s-4.2 - Act respecting health services and social services

Updated to 30 November 2005

This document has official status.

chapter S-4.2

Act respecting health services and social services

PART I OBJECT OF THE ACT AND RIGHTS OF USERS

TITLE I OBJECT

1. The health services and social services plan established by this Act aims to maintain and improve the physical, mental and social capacity of persons to act in their community and to carry out the roles they intend to assume in a manner which is acceptable to themselves and to the groups to which they belong.

The plan shall focus mainly on

(1)  reducing mortality caused by illness and trauma as well as morbidity, physical disabilities and handicaps;

(2)  acting on health and welfare determining factors and developing individual, family and community responsibility in that respect through prevention and promotion;

(3)  fostering the recovery of users’ health and welfare;

(4)  fostering the protection of public health;

(5)  fostering the adjustment or rehabilitation of users as well as their social integration or reintegration;

(6)  reducing the impact of problems which threaten the stability, fulfilment or autonomy of users;

(7)  attaining comparable standards of health and welfare in the various strata of the population and in the various regions.

1991, c. 42, s. 1; 1999, c. 40, s. 269.

2. In order to permit these objectives to be achieved, this Act establishes an organizational structure of human, material and financial resources designed

(1)  to ensure the participation of individuals and groups of individuals in the selection of orientations and in the setting up, improvement, development and management of services;

(2)  to foster the participation, in the various sectors of activity of the community, of all intervening parties whose action may have an influence on health and welfare;

(3)  to apportion responsibilities among public bodies, community organizations and other parties working in the field of health and social services;

(4)  to ensure that services are accessible on a continuous basis to respond to the physical, mental and social needs of individuals, families and groups;

(5)  to take account of the distinctive geographical, linguistic, sociocultural, ethnocultural and socioeconomic characteristics of each region;

(6)  to foster, to the extent allowed by the resources, access to health services and social services through adapted means of communication for persons with functional limitations;

(7)  to foster, to the extent allowed by the resources, access to health services and social services in their own languages for members of the various cultural communities of Québec;

(8)  to foster effective and efficient provision of health services and social services and respect for the rights of the users of such services;

(8.1)  to ensure users the safe provision of health services and social services;

(9)  to ensure participation of human resources of institutions referred to in Title I of Part II in the selection of orientations and the determination of priorities;

(10)  to promote research and education so as to respond more adequately to the needs of the population.

1991, c. 42, s. 2; 2002, c. 71, s. 1.

3. For the application of this Act, the following guidelines shall guide the management and provision of health services and social services:

(1)  the person requiring services is the reason for the very existence of those services;

(2)  respect for the user and recognition of his rights and freedoms must inspire every act performed in his regard;

(3)  the user must be treated, in every intervention, with courtesy, fairness and understanding, and with respect for his dignity, autonomy, needs and safety;

(4)  the user must, as far as possible, play an active role in the care and services which concern him;

(5)  the user must be encouraged, through the provision of adequate information, to use services in a judicious manner.

1991, c. 42, s. 3; 2002, c. 71, s. 2.

TITLE II RIGHTS OF USERS

CHAPTER I GENERAL PROVISIONS

4. Every person is entitled to be informed of the existence of the health and social services and resources available in his community and of the conditions governing access to such services and resources.

1991, c. 42, s. 4.

5. Every person is entitled to receive, with continuity and in a personalized and safe manner, health services and social services which are scientifically, humanly and socially appropriate.

1991, c. 42, s. 5; 2002, c. 71, s. 3.

6. Every person is entitled to choose the professional or the institution from whom or which he wishes to receive health services or social services.

Nothing in this Act shall restrict the freedom of a professional to accept or refuse to treat a person.

1991, c. 42, s. 6.

7. Every person whose life or bodily integrity is endangered is entitled to receive the care required by his condition. Every institution shall, where requested, ensure that such care is provided.

1991, c. 42, s. 7.

8. Before giving his consent to care concerning him, every user of health services and social services is entitled to be informed of his state of health and welfare and to be acquainted with the various options open to him and the risks and consequences generally associated with each option.

The user is also entitled to be informed, as soon as possible, of any accident having occurred during the provision of services that has actual or potential consequences for the user’s state of health or welfare and of the measures taken to correct the consequences suffered, if any, or to prevent such an accident from recurring.

For the purposes of this section and sections 183.2, 233.1, 235.1 and 431 and unless the context indicates otherwise,

“accident” means an action or situation where a risk event occurs which has or could have consequences for the state of health or welfare of the user, a personnel member, a professional involved or a third person.

1991, c. 42, s. 8; 2002, c. 71, s. 4.

9. No person may be made to undergo care of any nature, whether for examination, specimen taking, treatment or any other intervention, except with his consent.

Consent to care or the authorization to provide care shall be given or refused by the user or, as the case may be, his representative or the court, in the circumstances and manner provided for in articles 10 and following of the Civil Code.

1991, c. 42, s. 9; 1999, c. 40, s. 269.

10. Every user is entitled to participate in any decision affecting his state of health or welfare.

He is entitled, in particular, to participate in the development of his intervention plan or individualized service plan where such plans are required under sections 102 and 103.

The same applies to any modification made to such plans.

1991, c. 42, s. 10.

11. Every user is entitled to be accompanied and assisted by the person of his choice when he wishes to obtain information or take steps in relation to any service provided by an institution or on its behalf or by any professional practising in a centre operated by the institution.

1991, c. 42, s. 11.

12. The rights of any person which are recognized under this Act may be exercised by a representative.

The following persons are presumed to be representatives, according to the circumstances and subject to the priorities provided for in the Civil Code:

(1)  the holder of parental authority of a user who is a minor or the user’s tutor;

(2)  the curator, tutor, spouse or close relative of a user of full age under legal incapacity;

(3)  an authorized person mandated by the incapable user of full age before his incapacity;

(4)  a person proving that he has a special interest in the user of full age under legal incapacity.

1991, c. 42, s. 12; 1999, c. 40, s. 269.

13. The right to health services and social services and the right to choose a professional and an institution as provided in sections 5 and 6 shall be exercised within the framework of the legislative and regulatory provisions relating to the organizational and operational structure of the institution and within the limits of the human, material and financial resources at its disposal.

1991, c. 42, s. 13.

14. No institution may cease to lodge a user who has been discharged unless his condition allows his return home or his integration into a home, or unless his admission to another institution or any of its intermediate resources or to a family-type resource is assured and the services required by his condition will be provided to him by such institution or resource.

Subject to the first paragraph, a user must leave the institution where he is an in-patient immediately upon being discharged in accordance with the provisions of the regulation made under subparagraph 28 of the first paragraph of section 505.

1991, c. 42, s. 14.

15. English-speaking persons are entitled to receive health services and social services in the English language, in keeping with the organizational structure and human, material and financial resources of the institutions providing such services and to the extent provided by an access program referred to in section 348.

1991, c. 42, s. 15.

16. Nothing in this Act restricts the right of a person or his successors to pursue a remedy against an institution, its directors, employees or servants or a professional by reason of a professional or other fault. In no case may such remedy be waived.

The same applies to the right to pursue a remedy against a family-type resource.

1991, c. 42, s. 16; 1999, c. 40, s. 269.

CHAPTER II USER’S RECORD

17. Every user 14 years of age or over has right of access to his record. However, the institution may deny him access to it temporarily if, on the advice of his attending physician or the physician designated by the executive director of the institution, communication of the record or any part thereof would likely be seriously prejudicial to the user’s health. In that case, the institution, on the recommendation of the physician, shall determine the time at which the record or the part thereof to which access has been denied can be communicated to the user, and notify him thereof.

1991, c. 42, s. 17.

18. No user is entitled to be informed of the existence or be given communication of information concerning him furnished by a third person which is contained in his record, where knowledge of the existence or the communication thereof would make it possible to identify the third person, unless that person has agreed in writing to the disclosure of the information and of its source to the user.

The first paragraph does not apply where the information was furnished by a health or social services professional or by an employee of an institution in the performance of his duties. For the purposes of this paragraph, trainees, including medical residents, shall be regarded as health or social services professionals.

1991, c. 42, s. 18.

19. The record of a user is confidential and no person may have access to it except with the consent of the user or the person qualified to give consent on his behalf. Information contained in a user’s record may, however, be communicated without the user’s consent

(1)  on the order of a court or a coroner in the exercise of the functions of office;

(2)  at the request of the local service quality and complaints commissioner under section 36, of a medical examiner under the third paragraph of section 47, of a review committee referred to in section 51 or one of its members under the second paragraph of section 55, of a regional service quality and complaints commissioner under section 69, of a council of physicians, dentists and pharmacists or of an expert from outside the institution that the council calls on under the second paragraph of section 214;

(3)  at the request of a person designated by an agency to carry out an inspection under the second paragraph of section 413.2 or at the request of an agency or of a person designated by an agency to conduct an inquiry under the second paragraph of section 414;

(4)  to the Minister under section 433 for the exercise of the Minister’s functions under section 431;

(5)  to a person authorized to make an inspection under the second paragraph of section 489 or section 489.1;

(6)  to a person designated by the Government under the second paragraph of section 500 to investigate a matter referred to in the first paragraph of that section;

(7)  in the cases and for the purposes set out in sections 19.0.1, 19.0.2, 19.2 and 27.1, in the second paragraph of section 107.1, in the third paragraph of section 108, in sections 204.1 and 520.3.1 and in the first paragraph of section 520.3.2;

(8)  at the request of a revisory committee referred to in section 41 of the Health Insurance Act (chapter A-29) under section 77, or of a person or committee referred to in section 192 of the Professional Code (chapter C-26), if necessary to carry out their duties; or

(9)  for the purposes of the Public Health Act (chapter S-2.2).

1991, c. 42, s. 19; 1992, c. 21, s. 2; 1999, c. 45, s. 1; 2001, c. 60, s. 161; 2005, c. 32, s. 1.

19.0.1. Information contained in the record of a user may be communicated, in order to prevent an act of violence, including a suicide, where there is reasonable cause to believe that there is an imminent danger of death or serious bodily injury to the user, another person or an identifiable group of persons.

The information may in such case be communicated to any person exposed to the danger or that person’s representative, and to any person who can come to that person’s aid. The information may only be communicated by a person or a person belonging to a class of persons authorized by the director of professional services or, failing such a director, by the executive director of the institution.

The persons so authorized may only communicate such information as is necessary to achieve the purposes for which the information is communicated.

