedules, and the scope of practice currently in place for Toronto paramedics, specifically levels II and III.

The required qualifications for communications officers are also provided. New requirements for officers employed after January 1, 1999, include completion of a communications officer training program and a pass standing in an emergency communications examination. To date, Toronto Ambulance has not been advised of the training program nor the examination process.

Part IV: Continuing Education and Training of Persons Employed in Ambulance and Communication Services:

This part details the requirements of the operator - as a condition of the operator's licence - to ensure that the training and continuing education requirements of both the Director and the Base Hospital are met. Remedial training requirements for emergency medical attendants and paramedics are defined. Requalification examinations may be required every three years, at the direction of the Director.

The addition of training and continuing education requirements to the regulations supports the importance of an in-house education and training program capable of meeting the standards of the regulations. In addition, there is an opportunity for the Emergency Medical Services (EMS) education program to be enhanced to provide additional training and continuing education programs to external (non-Toronto) operators, beyond those which are currently offered. This may lead to additional opportunities for training-based revenue generation.

Under this Part, the Director may require that a person take a requalifying examination if the person has not taken any such examination in three years or if the Director has reasonable grounds for belief that the person may not be competent to perform, with reasonable skill, the duties normally required for his or her position.

Part V: Standards of Care for Emergency Medical Attendants and Paramedics:

The addition of standards of care requirements under the regulation is welcomed. The standards being used, however, are those published in 1995 by the Ministry of Health (Basic Life Support-Patient Care Standards Manual). Concerns have been identified that advances in out-of-hospital care may not result in sufficiently prompt changes to the standards of care described in the manual. No provision for doing so is outlined in the regulations, and may be a limiting force in the progress of out-of-hospital care.

Part VI: Functions and Duties of Base Hospitals:

The functions and duties of the Base Hospitals have been added to the regulations. These additions define the role of the Base Hospital and its relationship with an ambulance service.

The requirement for the Base Hospital to provide training for all emergency medical attendants and paramedics within the Base Hospital's jurisdiction is of concern. It is unclear whether the provision of such training will be a direct function of the Base Hospital, or whether it will best be accomplished in collaboration with the EMS education program already well established at Toronto Ambulance, as is the current situation. As well, the authority of the Base Hospital Medical Director to determine if the patient care skills of the emergency medical attendant or paramedic are deficient may be a source of contention as there may be confusion between the standards of care outlined in Part V and the Medical Director's own determination of patient care skill deficiency.

Part VII: Standards, Maintenance and Repairs of Ambulances, Emergency Response Vehicles and Equipment

This part requires the operator to ensure that standards set by the Ministry are met. It references documents detailing the minimum standards required for land ambulances and emergency response vehicles, as well as the document for minimum provincial equipment standards.

As the equipment standards are minimum standards, local ambulance services may exceed them, and are no longer required to carry specific manufacturer's products. This will enable Toronto Ambulance to seek efficiencies in equipment and supply selection beyond that previously permitted. Operators and/or municipalities will also be able to carry additional equipment on their ambulance vehicles; however, the permission of the base hospital medical director will be required to carry any additional equipment that is used by paramedics to perform controlled acts.

The requirements for the maintenance of ambulances and emergency response vehicles are defined, as is the requirement to maintain repair and maintenance records for a period of three years. The purpose of this regulation is to ensure that operators have a preventative maintenance program in place and that evidence of such program is available. At present, operators are required to follow preventative maintenance schedules established by the Emergency Health Services Branch of the Ministry of Health.

Regulations requiring that operators have each ambulance and emergency response vehicle inspected at a motor vehicle inspection station every six months have been deleted. This will allow municipalities to specify a vehicle inspection schedule that best meets their needs and requirements.

A regulation was added requiring that an operator immediately notify the communication service when an air or land ambulance or emergency response vehicle has been withdrawn from service for maintenance and repair, and when it is back in service. Regulations were also added to require that an operator make available each land ambulance and emergency response vehicle in the operator's service for an annual inspection of the communications equipment in the vehicles, to be arranged by their communication service.

Requirements for emergency medical attendants and paramedics regarding the sterilization and disinfection of equipment, cleaning of the patient compartment of ambulance vehicles, restocking of vehicles and the responsibility to safely and properly store accessories and patient care equipment is detailed. The operator is required to establish procedures relating to sterilization and disinfection of equipment.

