Purpose:

To update the Board of Health on the status of amalgamation related activities and seek Board endorsement on a matter requiring Council approval.

Funding Sources, Financial Implications and Impact Statement:

None.

It is recommended that:

Council Reference/Background/History:

The six former health units in Metro Toronto became one on January 1, 1998. As Acting Medical Officer of Health for the new amalgamated Toronto Public Health department, I have initiated a number of activities to facilitate the transition to a unified department, including:

Discussions:

In this time of uncertainty, it is critically important that programs and services continue to be delivered without disruption to the public. To maximize stability for staff and programs, each former health unit (now termed an Aarea office@) is being managed by the same team as was in place December 1997 (with the exception of East York, in which the former Associate MOH has stepped in for the former MOH). As well, all past reporting relationships remain the same, with the exception that the heads of each area office report directly to me.

While it is Abusiness as usual@ for each area office on matters that are strictly local, issues that require city-wide coordination or resolution are dealt with at the Interim Executive Team (IET). The IET is comprised of the heads of each area office (i.e., the six former MOH=s and the Regional Directors in Toronto) and is chaired by me. It meets weekly to share information and to manage city-wide issues, many of which are under consideration by the Board and/or Council and its Committees. In turn, my role is to ensure coordinated public health responses to city-wide issues and to be the primary interface between public health and the Board, Council, major media, etc.

To complement the IET, functional groups are being established to coordinate information and to advise the IET on a variety of issues that are either administrative (e.g., budget, human resources, etc.) or programmatic (e.g., environmental tobacco smoke by-law, Healthy Babies, Healthy Children, etc.). Membership on these groups is intended to maximize continuity with past roles and responsibilities where appropriate. It will also be used to provide new opportunities for staff at all levels in the organization to participate in discussions from a city-wide perspective, which will help build our capacity to identify and respond to health needs as a unified organization. All of this information has been shared with management and staff at Atown hall@ meetings throughout the City. These sessions have been a very positive step for all concerned; they will be continued on a regular basis and complemented by newsletters and other methods to ensure information flow on a timely basis.

All of the structures described above are Ainterim@, pending the department=s participation in corporate restructuring. In the meantime, immediate steps must be taken on an interim basis to provide other physicians in the department with medico-legal signing authority pursuant to the Health Protection and Promotion Act (HPPA). This is needed to ensure that the day-to-day medical work in each area office can proceed efficiently and to ensure that all physicians on the after-hours on-call roster have the necessary status. As Acting Medical Officer of Health, I am currently the only physician in the department with any signing authority on medical-legal matters. As a result, routine documents from area offices (e.g., letters, orders, etc.) cannot be signed by those staff but must be referred to me, which is highly inefficient and not consistent with their other roles and responsibilities. It also means there is no-one legally able to serve as my back-up should I fall ill or otherwise be unavailable.

Associate MOH designations are sought for all public health physicians currently on staff, both former MOH=s and former Associate MOH=s. The proposed designations would be strictly on an interim basis for the express purpose of providing continuity in medico-legal signing authority. It would be in no way reflective of current or future organizational structures, positions, or reporting relationships, a distinction that has been discussed with the incumbents. The final status of all public health physicians will be resolved in the course of corporate restructuring, subject to the applicable human resources policies approved by Council.

While designation of only some physicians was considered, this option is not recommended as it would further disrupt working relationships and conflict with existing roles and responsibilities at a time when program stability and clarity of roles is most needed. My advice to designate all current physicians as AMOH=s reflects considerable discussion within the department as well as with legal counsel and the Executive Director of Human Resources. Final advice on physician complement and AMOH designations will be provided in the context of corporate restructuring.

Under the City of Toronto Act No. 2, City Council directly appoints the MOH and AMOH=s, and these appointments must be ratified by the Minister of Health. Once these designations have been approved by Council, they will be forwarded to the Ministry with a request for expedited approval.

Conclusions:

This report describes the steps taken in the past month to maintain continuity of local programs and services while building capacity to coordinate issues at a City-wide level. Interim designation of Associate MOH=s is a necessary step to ensure continuity in signing authority on medical matters, pending organizational restructuring. The Board is requested to endorse the proposed designations and forward them to Council for approval.

Contact Name:

Dr. Sheela Basrur

Acting Medical Officer of Health

Tel: 392-7402

Fax: 392-0713

e-mail: sbasrur@city.toronto.on.ca