The executive director of the institution must, by a directive, determine the terms and conditions according to which the information may be communicated. Every person authorized to communicate the information is required to comply with the directive.

2001, c. 78, s. 14; 2005, c. 32, s. 2.

19.0.2. In order to ensure that the information contained in its local files or index is accurate, up-to-date and complete, or, if necessary, to verify a person’s eligibility under the health insurance plan established by the Health Insurance Act (chapter A-29) or the hospital insurance plan established by the Hospital Insurance Act (chapter A-28), an institution may send the following information contained in a user’s record to the Régie de l’assurance maladie du Québec: the name, date of birth, sex, address, language code, health insurance number, telephone number, unique identification number, date of death and social insurance number of each user or insured person of the institution, and the names of the mother and father or, if applicable, the legal representative of each user or insured person. The social insurance number may not be transmitted except for the purpose of verifying its validity or facilitating the transfer of the other information.

The Régie must destroy the local files or index containing the information that is communicated to it under this section for cross-matching with its register of insured persons.

2005, c. 32, s. 3.

19.1. Consent to a request for access to a user’s record for study, teaching or research purposes must be in writing ; in addition, it must be free and enlightened and given for specific purposes. Otherwise, it is without effect.

The consent is valid only for the time required for the attainment of the purposes for which it was granted or, in the case of a research project approved by an ethics committee, for the period determined, where that is the case, by the ethics committee.

1999, c. 45, s. 2.

19.2. The director of professional services of an institution or, if there is no such director, the executive director may authorize a professional to examine the record of a user for study, teaching or research purposes.

Before granting such authorization, the director must, however, ascertain that the criteria determined under section 125 of the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A-2.1) are satisfied. If the director is of the opinion that the professional’s project is not in compliance with generally accepted standards of ethics or scientific integrity, the director must refuse to grant the authorization.

The authorization must be granted for a limited period and may be subject to conditions. It may be revoked at any time if the director has reason to believe that the authorized professional is violating the confidentiality of the information obtained or is not complying with the conditions imposed or with generally accepted standards of ethics and scientific integrity.

1999, c. 45, s. 2; 2005, c. 32, s. 4.

20. A user under 14 years of age is not entitled, at the time of an application for information or rectification, to be informed of the existence or to be given communication of information of a medical or social nature concerning him that is contained in his record, except through his advocate within the framework of a judicial proceeding.

Nothing in the first paragraph shall restrict normal communication between a user and a health or social services professional or an employee of an institution. For the purposes of the first paragraph, trainees, including medical residents, shall be regarded as health or social services professionals.

1991, c. 42, s. 20.

21. The holder of parental authority is entitled to have access to the record of a user who is a minor.

However, an institution shall refuse to give the holder of parental authority access to the record of a user who is a minor where

(1)  the user is under 14 years of age, an intervention within the meaning of section 2.3 of the Youth Protection Act (chapter P-34.1) has been made in his regard or a decision respecting him has been made under the said Act, and the institution, after consulting the director of youth protection, determines that communication of the record of the user to the holder of parental authority will or could be prejudicial to the health of the user;

(2)  the user is 14 years of age or over and, after being consulted by the institution, refuses to allow his record to be communicated to the holder of parental authority and the institution determines that communication of the record of the user to the holder of parental authority will or could be prejudicial to the health of the user.

1991, c. 42, s. 21.

22. The tutor, curator, mandatary or the person who may give his consent to care for a user is entitled to have access to the information contained in the record of the user to the extent that such communication is necessary for the exercise of that power.

Any person who attests under oath that he intends to apply for the institution or review of protective supervision for a user or the homologation of a mandate given by the user for the eventuality of his inability, is entitled to have access to the information contained in the medical and psychosocial assessment of the user, if the assessment determines that the user is unable to care for himself and administer his property. Only one applicant has a right of access to such information.

1991, c. 42, s. 22.

23. The heirs, legatees by particular title and legal representatives of a deceased user are entitled to be given communication of information contained in his record to the extent that such communication is necessary for the exercise of their rights in such capacity. The same applies to the person entitled to the payment of a benefit under an insurance policy on the life of the user or under a pension plan of the user.

The spouse, ascendants or direct descendants of a deceased user are entitled to be given communication of information relating to the cause of death of the user, unless the deceased user entered in writing in his record his refusal to grant such right of access.

The holder of parental authority is entitled to be given communication of the information contained in the record of a user under 14 years of age even if the user is deceased. However, that right of access does not extend to information of a psychosocial nature.

Notwithstanding the second paragraph, persons related by blood to a deceased user may be given communication of information contained in his record to the extent that such communication is necessary to verify the existence of a genetic or hereditary disease.

1991, c. 42, s. 23; 1999, c. 40, s. 269; 2005, c. 32, s. 5.

24. At the request of a user, an institution must send a copy or summary of, or an extract from, the user’s record as soon as possible to another institution or to a professional.

However, where the request of the user is made for study, teaching or research purposes, the institution may require consent in writing as provided for in section 19.1.

1991, c. 42, s. 24; 1999, c. 45, s. 3.

25. Where an institution provides a user with information of a medical or social nature concerning him that is contained in his record, it shall, at the request of the user, provide him with the assistance of a qualified professional to help him to understand the information.

The same applies to the holder of parental authority, the tutor, the curator, the mandatary or any person who may give consent to care on behalf of a user.

1991, c. 42, s. 25.

26. The institution shall give the user access to his record as soon as possible.

The same applies to the persons referred to in sections 21 to 23.

1991, c. 42, s. 26.

27. A user to whom an institution refuses access to his record or to information contained therein may, by way of a motion, apply to a judge of the Superior Court or the Court of Québec or to the Commission d’accès à l’information for a review of the decision of the institution. He may also, within 60 days of the date on which the refusal was notified to him, contest the decision before the Administrative Tribunal of Québec.

The same applies to the persons referred to in sections 21 to 23.

1991, c. 42, s. 27; 1997, c. 43, s. 723.

27.1. An institution may communicate information contained in a user’s record to any person or body, if that communication is necessary for carrying out any fixed-term mandate or service contract given to that person or body by the institution, except, subject to section 108, a mandate or service contract related to the provision of certain health services or social services.

The mandate or contract must be given in writing and, on pain of nullity,

(1)  indicate the measures to be taken by the person or body to ensure at all times throughout the mandate or contract that

(a)  the confidentiality of the information is respected;

(b)  measures are established to ensure the security of the information;

(c)  the information is used only for carrying out the mandate or the contract; and

(d)  the information is not retained once the mandate is completed or the contract performed; and

(2)  set out the following obligations to be complied with by the person or body that carries out the mandate or contract:

(a)  before communicating the information, to send the institution a confidentiality agreement completed by every person to whom the information may be communicated in carrying out the mandate or contract;

(b)  if the mandate or contract is carried out on the premises of the institution, to refrain from transmitting any information or transporting any document containing such information outside those premises, unless the executive director of the institution permits it;

(c)  to immediately notify the executive director of the institution of any violation or attempted violation of an obligation relating to the confidentiality of information communicated under this section; and

(d)  to allow the institution to carry out any verification or investigation relating to the confidentiality of the information communicated.

On awarding a mandate or a service contract, the institution must take the necessary measures to ensure that the information communicated in accordance with this section will be protected in a manner equivalent to that prescribed in this Act in cases where the mandate or service contract could be given to a person or body outside Québec or the information could be communicated outside Québec.

A third person retained by a person or body to carry out a mandate or contract is subject to the same obligations as those imposed on the person or body under the second paragraph. However, the third person must send that person or body the confidentiality agreement required under subparagraph a of subparagraph 2 of the second paragraph and the notice required under subparagraph c of that paragraph.

2005, c. 32, s. 6.

27.2. The institution shall record any communication of information under section 27.1 in a register.

The register must contain, in particular,

(1)  the nature and type of the information communicated;

(2)  the names of the persons or bodies to whom the institution has given a mandate or a service contract and to whom information is communicated;

(3)  the intended use of the information communicated; and

(4)  the reasons justifying the communication of information.

2005, c. 32, s. 6.

27.3. An institution may use the name and address of a user to invite that user to make a gift to the institution or to a foundation of the institution within the meaning of section 132.2, unless the user objects. The institution must give the user a valid opportunity to refuse to allow that information to be used for such a purpose.

A user may at any time request the institution to no longer use that information for such a purpose.

For the purposes of this section, an institution must respect the rules of ethics adopted in accordance with the second paragraph of section 233.

2005, c. 32, s. 6.

28. Sections 17 to 27.3 apply notwithstanding the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A-2.1).

1991, c. 42, s. 28; 2005, c. 32, s. 7.

CHAPTER III USER COMPLAINTS

2001, c. 43, s. 41.

DIVISION I EXAMINATION OF COMPLAINTS BY INSTITUTION

2001, c. 43, s. 41.

29. The board of directors of every institution must make a by-law establishing a complaint examination procedure for the purposes of Division I and, after consulting with the council of physicians, dentists and pharmacists or the medical service concerned, for the purposes of Division II of this chapter.

1991, c. 42, s. 29; 1998, c. 39, s. 1; 2001, c. 43, s. 41.

30. A local service quality commissioner must be appointed by the board of directors of every institution, on the recommendation of the executive director. If a board of directors administers two or more institutions, the local commissioner shall handle the complaints from the users of all the institutions administered by the board.

The local service quality commissioner reports to the executive director or directly to the board of directors, according to the organization plan of the institution.

On the recommendation of the executive director and after having obtained the opinion of the local service quality commissioner, the board of directors may, whenever necessary, appoint one or more assistant local service quality commissioners.

An assistant local service quality commissioner shall exercise the functions delegated by and act under the authority of the local service quality commissioner. In the exercise of his or her functions, an assistant local commissioner is vested with the same powers and immunity as a local service quality commissioner.

1991, c. 42, s. 30; 2001, c. 43, s. 41.

31. The board of directors must take steps to preserve at all times the independence of the local service quality commissioner and the assistant local service quality commissioner in the exercise of their functions.

To that end, the board of directors must ensure that the local commissioner and the assistant local commissioner, having regard to the other functions they may exercise for the institution, are not in a conflict of interest situation in the exercise of their functions.

The local commissioner or assistant local commissioner may also exercise the same functions on behalf of any other institution, subject to the terms and conditions determined by agreement between the institutions concerned and approved by their boards of directors.

1991, c. 42, s. 31; 1998, c. 39, s. 2; 2001, c. 43, s. 41.