Part VIII: Reports and Records by Ambulance and Communication Services Employee Register:

This part limits the requirements for maintenance of a register for employee qualifications. The skills inventory currently maintained by Toronto Ambulance meets this requirement and provides an additional source of continuing education activity.

The 'incident reports' requirement for operators of communications services are defined. Previous requirements to submit incident reports have been removed, although copies are to be maintained for a period of three years.

The existing regulation requiring that an ambulance call report be completed by an emergency medical attendant or paramedic "with respect to the call" has been modified to clarify when a call report shall be completed. It is current policy that a call report be completed: (1) whenever a response to a request for ambulance service is initiated, and (2) with respect to each person for whom patient care is provided, regardless of whether the patient is transported by ambulance. This policy has been incorporated in the legislation. A retention period for the call reports was also added, since these reports may be essential, for example, in subsequent Ministry investigations and inspections or for litigation purposes.

Part IX: Accounting System and Report by Ambulance and Communication Services:

This part details the requirements for accounting system and reports to be provided by operators who receive funds from the Province of Ontario. Municipalities who assume responsibility and funding of ambulance services will not be required to provide reports to the Ministry, since they can specify the accounting system and types of reports they require of an operator.

Toronto's Ambulance Communications Centre, however, may be subject to the Ministry's reporting requirements.

Part X: Insurance:

The Ministry currently holds the policy for automobile insurance for all ambulances owned by the Province. There are only a few ambulances across the Province that are not owned by the Ministry. For non-Ministry vehicles, operators are required under the current legislation to obtain and maintain a contract of automobile insurance with minimum liability insurance in the amount of $1,000,000.00. This section in the regulation has been modified: (1) to apply to only those operators who receive funds from the Province, allowing municipalities to specify the municipality's insurance requirements in other cases, and (2) to update the amount of insurance that must be obtained to bring it in line with more recent damage awards. The proposed minimum is $2,000,000.00.

This section has also been modified to require that every communication service, base hospital and land ambulance service operator who receives funds from the Province obtain and maintain a contract of general liability insurance in the amount of $2,000,000.00. By Ministry policy, land ambulance service operators are currently required to obtain liability insurance in this amount.

As a result, this is not a new cost and it is included in the $228+M in land ambulance service costs being transferred from the Province to municipalities. However, the requirement for liability insurance for communication services and base hospitals is new, although many already have such insurance. The cost of this insurance will be borne by the Ministry.

Part XI: Management and Operation of Ambulance and Communication Services:

This part establishes requirements for the staffing of ambulances, and has broad implications for Toronto Ambulance. The staffing requirements are linked directly to the type of licence held by the operator. As noted in the comments regarding Part I, none of the definitions appear to apply to the level of paramedic currently provided by Toronto Ambulance.

There is no provision apparent for the hybrid Level III paramedic which the Department and other ambulance services now employ. Even if our current Level III paramedics were deemed equivalent to one of the paramedic levels under the regulations, the requirements of Part XI that each vehicle be staffed by at least one paramedic of the level of the operator's licence could not be met by current Level III trained staff. Alternatively, it is unclear if the Toronto Ambulance should therefore apply for a primary care licence, whose requirements we meet now, and in so doing possibly create a risk management issue by providing a service which exceeds the scope of the licence.

Specific standards for response time performance are set for the operator of an ambulance service in an upper-tier municipality based on the 90th percentile of 1996 performance of the operator. In other words, all operators of ambulance service must in 1998 achieve standards at least consistent with standards achieved in 1996.

There has been a modification to the regulations regarding the destination of the transported patient. The new regulations require that in the absence of direction by a communications officer, the patient shall be transported to the nearest facility which provides the type of care required for the patient. Previous regulations were less explicit, requiring only that the patient be transported to the nearest facility 'apparently' able to provide care.

The current hospital restructuring process will result in hospitals with varying individual capabilities and capacity. Situations of this type already exist in some Toronto hospitals, and will undoubtedly become more prevalent. This will necessitate that Toronto Ambulance enhance its liaison activity with the hospital community and provide the leadership, development and training to ensure that staff are able to determine which facility is appropriate for the patient receiving care. This may require enhanced diagnostic skills for paramedics, as well as triage guidelines for many conditions parallelling those currently in place for trauma triage.