32. In the exercise of his or her functions, the local service quality commissioner may consult any person whose expertise the commissioner requires, including, with the authorization of the board of directors, calling on an expert from outside the institution. Subject to the fourth paragraph of section 30, the functions of the local service quality commissioner may not be otherwise delegated.

1991, c. 42, s. 32; 1998, c. 39, s. 3; 2001, c. 43, s. 41.

33. The local service quality commissioner is answerable to the board of directors for the enforcement of user rights and for the diligent handling of user complaints.

To that end, the functions of the local service quality commissioner shall include

(1)  applying the complaint examination procedure in keeping with the rights of users ; if necessary, making recommendations to the board of directors for any appropriate action to improve the handling of complaints in the institution, including a revision of the complaint examination procedure ;

(2)  promoting the independent nature of the role of the local service quality commissioner within the institution, the rights and obligations of users and the code of ethics referred to in section 233, and publishing the complaint examination procedure ;

(3)  giving assistance or seeing to it that assistance is given to users who require assistance for the formulation of a complaint or for any further step related to the complaint, including an application to the review committee established under section 51 ; informing users of the possibility of being assisted and supported by the community organization in the region to which a user assistance and support mandate has been given pursuant to the provisions of section 76.6 ; and lastly, providing on request any information on the application of the complaint examination procedure, and informing users of the legal protection afforded pursuant to section 76.2 to any person who cooperates in the examination of a complaint ;

(4)  on receiving a complaint from a user, examining it with diligence ;

(5)  if questions of a disciplinary nature in relation to a practice or the conduct of a personnel member are raised during the examination of a complaint, bringing these questions to the attention of the department concerned or the human resources manager within the institution or the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of the complaint, for a more thorough investigation of the complaint, follow-up action or any other appropriate action ; making any appropriate recommendation to that effect in his or her conclusions ;

(6)  not later than 45 days after receiving a complaint, communicating his or her conclusions, including reasons, in writing in the case of a written complaint, to the user, together with any recommendations made to the department or service manager concerned within the institution and, where applicable, to the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of the complaint, and informing the user of the procedure for applying to the Health and Social Services Ombudsman appointed under the Act respecting the Health and Social Services Ombudsman (chapter P-31.1) ; communicating the same conclusions, including reasons, in writing in the case of a written complaint, to the department or service manager concerned within the institution and to the highest authority concerned ;

(7)  supporting, on his or her own initiative, any action to improve the quality of the services provided to users, user satisfaction and the enforcement of user rights, and recommending such action to any department or any service manager within the institution or, as the case may be, to the highest authority of any organization, resource or partnership or to the person holding the position of highest authority responsible for the services that may be the subject of a complaint under the first paragraph of section 34 ;

(8)  giving advice on any matter within the purview of the local service quality commissioner submitted by the board of directors, any council or committee created by the board under section 181 or any other council or committee of the institution, including the users’ committee ;

(9)  at least once a year and as needed, drawing up a summary of the activities of the local service quality commissioner together with a statement of any action recommended by the local commissioner to improve the quality of services, user satisfaction and the enforcement of user rights ;

(10)  preparing the report referred to in section 76.10, incorporating into the report the annual summary of the activities of the local service quality commissioner, the report of the medical examiner under section 50 and the report of the review committee under section 57, and presenting it to the board of directors for approval ; and

(11)  subject to section 31, carrying out any other function provided for in the organizational plan of the institution, provided that it is related to the enforcement of user rights or the improvement of the quality of services and the satisfaction of the clientele.

1991, c. 42, s. 33; 1998, c. 39, s. 4; 2001, c. 43, s. 41.

34. The complaint examination procedure must enable a user to address a verbal or written complaint to the local service quality commissioner regarding the health services or social services the user received, ought to have received, is receiving or requires from the institution, an intermediary or family-type resource or any other organization, partnership or person to which or whom the institution has recourse, in particular by an agreement under section 108, for the provision of those services.

The procedure must also allow the heirs or the legal representatives of a deceased user to make a complaint regarding the services the user received or ought to have received.

The complaint examination procedure must in particular

(1)  include the details allowing rapid access to the services of the local commissioner ;

(2)  provide that the local commissioner must give the necessary assistance or see to it that the necessary assistance is given to users who require assistance for the formulation of a complaint or for any further step related to the complaint, in particular by the community organization in the region to which a user assistance and support mandate has been given pursuant to section 76.6 ;

(3)  ensure that the user receives a written notice of the date on which the verbal or written complaint is received by the local commissioner ;

(4)  establish a procedure for the examination of complaints regarding a physician, dentist or pharmacist, or a resident, in accordance with Division II, except the procedure to be followed by the board of directors in taking disciplinary measures in accordance with a regulation under paragraph 2 of section 506 ;

(5)  provide for the prompt referral of any complaint concerning or involving a physician, dentist or pharmacist, or a resident, to the medical examiner designated under section 42 ;

(6)  provide that, where a complaint is received regarding the services provided by a resource, organization, partnership or person referred to in the first paragraph, the local commissioner is to inform the authority concerned in writing of the receipt of the complaint or, if the local commissioner is of the opinion that no prejudice will be caused to the user, forward a copy of the complaint to the authority ; provide that, if the complaint is verbal, the authority concerned is to be informed verbally ;

(7)  specify what communications must be made in writing in the case of a written complaint ;

(8)  allow the user and the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of a complaint referred to in the first paragraph to present their observations ; and

(9)  provide that the local commissioner, after examining the complaint, is to communicate his or her conclusions, including reasons, to the user within the time prescribed in subparagraph 6 of the second paragraph of section 33, together with the procedure for applying to the Health Services Ombudsman.

1991, c. 42, s. 34; 1998, c. 39, s. 5; 2001, c. 43, s. 41.

34.1. (Replaced).

2001, c. 43, s. 41.

35. The local service quality commissioner may, upon summary examination, dismiss a complaint if, in the commissioner’s opinion, it is frivolous, vexatious or made in bad faith.

The local service quality commissioner shall so inform the user, in writing in the case of a written complaint.

1991, c. 42, s. 35; 1998, c. 39, s. 7; 2001, c. 43, s. 41.

36. The user and any other person, including any member of the personnel of the institution, any midwife having entered into a service contract with the institution under section 259.2 and any member of the council of physicians, dentists and pharmacists, must supply all information and, subject to the second paragraph of section 190 and section 218, all documents required by the local service quality commissioner for the examination of a complaint, including access to and the communication of the information or documents contained in the user’s record ; all such persons must also, unless they have a valid excuse, attend any meeting called by the local commissioner.

1991, c. 42, s. 36; 1998, c. 39, s. 8; 2001, c. 43, s. 41; 2005, c. 32, s. 13.

37. If, pursuant to subparagraph 5 of the second paragraph of section 33, the local service quality commissioner brings a practice or the conduct of a personnel member that raises questions of a disciplinary nature to the attention of the department concerned or the human resources manager within the institution or the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of a complaint under the first paragraph of section 34, the department, manager, authority or person must investigate and follow up the case diligently and report periodically to the local commissioner on the progress of the investigation.

The local service quality commissioner must be informed of the outcome of the case and of any disciplinary measure taken against the personnel member concerned. The local commissioner must in turn inform the user.

1991, c. 42, s. 37; 1998, c. 39, s. 9; 2001, c. 43, s. 41.

38. The local service quality commissioner may bring any report or recommendation regarding the improvement of the quality of services, user satisfaction and the enforcement of user rights to the attention of the board of directors, in particular where the department or service manager concerned within the institution or the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of a complaint under the first paragraph of section 34 has decided not to act upon a recommendation accompanying the conclusions and reasons communicated by the local commissioner.

The local commissioner must bring such a report or recommendation to the attention of the board of directors if warranted by the gravity of the complaint, in particular where the commissioner has been informed by the department concerned of a disciplinary measure taken against a personnel member of the institution.

The executive director of the institution must transmit to the board of directors any report or recommendation transmitted for that purpose by the local commissioner.

1991, c. 42, s. 38; 1992, c. 21, s. 3; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

39. If warranted, in the opinion of the board of directors, by the gravity of a complaint against an employee of the institution who belongs to a professional order or against a midwife, the board shall transmit the complaint to the professional order concerned.

If any disciplinary measure is taken against the professional, the executive director must inform the professional order in writing. The local commissioner must also be informed and in turn must inform the user in writing.

1991, c. 42, s. 39; 1992, c. 21, s. 4; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

40. If the local service quality commissioner fails to communicate his or her conclusions to the user within 45 days after receiving a complaint from the user, the commissioner is deemed to have communicated negative conclusions to the user on the date of expiry of the time limit.

Such failure gives rise to the right to apply to the Health Services Ombudsman.

1991, c. 42, s. 40; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

DIVISION II EXAMINATION OF COMPLAINTS CONCERNING A PHYSICIAN, DENTIST OR PHARMACIST

2001, c. 43, s. 41.

41. In this division, unless the context indicates otherwise, the word “professional” includes a resident.

1991, c. 42, s. 41; 1992, c. 21, s. 5; 1994, c. 40, s. 457; 1998, c. 39, s. 173; 1999, c. 24, s. 26; 2001, c. 43, s. 41.

42. For the purposes of the examination procedure applicable to complaints concerning a physician, dentist or pharmacist, or a resident, the board of directors of every institution shall designate a medical examiner, possibly the director of professional services, on the recommendation of the council of physicians, dentists and pharmacists.

Where an institution operates two or more centres or maintains two or more facilities, the board of directors may, where necessary and on the recommendation of the council of physicians, dentists and pharmacists, designate one medical examiner for each centre or facility.

Where a board of directors administers two or more institutions, it may, on the recommendation of the council of physicians, dentists and pharmacists, designate a single medical examiner for the group of institutions it administers.

If no council of physicians, dentists and pharmacists has been established for an institution, the board of directors shall designate a medical examiner after consulting with the physicians, dentists and pharmacists practising in the centre or centres operated by the institution.

In the cases described in the preceding paragraphs, if there are fifteen or fewer physicians, dentists and pharmacists practising in the centre or centres operated by the institution or group of institutions administered by the board of directors, a physician who does not practise in any of those centres or exercise other functions for any of those institutions may, by way of exception, be designated as medical examiner.

1991, c. 42, s. 42; 1998, c. 39, s. 10; 2001, c. 43, s. 41.

43. The board of directors must take steps to preserve at all times the independence of the medical examiner in the exercise of his or her functions

To that end, the board of directors must ensure that the medical examiner, having regard to the other functions he or she may exercise for the institution, is not in a conflict of interest situation in the exercise of his or her functions.

1991, c. 42, s. 43; 1998, c. 39, s. 11; 2001, c. 24, s. 1; 2001, c. 43, s. 41.

44. In addition to his or her functions relating to the complaint examination procedure provided for in this division, the medical examiner shall examine in the same manner any complaint concerning a physician, dentist or pharmacist, or a resident, made by any person other than a user or the representative of a user.

This division applies to every such complaint and the word “user” includes any person referred to in the first paragraph, with the necessary modifications.

1991, c. 42, s. 44; 1998, c. 39, s. 12; 2001, c. 43, s. 41.

45. Where a user makes a complaint concerning a physician, dentist or pharmacist, or a resident, the local service quality commissioner shall without delay refer the complaint for investigation to the medical examiner designated pursuant to section 42 and shall inform the user in writing, indicating the date of the referral.

However, where a user makes a complaint regarding administrative or organizational problems involving medical, dental or pharmaceutical services, the complaint shall be examined by the local service quality commissioner in accordance with the provisions of Division I unless the local service quality commissioner, after consulting with the medical examiner, is of the opinion that one or more physicians, dentists or pharmacists, or residents, are the subject of the complaint, in which case the commissioner shall proceed in accordance with the first paragraph.

Any complaint that involves the supervision or assessment of medical, dental or pharmaceutical acts remains within the jurisdiction of the medical examiner.

Where a complaint is examined by the local commissioner, the medical examiner must collaborate to find solutions to the administrative or organizational problems underscored by the complaint.

1991, c. 42, s. 45; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

46. According to the nature of the facts and their significance in terms of the quality of medical, dental or pharmaceutical care or services, the medical examiner, on receiving a complaint, must decide whether to

(1)  examine the complaint in accordance with this division ;

(2)  where the complaint concerns a physician, dentist or pharmacist who is a member of the council of physicians, dentists and pharmacists, refer the complaint to that council for a disciplinary investigation by a committee established for that purpose, and transmit a copy of the complaint to the professional concerned ; if there is no such council, the complaint shall be handled according to the procedure determined by a regulation under paragraph 2 of section 506 ;

(3)  where the complaint concerns a resident and raises questions of a disciplinary nature, refer the complaint, with a copy to the resident, to the authority determined by a regulation made under paragraph 2 of section 506 ; or

(4)  dismiss the complaint if, in the medical examiner’s opinion, it is frivolous, vexatious or made in bad faith.

Where the medical examiner chooses to proceed pursuant to subparagraph 2, 3 or 4, the medical examiner must inform the user and the local service quality commissioner.

1991, c. 42, s. 46; 1998, c. 39, s. 13; 2001, c. 43, s. 41.

47. Where the medical examiner chooses to proceed pursuant to subparagraph 1 of the first paragraph of section 46, the medical examiner shall send a copy of the complaint to the professional concerned.

The user and the professional must be allowed to present observations during the examination of the complaint. The professional shall have access to the user’s complaint record.

The obligations set out in section 36 apply, with the necessary modifications, to any information required or meeting called by the medical examiner.

The medical examiner must examine the complaint within 45 days of its referral and attempt to conciliate the interests involved. The medical examiner may consult any person whose expertise the medical examiner requires, including, with the authorization of the board of directors, an expert from outside the institution. Before the expiry of the time limit, the medical examiner must transmit his or her conclusions, including reasons, in writing to the user and the professional concerned, together with any appropriate recommendations, and inform the user of the conditions and procedure for applying to the review committee established under section 51. The conclusions, reasons and recommendations must also be communicated to the local service quality commissioner.

1991, c. 42, s. 47; 1998, c. 39, s. 14; 2001, c. 43, s. 41.

48. If, during the examination of a complaint concerning a physician, dentist or pharmacist who is a member of the council of physicians, dentists and pharmacists, the medical examiner is of the opinion that, owing to the nature of the facts under examination and their significance in terms of the quality of medical, dental or pharmaceutical care or services, the complaint ought to be referred for a disciplinary investigation by a committee established for that purpose by the council of physicians, dentists and pharmacists, the medical examiner must send a copy of the complaint and of the record to the council. If there is no such council, the complaint shall be handled according to the procedure determined by a regulation under paragraph 2 of section 506.

However, where the complaint concerns a resident and raises questions of a disciplinary nature, the medical examiner must refer a copy of the complaint and of the record to the authority determined by a regulation made under paragraph 2 of section 506.

The medical examiner must inform the user, the professional concerned and the local service quality commissioner of the decision to so refer the complaint.

1991, c. 42, s. 48; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

49. If the medical examiner fails to communicate his or her conclusions to the user within 45 days after being referred a complaint, the medical examiner is deemed to have communicated negative conclusions to the user on the date of expiry of the time limit. Such failure gives rise to the right to apply to the review committee established under section 51.

1991, c. 42, s. 49; 1998, c. 39, s. 15; 2001, c. 43, s. 41.

50. At least once a year and whenever warranted in his or her opinion, the medical examiner must submit a report to the board of directors and to the council of physicians, dentists and pharmacists, describing the reasons for the complaints examined since the last report, and the medical examiner’s recommendations, in particular for the improvement of the quality of medical, dental and pharmaceutical care or services provided in a centre operated by the institution.

A copy of the report shall also be sent to the local service quality commissioner so that its contents may be incorporated into the report submitted under section 76.10.

1991, c. 42, s. 50; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

51. A review committee shall be established for each institution operating one or more centres where physicians, dentists or pharmacists practise.

If a board of directors administers two or more institutions, the board may establish a single review committee for the group of institutions it administers, after consulting with the council of physicians, dentists and pharmacists or, where there is no such council, with the physicians, dentists and pharmacists concerned.

The review committee shall be composed of three members appointed by the board of directors. The chair of the review committee shall be appointed from among the elected or co-opted members of the board of directors. The other two members shall be appointed from among the physicians, dentists and pharmacists who practise in a centre operated by an institution administered by the board of directors, on the recommendation of the council of physicians, dentists and pharmacists or, where no such council has been established for an institution, after consulting with the physicians, dentists and pharmacists concerned.

However, if there are fifteen or fewer physicians, dentists and pharmacists practising in the centre or centres operated by the institution or group of institutions administered by the board of directors, the other two members of the review committee may be recruited among physicians, dentists and pharmacists who do not practise in any of those centres or exercise other functions for any of those institutions.

The board of directors shall fix the term of appointment of the members of the review committee and determine its operating rules.

1991, c. 42, s. 51; 1998, c. 39, s. 173; 2001, c. 43, s. 41.

52. Except where a complaint is referred for a disciplinary investigation, the function of the review committee is to review the handling of a user complaint by the medical examiner. To that end, the review committee must acquaint itself with the entire complaint record and examine whether the complaint was examined properly, diligently and equitably and whether the reasons for the medical examiner’s conclusions, if any, are based on the enforcement of user rights and compliance with standards of professional practice. At the conclusion of its review and within 60 days after receiving a review application, the review committee must communicate a written opinion, including reasons, to the user, to the professional concerned and to the medical examiner. The local service quality commissioner must also be given a copy.

In its opinion, and the reasons therefor, the review committee must either

(1)  confirm the conclusions of the medical examiner ;

(2)  require that the medical examiner carry out a supplementary examination within the time specified and transmit his or her new conclusions to the user and a copy to the review committee and to the professional concerned as well as to the local service quality commissioner ;

(3)  where the complaint concerns a physician, dentist or pharmacist who is a member of the council of physicians, dentists and pharmacists, forward a copy of the complaint and of the record to that council for a disciplinary investigation by a committee established for that purpose ; if there is no such council, the complaint shall be handled according to the procedure determined by a regulation under paragraph 2 of section 506 ;

(4)  where the complaint concerns a resident and raises questions of a disciplinary nature, forward a copy of the complaint and of the record to the authority determined by a regulation made under paragraph 2 of section 506 ;

(5)  recommend any action that is likely to resolve the matter to the medical examiner or, if appropriate, to the parties themselves.

1991, c. 42, s. 52; 1998, c. 39, s. 173; 2001, c. 24, s. 2; 2001, c. 43, s. 41.

53. A user who disagrees with the conclusions transmitted by the medical examiner, or deemed to have been transmitted by the medical examiner under section 49, may apply in writing for a review of the complaint by the review committee.

The review application must be filed within 60 days after receipt of the medical examiner’s conclusions or after the date on which the conclusions are deemed to have been transmitted to the user under section 49. The time limit is definitive, unless the user proves to the review committee that it was impossible for him or her to act sooner.

The local service quality commissioner must give assistance or see to it that assistance is given to users who require assistance for the formulation of their application for review or for any further step related thereto, in particular by the community organization in the region to which a user assistance and support mandate has been given pursuant to section 76.6.

The user shall address the application to the chair of the review committee and include the conclusions and reasons transmitted by the medical examiner, if any.

The chair must give the user a written notice of the date of receipt of the application for review and send a copy to the medical examiner, the professional concerned and the local commissioner.

1991, c. 42, s. 53; 1998, c. 39, s. 16; 2001, c. 43, s. 41.

53.1. (Replaced).

1998, c. 39, s. 17; 2001, c. 43, s. 41.

54. Within five days after receiving a copy of a review application, the medical examiner shall forward a copy of the entire complaint record to the chair of the review committee.

1991, c. 42, s. 54; 1998, c. 39, s. 18; 2001, c. 43, s. 41.

55. The review committee must allow the user, the professional concerned and the medical examiner to present observations.

The obligations set out in section 36 apply, with the necessary modifications, to any information required or meeting called by the review committee or a member of the review committee.

1991, c. 42, s. 55; 2001, c. 43, s. 41.

56. Subject to the information that must be transmitted to the user where the complaint is referred to the council of physicians, dentists and pharmacists, the opinion of the review committee is final.

1991, c. 42, s. 56; 1998, c. 39, s. 19; 2001, c. 43, s. 41.

57. At least once a year and whenever warranted in the opinion of the review committee, the review committee must submit a report to the board of directors, sending a copy to the council of physicians, dentists and pharmacists, in which it describes the reasons for the complaints having given rise to an application for review since the last report, sets out its conclusions and reports on the speed of its review process ; the committee may also make recommendations, in particular for the improvement of the quality of medical, dental and pharmaceutical care or services provided in a centre operated by the institution.

A copy of the report shall also be sent to the local service quality commissioner so that its contents may be incorporated into the report submitted under section 76.10, and to the Health Services Ombudsman.