A limitation on the ability of a physician or midwife to direct the destination of the patient is imposed on the communications officer. The communications officer will direct the ambulance elsewhere if the facility cannot receive the patient. This would appear to be linked to the current Central Resource Registry System but this is not specified and may be open to much wider interpretation by the receiving hospital as well as the communications officer. Attention to this area will be required to ensure that communications and hospital staff are interpreting this section in an equivalent manner.

A new requirement to the regulations has been added regarding submission of deployment procedures to the Director for approval. The approval is predicated on the response to calls being efficient, accurate and timely, which appears to permit any level of response standard or any deployment plan deemed appropriate to be imposed on the operator.

3

Legal Validity of Toronto Licensing

Obtaining Personal Information

in the Possession of the Toronto Police Service.

(City Council on February 2, 3 and 4, 1999, adopted this Clause, without amendment.)

The Emergency and Protective Services Committee recommends that:

(1)Toronto Licensing be considered a law enforcement agency under section 32(f)(ii) of the Municipal Freedom of Information and Protection of Privacy Act; and

(2)the Toronto Police Services Board be requested to provide, on a voluntary basis, the personal information referred to in the report dated December 7, 1998, from the City Solicitor to Toronto Licensing upon request.

The Emergency and Protective Services Committee submits the following report (December7, 1998) from the City Solicitor:

Purpose:

The purpose of this report is to respond to the request of the Emergency and Protective Services Committee for an opinion on the "legal validity of Toronto Licensing obtaining Police information in regard to charges laid against a licence holder or applicant."

Funding Sources, Financial Implications and Impact Statement:

N/A

Recommendation:

It is recommended that this report be received for information.

Council Reference/Background/History:

At its meeting held on June 16, 1998, the Emergency and Protective Services Committee had before it a communication, dated June 2, 1998, from Councillor Dennis Fotinos. Among other things, this communication requested that the City Solicitor report on the "legal validity of Toronto Licensing obtaining Police information in regard to charges laid against a licence holder or applicant." The Committee referred that request to the City Solicitor for a report.

Comments and/or Discussion and/or Justification:

Both the ability of the Toronto Licensing Commission (the "Commission") to obtain the production of the relevant information, and the ability of the Toronto Police Service (the "Service") to disclose that information, are governed by the terms of the Municipal Freedom of Information and Protection of Privacy Act ("MFIPPA").

The type of information identified by Councillor Fotinos would constitute personal information under MFIPPA. Subsection 2(1) of MFIPPA generally defines "personal information" as recorded information about an identifiable individual. This general definition of personal information also specifies certain types of information that are included within it. Information regarding charges laid against a licence holder or applicant is recorded information regarding an identifiable individual. The Ontario Information and Privacy Commissioner (the "IPC") has held in similar situations that a record of charges being laid constitutes personal information.

In light of this, there are two ways in which the Commission could seek access to the relevant information. These are:

(1)The Commission could request the Service for access to the information under Part I of MFIPPA, in the same manner as any other person. If a request is denied, the Commission could appeal that decision to the IPC.

(2)Part II of MFIPPA confers a discretionary power on the institution in possession of personal information to disclose it if certain statutory criteria are met. Under this Part, there is no formal request for disclosure and no right of access is created. This is a voluntary and discretionary power that the Service could use to disclose personal information in circumstances authorized by MFIPPA.

(1)Right of Access to Personal Information Record:

Subsection 4(1) of MFIPPA confers a right on all persons to gain access to a record in the custody or control of an institution. The Commission has a right of access to a record.

Sections 6 through 15 of MFIPPA set out a variety of exceptions to the general right of access established by subsection 4(1).

In particular, subsection 14(1) of MFIPPA sets out a general principle of mandatory non-disclosure of personal information in the custody of a public institution in response to an access request. There are limited statutory exceptions to this principle establishing when an institution may disclose personal information in response to a request, the application of which will vary depending on the circumstances of the individual case. If the Commission's request were to fall within an exception, it would have a right of access to the information. In the event the Service denied the request, the Commission could appeal that decision to the IPC.

Subsection 8(1) of MFIPPA is another possible exemption that may be applicable to deny a Commission request for access to a record. This section confers on the Service the discretion to deny disclosure of records for the specified reasons pertaining to law enforcement. In particular, clauses8(1)(a) and (b) are relevant in that they allow an institution to deny disclosure of a record if it could reasonably be expected to interfere with a law enforcement matter or interfere with an investigation undertaken with a view to a law enforcement proceeding.