1991, c. 42, s. 57; 1998, c. 39, s. 20; 2001, c. 43, s. 41.

58. Subject to the provisions of the second and third paragraphs, where pursuant to subparagraph 2 of the first paragraph of section 46, section 48 or subparagraph 3 of the second paragraph of section 52, a complaint is referred to the council of physicians, dentists and pharmacists for a disciplinary investigation by a committee formed by the council, the procedure determined by a regulation under paragraph 2 of section 506 shall be followed.

During the investigation of the complaint, the user must be allowed to present observations. The medical examiner shall be kept informed of the progress of the investigation on a regular basis or at the very least on completion of each of the key stages of the investigation. The medical examiner must inform the user periodically. Every 60 days from the date on which the user was informed of the referral of the complaint until the completion of the investigation, the medical examiner must inform the user in writing on the progress of the investigation.

If, following the investigation of the complaint, the council of physicians, dentists and pharmacists is of the opinion that no disciplinary measures are called for, it shall communicate its conclusions, including reasons, to the professional concerned and the medical examiner. If the complaint was referred to the council by the review committee, the council shall also communicate its conclusions to the review committee. If the council of physicians, dentists and pharmacists is of the opinion that the board of directors should impose disciplinary measures, the executive director of the institution shall notify the professional concerned and the medical examiner of the decision of the board of directors and the reasons therefor. If the complaint was referred to the council by the review committee, the executive director shall also notify the review committee. In all cases, the medical examiner must inform the user, in writing in the case of a written complaint. The medical examiner must also inform the local service quality commissioner.

1991, c. 42, s. 58; 1998, c. 39, s. 21; 2001, c. 43, s. 41.

59. If warranted, in the opinion of the board of directors, by the gravity of the complaint, the board shall transmit the complaint to the professional order concerned.

If the board of directors takes disciplinary measures against a physician, a dentist or a pharmacist, the executive director must notify the professional order in writing. In such cases, the medical examiner shall inform the user and the local service quality commissioner in writing.

1991, c. 42, s. 59; 1998, c. 39, s. 22; 2001, c. 43, s. 41.

DIVISION III EXAMINATION OF COMPLAINTS BY REGIONAL BOARD

2001, c. 43, s. 41.

60. A complaint may be addressed directly to the regional board

(1)  by any person who uses the services of a community organization within the meaning of section 334 or resides in a nursing home operated by a person accredited for the purposes of subsidies within the meaning of section 454, regarding the services the person received or ought to have received from the organization or nursing home;

(2)  (paragraph repealed);

(3)  by any natural person regarding a function or an activity of the regional board by which the person is personally affected owing to the fact that the person receives or ought to receive services provided by institutions, intermediary resources, family-type resources, community organizations or residences accredited for the purposes of subsidies within the meaning of section 454;

(4)  by any natural person regarding any clientele assistance provided by the regional board itself as part of its functions as regards services to the public and user rights;

(5)  by any natural person who requires or uses services provided by an organization, partnership or person whose services or activities relate to the field of health and social services and with which or whom a service agreement has been made by the regional board for the provision of services, and who cannot otherwise apply to an institution under Division I. Such an agreement must provide for the carrying out of the provisions of Divisions III to VII of this chapter and of the Act respecting the Health and Social Services Ombudsman (chapter P‐31.1) concerning such services.

1991, c. 42, s. 60; 1998, c. 39, s. 23; 2001, c. 43, s. 41; 2002, c. 69, s. 152; 2005, c. 32, s. 25.

61. (Repealed).

1991, c. 42, s. 61; 1998, c. 39, s. 24; 2001, c. 43, s. 41; 2002, c. 69, s. 153.

62. The board of directors of every regional board must make a by-law establishing a complaint examination procedure for the purposes of this division.

1991, c. 42, s. 62; 1998, c. 39, s. 25; 2001, c. 43, s. 41.

62.1. (Replaced).

1998, c. 39, s. 26; 2001, c. 43, s. 41.

63. A regional service quality commissioner shall be appointed by the board of directors, on the recommendation of the president and executive director.

The regional service quality commissioner comes under the authority of the president and executive director. The regional service quality commissioner alone is answerable to the board of directors for the application of the complaint examination procedure. A member of the personnel of the regional board may act under the authority of the regional service quality commissioner provided that it is permitted by the organization plan of the regional board.

1991, c. 42, s. 63; 2001, c. 43, s. 41.

64. The board of directors must take steps to preserve at all times the independence of the regional service quality commissioner in the exercise of his or her functions.

To that end, the board of directors must ensure that the regional commissioner, having regard to the other functions he or she may exercise for the regional board, is not in a conflict of interest situation in the exercise of his or her functions.

1991, c. 42, s. 64; 1999, c. 40, s. 269; 2001, c. 43, s. 41.

65. In the exercise of his or her functions, the regional service quality commissioner may consult any person whose expertise the commissioner requires, including, with the authorization of the board of directors, an expert from outside the institution.

1991, c. 42, s. 65; 2000, c. 8, s. 242; 2001, c. 43, s. 41.

65.1. (Replaced).

1998, c. 39, s. 27; 2001, c. 43, s. 41.

66. The regional service quality commissioner is answerable to the board of directors for the enforcement of the rights of persons who apply to the regional commissioner pursuant to this division and for the diligent handling of their complaints.

To that end, the functions of the regional service quality commissioner shall include

(1)  applying the complaint examination procedure established by by-law of the board of directors in keeping with personal rights ; if necessary, making recommendations to the board of directors for any appropriate action to improve the handling of complaints, including a revision of the complaint examination procedure ;

(2)  promoting the independent nature of the role of the regional service quality commissioner within the regional board, and publishing the complaint examination procedure for the public in the region ;

(3)  giving assistance or seeing to it that assistance is given to persons who require assistance for the formulation of a complaint or for any further step related to the complaint ; informing users of the possibility of being assisted and supported by the community organization in the region to which a user assistance and support mandate has been given pursuant to the provisions of section 76.6 ; and lastly, providing on request any information on the application of the complaint examination procedure of the regional board and on the other remedies provided for in this chapter, and informing users of the legal protection afforded pursuant to section 76.2 to any person who cooperates in the examination of a complaint ;

(4)  on receiving a complaint, examining it with diligence ;

(5)  if questions of a disciplinary nature in relation to a practice or the conduct of a personnel member are raised during the examination of a complaint, bringing these questions to the attention of the department concerned or the human resources manager within the regional board or the highest authority of the organization, resource or partnership or the person holding the position of highest authority responsible for the services that are the subject of the complaint, for a more thorough investigation of the complaint, follow-up action or any other appropriate action ; making any appropriate recommendation to that effect in his or her conclusions ;

(6)  not later than 45 days after receiving a complaint, communicating his or her conclusions, including reasons, in writing in the case of a written complaint, to the complainant, together with any recommendations made to the department or service manager concerned within the regional board and to the highest authority of the organization, resource or partnership or to the person holding the position of highest authority responsible for the services that are the subject of the complaint, and informing the complainant of the procedure for applying to the Health Services Ombudsman ; communicating the same conclusions, including reasons, in writing in the case of a written complaint, to the department or manager concerned within the regional board and to the highest authority concerned ;

(7)  supporting, on his or her own initiative, any action to improve the quality of the services provided to the clientele, clientele satisfaction and the enforcement of the rights of the clientele, and recommending such action to any department or any service manager within the board or, as the case may be, to the highest authority of any organization, resource or partnership or to the person holding the position of highest authority responsible for the services that may be the subject of a complaint under section 60 ;

(8)  giving advice on any matter within the purview of the regional service quality commissioner submitted by the board of directors, any council or committee created under section 407 or any department or service or other council or committee of the regional board ;

(9)  at least once a year and whenever necessary, drawing up a summary of the activities of the regional service quality commissioner, together with a statement of any action recommended by the regional commissioner to improve the quality of services, clientele satisfaction and the enforcement of the rights of the clientele ;

(10)  seeing to it that the board of directors of every institution in the region prepares a report under section 76.10 and submits it to the regional board ;

(11)  preparing the report referred to in section 76.12, incorporating into the report the annual summary of the activities of the regional service quality commissioner and all other reports referred to in section 76.10, and presenting the report to the board of directors for approval ; and

(12)  subject to section 64, carrying out any other function provided for in the organization plan of the regional board.

1991, c. 42, s. 66; 2001, c. 43, s. 41.

67. The complaint examination procedure must enable any person referred to in section 60 to address a verbal or written complaint to the regional service quality commissioner.

The procedure must also allow the heirs or the legal representatives of a deceased person to make a complaint regarding the services the person received or ought to have received.

The complaint examination procedure must in particular

(1)  include the details allowing rapid access to the services of the regional commissioner ;

(2)  provide that the regional commissioner must give assistance or see to it that assistance is given to users or persons who require assistance for the formulation of a complaint or for any further step related to the complaint, in particular by the community organization in the region to which a user assistance and support mandate has been given pursuant to section 76.6 ;

(3)  ensure that the complainant receives a written notice of the date on which the verbal or written complaint is received by the regional commissioner ;

(4)  provide that, where a complaint is received regarding the services provided by a resource, organization, partnership or person other than the regional board, the regional commissioner is to inform the authority concerned in writing of the receipt of the complaint or, if the regional commissioner is of the opinion that no prejudice will be caused to the user, forward a copy of the complaint to the authority ; provide that, if the complaint is verbal, the authority concerned is to be informed verbally ;

(5)  specify what communications must be made in writing in the case of a written complaint ;

(6)  allow the complainant and the highest authority of the organization, resource or partnership or the person holding the position of highest authority who is responsible for the services that may be the subject of a complaint under section 60 to present observations ; and

(7)  provide that the regional commissioner, after examining the complaint, is to communicate his or her conclusions, including reasons, to the complainant within the time prescribed in subparagraph 6 of the second paragraph of section 66, together with the procedure for applying to the Health Services Ombudsman.

1991, c. 42, s. 67; 2001, c. 43, s. 41.

68. The regional service quality commissioner may, upon summary examination, dismiss a complaint if, in the commissioner’s opinion, it is frivolous, vexatious or made in bad faith.

The regional service quality commissioner shall so inform the complainant, in writing in the case of a written complaint.

1991, c. 42, s. 68; 2001, c. 43, s. 41.

69. The complainant and any other person, including any person working or practising on behalf of any institution, resource, organization, partnership or person other than the regional board, must supply all information and, subject to the second paragraph of section 190 and section 218, all documents required by the regional service quality commissioner for the examination of a complaint, including access to and the communication of the information or documents contained in the user’s record ; all such persons must also, unless they have a valid excuse, attend any meeting called by the regional service quality commissioner.

1991, c. 42, s. 69; 1998, c. 39, s. 28; 2001, c. 43, s. 41; 2005, c. 32, s. 32.

69.1. (Replaced).

1998, c. 39, s. 29; 2001, c. 43, s. 41.

70. If, pursuant to subparagraph 5 of the second paragraph of section 66, the regional service quality commissioner brings a practice or the conduct of a personnel member that raises questions of a disciplinary nature to the attention of the department concerned or the human resources manager within the regional board or the highest authority of the resource, organization or partnership or the person holding the position of highest authority responsible for the services that are the subject of a complaint under section 60, the department, manager, authority or person must investigate and follow up the case diligently and report periodically to the regional commissioner on the progress of the investigation.

The regional service quality commissioner must be informed of the outcome of the case and of any disciplinary measure taken against the personnel member concerned. The regional commissioner must in turn inform the complainant.

1991, c. 42, s. 70; 1998, c. 39, s. 30; 2001, c. 43, s. 41.

71. The regional service quality commissioner may bring any report or recommendation regarding the improvement of the quality of services provided to the public, clientele satisfaction and the enforcement of the rights of the clientele to the attention of the board of directors of the regional board, in particular where the department or service manager concerned within the regional board or the highest authority of the resource, organization or partnership or the person holding the position of highest authority responsible for the services that are the subject of a complaint under section 60 has decided not to act upon a recommendation accompanying the conclusions and reasons communicated by the regional commissioner.

The regional commissioner must bring such a report or recommendation to the attention of the board of directors if warranted by the gravity of the complaint, in particular where the commissioner has been informed of a disciplinary measure taken against a personnel member of the department or authority concerned.

The president and executive director of the regional board must transmit to the board of directors any report or recommendation transmitted for that purpose by the regional commissioner.

1991, c. 42, s. 71; 2001, c. 43, s. 41.

CHAPTER IV

Heading replaced, 2001, c. 43, s. 41.

2001, c. 43, s. 41.

72. If the regional service quality commissioner fails to communicate his or her conclusions to the complainant within 45 days after receiving a complaint, the commissioner is deemed to have communicated negative conclusions to the complainant on the date of expiry of the time limit.

Such failure gives rise to the right to apply to the Health Services Ombudsman.

1991, c. 42, s. 72; 1998, c. 39, s. 31; 2001, c. 43, s. 41.

DIVISION IV OTHER PROVISIONS

2001, c. 43, s. 41.

73. No person shall take reprisals or attempt to take reprisals in any manner whatever against any person who makes or intends to make a complaint under section 34, 44, 45, 53 or 60.

The person responsible for examining the complaint must intervene without delay upon being apprised of reprisals or of an attempt to take reprisals.

1991, c. 42, s. 73; 1998, c. 39, s. 32; 2001, c. 43, s. 41.

74. No civil action may be instituted by reason or in consequence of a complaint made in good faith under this chapter, whatever the conclusions issued following its examination.

Nothing in this provision shall operate to restrict the right of any person or the person’s successors to exercise a remedy based on the same facts as those on which a complaint is based.

1991, c. 42, s. 74; 1998, c. 39, s. 33; 2001, c. 43, s. 41.

75. No legal proceedings may be brought against the following persons or entities for an act or omission made in good faith in the exercise of their functions :

(1)  a local service quality commissioner, an assistant local commissioner, a consultant or an outside expert referred to in section 32, a medical examiner, a consultant or an outside expert referred to in section 47, a review committee established under section 51 or a member of such a committee, a council of physicians, dentists and pharmacists or a member of such a council, an outside expert referred to in section 214 or the board of directors of an institution or a member of such a board ;

(2)  a regional service quality commissioner, a person acting under the authority of a regional service quality commissioner or a consultant or outside expert referred to in section 65.

1991, c. 42, s. 75; 1998, c. 39, s. 34; 2001, c. 43, s. 41.

76. Except on a question of jurisdiction, no extraordinary recourse under articles 834 to 846 of the Code of Civil Procedure (chapter C-25) may be exercised and no injunction may be granted against any of the persons referred to in section 75 acting in their official capacity.

1991, c. 42, s. 76; 1998, c. 39, s. 35; 2001, c. 43, s. 41.

76.1. A judge of the Court of Appeal may, on a motion, summarily annul any writ, order or injunction issued or granted contrary to section 75 or 76.

2001, c. 43, s. 41.

76.2. The answers given or statements made by a person for the purposes of the examination of a complaint, including any information or document supplied in good faith by the person in response to a request of a local service quality commissioner or a regional service quality commissioner, an assistant local commissioner, a consultant or an outside expert referred to in section 32 or 65, a person acting under the authority of a regional service quality commissioner, a medical examiner, a consultant or an outside expert referred to in section 47, a review committee established under section 51 or a member of such a committee may not be used or be admitted as evidence against the person in a judicial proceeding or a proceeding before a person or body exercising adjudicative functions.

2001, c. 43, s. 41.

76.3. Before beginning to exercise their functions under this Title or in accordance with the procedure determined by a regulation under paragraph 2 of section 506, a local service quality commissioner or a regional service quality commissioner, an assistant local commissioner, a consultant or an outside expert referred to in section 32 or 65, a person acting under the authority of a regional service quality commissioner, a medical examiner, a consultant or an outside expert referred to in section 47, a member of a review committee established under section 51, a member of a committee of a council of physicians, dentists and pharmacists, an outside expert referred to in section 214 and a member of the board of directors of an institution must take the oath provided in Schedule I.

2001, c. 43, s. 41.

76.4. Notwithstanding any inconsistent legislative provision, a local service quality commissioner or a regional service quality commissioner, an assistant local commissioner, a consultant or an outside expert referred to in section 32 or 65, a person acting under the authority of a regional service quality commissioner, a medical examiner, a consultant or an outside expert referred to in section 47, a review committee established under section 51 or a member of such a committee may not be compelled to make a deposition in a judicial proceeding or a proceeding before a person or body exercising adjudicative functions concerning any confidential information obtained in the exercise of their functions, or to produce a document containing such information, except to confirm its confidential nature.

2001, c. 43, s. 41.

76.5. Nothing contained in a user’s complaint record, including the conclusions with reasons and any related recommendations, may be construed as a declaration, recognition or extrajudicial admission of professional, administrative or other misconduct capable of establishing the civil liability of a party in a judicial proceeding.

2001, c. 43, s. 41.

DIVISION V ASSISTANCE BY COMMUNITY ORGANIZATION

2001, c. 43, s. 41.

76.6. The Minister, after consulting with the regional board, shall give a community organization in the region the mandate to assist and support, on request, users residing in the region who wish to address a complaint to an institution in the region, to the regional board or to the Health Services Ombudsman.

Where a complaint is made by a user regarding the services of an institution or board of another region than the region in which the user resides, the community organization in the region of the user’s residence shall provide any assistance and support requested, unless the user requests assistance and support from the community organization in the region of the institution or board concerned.

In all cases, the community organizations involved must collaborate in providing any assistance and support requested by a user.

2001, c. 43, s. 41.

76.7. Every community organization to which a mandate under section 76.6 is given shall, on request, assist a user in any step undertaken to file a complaint with an institution or regional board or with the Health Services Ombudsman, and provide support to the user throughout the proceeding. The community organization shall provide information on the complaints process, help the user define the subject of the complaint, draft the complaint where necessary and provide assistance and support on request to the user at each stage of the proceeding, facilitate conciliation between the user and any authority concerned and contribute, through the support so afforded, to the enforcement of the user’s rights and the improvement of the quality of services.

2001, c. 43, s. 41.

DIVISION VI USER’S COMPLAINT RECORD

2001, c. 43, s. 41.

76.8. The contents of a user’s complaint record shall be determined by a regulation under paragraph 23 of section 505.

Notwithstanding any contrary provision of this Act, no document contained in a user’s complaint record may be filed in the record of a personnel member or a member of the council of physicians, dentists and pharmacists.

The preceding paragraph does not apply to the conclusions and reasons of the medical examiner or to any related recommendations.

2001, c. 43, s. 41.

76.9. The provisions of sections 17 to 28 apply to all records kept by the institution or regional board in the exercise of their respective functions under Divisions I, II and III.

2001, c. 43, s. 41.

DIVISION VII REPORTS

2001, c. 43, s. 41.

76.10. Once a year and whenever so required by the regional board, the board of directors of an institution must transmit a report on the application of the complaint examination procedure and the improvement of the quality of services to the regional board.

2001, c. 43, s. 41.

76.11. The report shall incorporate the activities summary of the local service quality commissioner referred to in subparagraph 9 of the second paragraph of section 33, the medical examiner’s report referred to in section 50 and the review committee’s report referred to in section 57.

The report shall describe the reasons for the complaints received and shall indicate in respect of each type of complaint

(1)  the number of complaints received, dismissed upon summary examination, examined, refused or abandoned since the last report ;

(2)  the time taken for the examination of complaints ;

(3)  the actions taken following the examination of complaints ; and

(4)  the number of complaints that gave rise to an application to the Health Services Ombudsman and the reasons for those complaints.

The report must also give an account of any action recommended by the local service quality commissioner and of any action taken to improve the quality of services, user satisfaction and the enforcement of user rights.

The board of directors shall also include in the report, where required, any mandatory objectives relating to the enforcement of user rights and the diligent handling of user complaints.

2001, c. 43, s. 41.

76.12. Once a year and whenever so required by the Minister, the board of directors of a regional board must transmit a report summarizing all the reports received from the boards of directors of institutions.

The report shall describe the types of complaints received, including any complaints concerning physicians, dentists or pharmacists, and shall indicate in respect of each type of complaint

(1)  the number of complaints received, dismissed upon summary examination, examined, refused or abandoned since the last report ;

(2)  the actions taken following the examination of complaints ;

(3)  the names of the institutions concerned ; and

(4)  the time taken for the examination of complaints.

The report shall also incorporate the activities summary of the regional service quality commissioner referred to in subparagraph 9 of the second paragraph of section 66, describe the reasons for the complaints received by the regional board itself and indicate in respect of each type of complaint

(1)  the number of complaints received, dismissed upon summary examination, examined, refused or abandoned since the last report ;

(2)  the time taken for the examination of complaints ;

(3)  the actions taken following the examination of complaints ; and

(4)  the number of complaints that gave rise to an application to the Health Services Ombudsman and the reasons for those complaints.