Therefore, the Commission can make a request for access to the Service. The analysis of whether the Commission is entitled to access will depend on the circumstances of each case.

(2)Discretionary Power to Disclose Personal Information:

Section 32, contained in Part II of MFIPPA, governs the daily and voluntary disclosure of personal information by institutions in administering their public responsibilities in the absence of a formal request for such information under Part I of MFIPPA, discussed above. Disclosure of personal information pursuant to section 32 is discretionary and voluntary on the part of the institution in possession of the information. It does not create a right of access. Section 32 prohibits disclosure of personal information except in the circumstances set out in the section.

The Commission may fall within the exception to non-disclosure set out in clause 32(f)(ii) which authorizes a law enforcement institution to disclose personal information to another law enforcement agency in Canada. Clearly, the Service is a law enforcement institution. There have also been orders of the IPC in which the Commission's by-law enforcement process has been held to be a "law enforcement" proceeding. Therefore, there is an argument that, at least with respect to the enforcement of the licensing by-law, the Commission may be considered a "law enforcement agency" for the purposes of clause 32(f)(ii) of MFIPPA. This conclusion would permit disclosure of personal information by the Service to the Commission, at the Service's election.

The exception contained in subsection 32(g) of MFIPPA may also apply. This exception allows disclosure to "an institution or a law enforcement agency in Canada to aid an investigation undertaken with a view to a law enforcement proceeding or from which a law enforcement proceeding is likely to result." The IPC has held that a by-law enforcement process does qualify as a "law enforcement" proceeding or matter. Therefore, if the Commission can establish that the information requested is for the purpose identified in the subsection, disclosure would again be permitted, at the Service's election.

Thus, it is possible that the Service can disclose information to the Commission under clause 32(f)(ii) or subsection 32(g). However, this would be a voluntary disclosure by the Service and the Commission cannot compel the Service to disclose records under section 32.

It should be noted that the IPC has held in recent decisions that section 32 is not relevant when considering a request for access under Part I of MFIPPA.

Conclusions:

Generally, MFIPPA prohibits the disclosure of personal information. However, the Commission can request access to records under subsection 4(1) of MFIPPA. This request for access can only be assessed on a case-by-case basis. The Commission can also receive information from the Service based on the Service's discretionary power to disclose information under section 32 of MFIPPA. Section 32 only confers a discretionary power and the Commission cannot compel the Service to disclose personal information under that section.

Contact Name:

Albert H. Cohen, Director, Litigation, Legal Division

Tel: 392-8041

4

Other Items Considered by the Committee.

(City Council on February 2, 3 and 4, 1999, received this Clause, for information.)

(a)Integration of the Public Access Defibrillating (Cardiac Safe City) Program into the Emergency Response System.

The Emergency and Protective Services Committee reports having received the following report:

(December 9, 1998) from the Commissioner of Works and Emergency Services advising of the integration of the Public Access Defibrillation (Cardiac Safe City) Program into the City's existing emergency response system; noting that the program at Toronto City Hall will act as a demonstration project to show how workplaces across the City can increase the level of life safety present in their buildings; and recommending that the report be received for information.

(b)Collision Reporting Centres and Their Profit Margins.

The Emergency and Protective Services Committee report having:

(a)referred the following motions to the City Solicitor for a report thereon to the Emergency and Protective Services Committee:

(1)that a fourth Downtown Collision Reporting Centre (CRC) be opened;

(2)that the appropriate City staff recommend suitable City lands for a Downtown CRC, in order to minimize the cost;

(3)that the appropriate staff report on a suitable location;

(4)that the Downtown CRC be operated by the City of Toronto; and further that the responsibility for the administration of all CRC contracts be transferred to the City, with the Toronto Police Services Board continuing to provide Police personnel;

(5)that proceeds from the CRCs be directed towards civilian staffing by the CRCs;

(6)that, initially, the Downtown CRC be operated as a nine-hour facility, with the possibility of expansion to a twenty-four hour facility; and

(7)that the insurance industry be advised that, should any legal actions nullify the provisions of the by-law that prohibits persons in a CRC from recommending an autobody shop, the City exercise its options with the Collision Reporting Centres' contracts to terminate and operate them as City facilities without the direct involvement of the insurance industry;