The report must also give an account of the most significant actions recommended by local service quality commissioners and by the regional service quality commissioner and of the most significant actions taken by the institutions and by the regional board to improve the quality of services to the public in the region, clientele satisfaction and the enforcement of the rights of the clientele.

The board of directors shall also include in the report, where required, any mandatory objectives relating to the enforcement of the rights of persons who apply to the regional service quality commissioner under Division III and the diligent handling of their complaints.

A copy of the report must be sent at the same time to the Health Services Ombudsman.

2001, c. 43, s. 41.

76.13. Whenever so required by the Health Services Ombudsman, the board of directors of an institution or a regional board must transmit a report to the Ombudsman regarding any item of information referred to in section 76.11 or 76.12 recorded since the last report and on any matter relating to the application of the complaint examination procedure, including the provisions applicable to any user complaint concerning a physician, dentist or pharmacist.

2001, c. 43, s. 41.

76.14. The Minister shall table the reports of the regional boards in the National Assembly within 30 days of receiving them or, if the Assembly is not in session, within 30 days of resumption.

2001, c. 43, s. 41.

CHAPTER V POWERS OF SUPERVISION AND SUBROGATION

77. Nothing in this Act may be construed as limiting the powers of the revisory committees established by section 41 of the Health Insurance Act (chapter A-29) or of the professional orders governed by the Professional Code (chapter C-26).

The representatives of the professional orders governed by the Professional Code shall have access to any facility maintained by an institution for the performance of the functions which the professional orders must fulfil to ensure protection of the public.

1991, c. 42, s. 77; 1992, c. 21, s. 6; 1994, c. 40, s. 457.

78. The Gouvernement du Québec is subrogated by operation of law to any user with respect to any right of recovery against a third person up to the cost of the services it has assumed following injury caused through the fault of that third person.

In case of contributory negligence the amount of such subrogation shall be subject to reduction in the same proportion as the user’s remedy.

The Minister has the power to transact on any claim arising from this section and he may delegate that power.

The insurer of the liability of a third person shall not discharge his obligation to indemnify the latter for his liability under this section otherwise than by payment.

An undertaking by a person to discharge a third person’s or an insurer’s liability under this section or to compensate him for it is shall be deemed unwritten in any agreement, transaction or release.

The rights acquired by the effect of the subrogation provided for in this section are part of the domain of the State from the time they arose and are subject to the rules applicable to rights included therein; however, the resulting right of action is prescribed by three years.

1991, c. 42, s. 78; 1999, c. 40, s. 269.

PART II PROVISION OF HEALTH SERVICES AND SOCIAL SERVICES

TITLE I INSTITUTIONS

CHAPTER I GENERAL PROVISIONS

79. Health services and social services shall be provided by the institutions in the following centres:

(1)  a local community service centre;

(2)  a hospital centre;

(3)  a child and youth protection centre;

(4)  a residential and long-term care centre;

(5)  a rehabilitation centre.

1991, c. 42, s. 79; 1992, c. 21, s. 70.

80. The mission of a local community service centre is to offer, at the primary level of care, basic health and social services, and to offer health and social services of a preventive or curative nature and rehabilitation or reintegration services to the population of the territory served by it.

To that end, an institution which operates such a centre shall see to it that the persons who require such services for themselves or for their families are contacted, assess their needs, dispense the required services in its facilities, or in the persons’ own environment, in school, at work or at home or, where necessary, refer the persons to the centres, organizations or persons best suited to assist them.

The mission of such a centre is also to carry out public health activities in its territory, in accordance with the provisions of the Public Health Act (chapter S-2.2).

1991, c. 42, s. 80; 1998, c. 39, s. 36; 2001, c. 60, s. 162.

81. The mission of a hospital centre is to offer diagnostic services and general and specialized medical care. To that end, an institution which operates a hospital centre shall admit, mainly on referral, the persons who require such services or care, ensure that their needs are assessed and that the required services, including nursing care and specialized, preventive or rehabilitative psychosocial services, are offered within the facilities or, where necessary, that the persons are referred as soon as possible to the centres, organizations or persons best suited to assist them.

1991, c. 42, s. 81; 1992, c. 21, s. 70.

82. The mission of a child and youth protection centre is to offer in the region such psychosocial services, including social emergency services, as are required by the situation of a young person pursuant to the Youth Protection Act (chapter P-34.1) and the Act respecting young offenders (Revised Statutes of Canada, 1985, chapter Y-1), and services for child placement, family mediation, expertise at the Superior Court on child custody, adoption and biological history.

To that end, every institution which operates such a centre shall ensure that the needs of the persons who require such services are assessed and that the services which these persons or their families require are offered to them either directly or through the centres, organizations or persons best suited to assist them.

1991, c. 42, s. 82.

83. The mission of a residential and long-term care centre is to offer, on a temporary or permanent basis, an alternative environment, lodging, assistance, support and supervision services as well as rehabilitation, psychosocial and nursing care and pharmaceutical and medical services to adults who, by reason of loss of functional or psychosocial autonomy can no longer live in their natural environment, despite the support of their families and friends.

To that end, every institution which operates such a centre shall receive, on referral, the persons who require such services, ensure that their needs are periodically assessed and that the required services are offered within its facilities.

The mission of such a centre may include the operation of a day centre or day hospital.

1991, c. 42, s. 83.

84. The mission of a rehabilitation centre is to offer adjustment, rehabilitation and social integration services to persons who, by reason of physical or mental impairment, behavioral disorders, psychosocial or family difficulties, alcoholism or other problems of addiction, require such services, as well as persons to accompany them, or support services for their families and friends.

To that end, every institution which operates such a centre shall receive, on referral, young persons with adjustment problems and persons suffering from and, mainly on referral, persons suffering from alcoholism or other problems of addiction and mothers with adjustment problems; it shall ensure that their needs are assessed and the required services offered to them within its facilities or within the person’s own environment, in school, at work or at home or, where necessary, that they are referred, as soon as possible, to the centres, organizations or persons best suited to assist them.

1991, c. 42, s. 84.

85. Hospital centres belong to one or another of the following classes:

(1)  general and specialized hospital centres;

(2)  psychiatric hospital centres.

1991, c. 42, s. 85; 1992, c. 21, s. 70.

86. Rehabilitation centres belong to one or more of the following classes, depending on the clientele they serve:

(1)  rehabilitation centres for mentally impaired persons;

(2)  rehabilitation centres for physically impaired persons;

(3)  rehabilitation centres for persons suffering from alcoholism or other problems of addiction;

(4)  rehabilitation centres for young persons with adjustment problems;

(5)  rehabilitation centres for mothers with adjustment problems.

1991, c. 42, s. 86.

87. Rehabilitation centres for physically impaired persons belong to one or more of the following types of centres, depending on the clientele they serve:

(1)  rehabilitation centres for persons with hearing impairment;

(2)  rehabilitation centres for persons with visual impairment;

(3)  rehabilitation centres for persons with motricity impairment.

1991, c. 42, s. 87.

88. The Minister may, after consulting the Minister of Education, Recreation and Sports and the Minister of Economic and Regional Development and Research, designate as a university hospital centre a hospital centre operated by an institution which, in addition to carrying on the activities inherent in its mission, offers specialized or highly specialized services in several medical disciplines, evaluates health technologies, participates in medical education in several specialties under the terms of a contract of affiliation entered into under section 110, and manages a research centre or research institute recognized by the Fonds de la recherche en santé du Québec established by the Act respecting the Ministère du Développement économique et régional et de la Recherche (chapter M‐30.01).

1991, c. 42, s. 88; 1992, c. 21, s. 70; 1993, c. 51, s. 51; 1994, c. 16, s. 50; 1999, c. 8, s. 31; 2003, c. 29, s. 140, s. 170; 2005, c. 28, s. 195.

89. The Minister, after consulting the Minister of Education, Recreation and Sports and the Minister of Economic and Regional Development and Research, may, for any one medical discipline, designate as a university institute any centre operated by an institution which, in addition to carrying on the activities inherent in the mission of such a centre, participates in medical education, mainly in that medical discipline, under the terms of a contract of affiliation entered into under section 110, offers highly specialized or specialized medical services or services relating to family medicine, evaluates health technologies, and manages a research centre or research institute recognized by the Fonds de la recherche en santé du Québec.

1991, c. 42, s. 89; 1992, c. 21, s. 7; 1993, c. 51, s. 52; 1994, c. 16, s. 50; 1999, c. 8, s. 32; 2003, c. 29, s. 137; 2005, c. 28, s. 195.

90. The Minister may, after consulting the Minister of Education, Recreation and Sports and the Minister of Economic and Regional Development and Research, designate as a university institute any centre operated by an institution which, in addition to carrying on the activities inherent in the mission of such a centre, meets the following conditions:

(1)  it provides advanced services in a multidisciplinary field of intervention related to health and social services or to the social sector;

(2)  it contributes to the training, as the case may be, of health and social services professionals or human and social sciences professionals according to the terms of a contract of affiliation entered into under section 110;

(3)  it disposes of a research structure recognized, as the case may be, jointly by the Fonds de la recherche en santé du Québec and an organization engaged in the development of social research, or exclusively by the latter organization;

(4)  it evaluates technologies or methods of intervention related to its advanced sector.

1991, c. 42, s. 90; 1993, c. 51, s. 53; 1994, c. 16, s. 50; 1999, c. 8, s. 32; 2001, c. 24, s. 3; 2003, c. 29, s. 137; 2005, c. 28, s. 195.

91. The Minister may, after consulting the Minister of Education, Recreation and Sports and the Minister of Economic and Regional Development and Research, designate as an affiliated university centre any centre, other than a centre designated as university hospital centre or university institute, operated by an institution which, in addition to carrying on the activities inherent in the mission of such a centre, participates in the training of professionals in the field of health or social services or in research activities under the terms of a contract entered into under subparagraph 1 of the first paragraph of section 110.

1991, c. 42, s. 91; 1992, c. 21, s. 70; 1993, c. 51, s. 54; 1994, c. 16, s. 50; 1999, c. 8, s. 32; 2003, c. 29, s. 137; 2005, c. 28, s. 195.

92. (Repealed).

1991, c. 42, s. 92; 2001, c. 24, s. 4; 2005, c. 32, s. 46.