(b)referred the following joint memorandum from the Executive Director, Municipal Licensing and Standards, and the General Manager, Toronto Licensing, to the City Solicitor with a request that he submit a confidential report thereon to the next meeting of the Emergency and Protective Services Committee, such report to include a full range of remedies that might be available to respond to the actions taken by the insurance industry with respect to the Collision Reporting Centres;

(c)requested the Toronto Police Services Board to give consideration to bringing accident data back on line within six months;

(d)directed that, if it is the wish of the private sector that a third-party survey be conducted to investigate allegations with respect to customer persuasion, direction, and satisfaction, and they wish to fund such a survey, the appropriate staff be requested to help the industry develop terms of reference; that such survey be managed and controlled by the City Auditor, and directed to customers of the Collision Reporting Centres; and further that a report thereon be submitted to the Emergency and Protective Services Committee; and

(e)received the following reports dated November 17 and December 16, 1998, from the City Auditor:

(i)(November 17, 1998) responding to a recommendation by the Budget Committee that the City Auditor report on the collision reporting centres' operations and their profit margins; and recommending that the report be received for information;

(ii)(December 16, 1998) responding to the request of the Emergency and Protective Services Committee on December 1, 1998, to provide the names of the members of the Collision Reporting Centre Evaluation Committee; and

(iii)(January 12, 1999) from the Executive Director, Municipal Licensing and Standards, and the General Manager, Toronto Licensing, recommending that the City Solicitor be requested to submit a confidential report to the next meeting of the Emergency and Protective Services Committee on the legal proceedings initiated by the Allstate Insurance Company of Canada, the General Accident Group (Canada) Ltd., and the Progressive Casualty Insurance Company of Canada with respect to Schedule 24 of By-law No.20-85.

The following persons appeared before the Emergency and Protective Services Committee in connection with the foregoing matter:

-Mr. Michael Wines, representing the Independent Auto Repairer's Association, and submitted a brief in regard thereto; and

-Councillor Blake F. Kinahan, Lakeshore-Queensway.

(c)Communication Respecting the Granting or Extension of Liquor Licences.

The Emergency and Protective Services Committee reports having referred the following motion by Councillor Frances Nunziata to the Commissioner of Urban Planning and Development Services, in consultation with appropriate staff, with a request that she report thereon to the Emergency and Protective Services Committee, such report to include a systematic approach to be undertaken by all the Community Councils in the consideration of liquor licence issues:

"WHEREAS the granting of liquor licences or the extension of liquor licences in most communities is a sensitive issue; and

WHEREAS in some of the former municipalities that now constitute the City of Toronto, prior to the issuance of a liquor licence, the opportunity to comment was provided to the local police division, fire department, by-law staff and other appropriate departments; and

WHEREAS the lack of communication between these bodies in the issuance of liquor licences afforded each of them the opportunity to obtain information on the applicant;

THEREFORE BE IT RESOLVED THAT such a process now be implemented in the City of Toronto and that the City urge the provincial Alcohol and Gaming Commission to take into serious consideration any comments received from the police, fire and any other appropriate department."

Councillor John Adams, Midtown, appeared before the Emergency and Protective Services Committee in connection with the foregoing matter.

(d)Request for Reports from the Toronto Ambulance and Fire Services - Current Snow Storm Emergency.

The Emergency and Protective Services Committee reports having:

(1)referred the following communications from Councillor Duguid to the Fire Chief and General Manager, Toronto Ambulance with a request that they report thereon to the next meeting of the Emergency and Protective Services Committee; and

(2)directed that the Chair of the Emergency and Protective Services Committee be requested to write to the General Manager, Ambulance Services, the Fire Chief, and the Chief of Police commending their staff for their efforts during the recent winter snow storms:

(January 4, 1999) addressed to Chief Alan Speed, Toronto Fire Service and the General Manager, Toronto Ambulance, from Councillor Brad Duguid, Scarborough City Centre, requesting reports be submitted to the Committee on their responses to the current snow storm emergency, and on the risks faced by residents due to the inaccessibility of some streets to emergency services as a result of the storm.

The Commissioner of Works and Emergency Services, in response to concerns raised by CouncillorBrian Ashton, advised the Emergency and Protective Services Committee that clearance of snow around fire hydrants would be given priority.

Respectfully submitted,

DENNIS FOTINOS

Chair

Toronto, January 12, 1999

(Report No. 1 of The Emergency and Protective Services Committee was adopted, as amended, by City Council on February 2, 3 and 4, 1999.)