93. The regional board, within the scope of its regional service organization plans, may allow an institution to engage, as complement and in addition to the activities inherent in the mission of any centre operated by it, in certain activities inherent in the mission of any other centre.

The regional board may, in the same manner, entrust an institution operating any centre with the responsibility of serving all or part of the population of the region.

It may, lastly, entrust the institution which operates a child and youth protection centre in the region with the responsibility of offering, notwithstanding section 82, all or some of its services in a region where there is no institution operating such a centre.

1991, c. 42, s. 93; 1992, c. 21, s. 8.

94. Any person or partnership carrying on activities inherent in the mission of one or more of the centres mentioned in section 79 is an institution.

1991, c. 42, s. 94.

95. A person or a partnership operating a private health facility is not an institution.

A private health facility is a facility, situated elsewhere than in a facility maintained by an institution, in which one or more physicians, dentists or other professionals, individually or as a group, regularly practise their professions, privately and solely on their own account, without providing their patients with lodging.

1991, c. 42, s. 95.

96. A religious or teaching institution which operates an infirmary to receive members of its personnel or its students or a religious institution which maintains residential and long-term care facilities to receive its members or followers, provided that the number of followers does not exceed 20, is not an institution within the meaning of this Act.

1991, c. 42, s. 96.

97. Institutions are either public or private.

1991, c. 42, s. 97.

98. The following are public institutions:

(1)  an institution constituted as a non-profit legal person before 1 June 1972, irrespective of the Act under which its constituting instrument was granted;

(2)  an institution constituted as a non-profit legal person after 1 June 1972 and continued in accordance with sections 540 to 544;

(3)  an institution constituted as a legal person under this Act;

(4)  an institution resulting from an amalgamation or conversion under this Act.

1991, c. 42, s. 98; 1996, c. 36, s. 51; 1999, c. 40, s. 269.

99. The following are private institutions:

(1)  an unincorporated institution;

(2)  an institution constituted as a profit-making legal person;

(3)  an institution constituted as a non-profit legal person engaging in activities inherent in the mission of a centre referred to in paragraph 2, 4 or 5 of section 79, provided the facilities maintained by the institution do not provide lodging to more than 20 users.

1991, c. 42, s. 99; 1996, c. 36, s. 51.

99.1. A public institution described in paragraph 1 of section 98 shall remain public even if the facilities it maintains no longer allow more than 20 persons to be lodged or if, by reason of the reorganization of the services it dispenses, it ceases to lodge more than 20 persons.

1992, c. 21, s. 9.

CHAPTER I.1 LOCAL HEALTH AND SOCIAL SERVICES NETWORK AND LOCAL AUTHORITY

2005, c. 32, s. 48.

99.2. For the purposes of this Act, “local health and social services network” means a network set up in accordance with an order of the Government made under the Act respecting local health and social services network development agencies (chapter A-8.1) and a new network set up in accordance with an order made under section 347.

2005, c. 32, s. 48.

99.3. The purpose of establishing a local health and social services network is to foster a greater sense of responsibility among all the health and social service providers in the network to ensure that the people in the network’s territory have continuous access to a broad range of general, specialized and superspecialized health services and social services.

2005, c. 32, s. 48.

99.4. The services offered by the health and social service providers in a local health and social services network are coordinated by a local authority, which is a multivocational institution operating a local community service centre, a residential and long-term care centre and, where applicable, a general and specialized hospital centre.

Only a local authority within the meaning of the first paragraph may use the words “health and social services centre” in its name.

2005, c. 32, s. 48.

99.5. The local authority is responsible for defining a clinical and organizational project in which the following elements are identified for the territory of the local health and social services network:

(1)  the social and health needs and the distinctive characteristics of the population based on an understanding of the state of health and well-being of that population;

(2)  the objectives to be pursued to improve the health and well-being of the population;

(3)  the supply of services required given the needs and the particular characteristics of the population; and

(4)  the organizational structures and the contributions expected of the different partners in the network.

The clinical and organizational project must be consistent with ministerial and regional orientations and recognized standards of accessibility, integration, quality, effectiveness and efficiency, and take into account the resources available.

For the purpose of defining its clinical and organizational project, a local authority must mobilize and ensure the participation, in the territory of its local network, of the institutions offering specialized and superspecialized services, of the various groups of professionals, of the community organizations, of the social economy enterprises, of the private resources and of the key players in the other sectors of activity that have an impact on health services and social services

2005, c. 32, s. 48.

99.6. With a view to improving the health and well-being of the people in its territory, a local authority must offer

(1)  general services, including prevention, assessment, diagnostic, treatment, rehabilitation, support and lodging services; and

(2)  certain specialized and superspecialized services, when available.

2005, c. 32, s. 48.

99.7. In order to coordinate the services required in the territory of the local health and social services network, the local authority must

(1)  define and establish mechanisms for the reception, referral and follow-up of users of health and social services;

(2)  introduce mechanisms or enter into agreements with different partners or producers of services, including institutions offering specialized and superspecialized services, physicians in the territory, community organizations, social economy enterprises and private resources;

(3)  take in charge, accompany and support persons, especially those with particular and more complex needs, in order to provide, within the local health and social services network, the continuity of service required by their state of health; and,

In force: 2006-01-01

(4)  together with the agency, the regional department of general medicine and the regional panel of heads of departments of specialized medicine, create conditions that foster accessibility, continuity and networking of general medical services, focusing in particular on accessibility

(a)  to technical/diagnostic facilities for all physicians;

(b)  to clinical information, including the results of diagnostic tests such as laboratory tests and medical imaging, drug profiles and record summaries; and

(c)  to specialists by family physicians, when appropriate, with a view to the hierarchization of services.

2005, c. 32, s. 48.

99.8. A local authority must use different methods of informing and consulting the public in order to involve people in the organization of services and ascertain their level of satisfaction with the results obtained.

2005, c. 32, s. 48.

CHAPTER II FUNCTIONS

100. The function of institutions is to ensure the provision of safe, continuous and accessible quality health or social services which respect the rights and spiritual needs of individuals and which aim at reducing or solving health and welfare problems and responding to the needs of the various population groups. To that end, institutions must manage their human, material, information, technological and financial resources effectively and efficiently and cooperate with other key players, including community organizations, to act on health and social determinants and improve the supply of services to the public. In addition, a local authority must elicit and facilitate such cooperation.

1991, c. 42, s. 100; 2002, c. 71, s. 5; 2005, c. 32, s. 49.

101. Every institution must, in particular,

(1)  receive any person requiring services and assess his needs;

(2)  dispense the required health or social services directly, or have them provided by an institution, body or person with which or with whom it has entered into a service agreement under section 108;

(3)  ensure that its services are provided in continuity and complementarity with those provided by the other institutions and resources of the region, and that such services are organized in a way that reflects the needs of the population it serves;

(4)  refer persons to whom it cannot provide certain services to another institution or body or to another person that provides them.

1991, c. 42, s. 101.

102. Each institution must develop for users of a class determined by regulation under subparagraph 27 of the first paragraph of section 505, to the extent prescribed therein, an intervention plan in order to identify the needs of the user, the objectives pursued, the means to be used and the estimated period during which services are to be provided. The intervention plan must ensure coordination of the services provided to the user by the various resources of the institution that are involved.

1991, c. 42, s. 102.

103. Where a user of a class determined by regulation under subparagraph 27 of the first paragraph of section 505 is to receive over an extended period health and social services which require, in addition to the participation of an institution, that of other resources, the institution which provides the greater part of the services involved or the resource designated jointly by the resources concerned must, as soon as possible, develop an individualized service plan for the user.

1991, c. 42, s. 103.

Not in force

103.1. (Not in force).

2005, c. 32, s. 50.

104. Each of the plans referred to in sections 102 and 103, respectively, must be developed with the participation of the user as provided in section 10.

Each plan must contain a timetable for assessment and review. A plan may, however, be modified at any time to take account of new circumstances.

1991, c. 42, s. 104.

105. Each institution shall determine the health services and the social services it will provide and the various activities it will organize, within the scope of the mission of any centre it operates and the resources at its disposal and in accordance with the regional service organization plan established by the regional board.

The institution shall also determine parameters for the health services and the social services it will provide and subject such parameters to the approval of the regional board.

1991, c. 42, s. 105; 1998, c. 39, s. 37.

106. An institution may adopt such by-laws as are necessary for the conduct of its affairs and the discharge of its duties. It must, however, adopt by-laws on any matter determined by regulation under paragraph 6 of section 505 coming under the authority of the institution.

A copy of the by-laws adopted by an institution shall be transmitted to the regional board or to the Minister on request.

1991, c. 42, s. 106.

107. Every institution must, at the request of the Minister or the regional board, take part in the assessment of the overall performance of the health and social services system.

An institution may use the name, address and telephone number contained in a user’s record to carry out surveys to ascertain user expectations and satisfaction with respect to the quality of the services offered by the institution.

A local authority may do the same to ascertain the level of user satisfaction with the organization of services and the results obtained.

A user may at any time request the institution or local authority to no longer use the information concerning the user for such a purpose.

For the purposes of this section, an institution must respect the rules of ethics adopted in accordance with the second paragraph of section 233.

1991, c. 42, s. 107; 2005, c. 32, s. 53.

107.1. Every institution must have the health services and social services it provides accredited by a recognized accreditation body every three years.

To that end, an institution may communicate to a recognized accreditation body the same information as it may use under section 107 for carrying out surveys, to the extent that the information is required for verifying the satisfaction of the institution’s clientele with the services obtained. Sections 27.1 and 27.2 apply, with the necessary modifications, when information is communicated to such a body. In addition, the body must agree to respect the rules governing the use of such information set out in the code of ethics adopted under section 233.

On receiving a response concerning the accreditation, the institution shall send to the Minister, the regional board and the various professional orders concerned that have members practising in a centre operated by the institution, a condensed report containing the recommendations relating to accreditation and specifying the validity period of the accreditation.

2002, c. 71, s. 6; 2005, c. 32, s. 54.

108. An institution may enter into an agreement with another institution, a body or any other person for any of the following purposes:

(1)  the provision on behalf of the institution of certain health services or social services required by a user of the institution;

(2)  the provision or exchange of professional health or social services.

An institution may also enter into an agreement with another institution concerning the acquisition and the automated preparation and distribution of drugs.

For the purposes of an agreement referred to in subparagraph 1 of the first paragraph or in the second paragraph, an institution may communicate information contained in a user’s record only if that communication is necessary either to ensure the provision by that other institution, that body or that other person of certain health services or social services to the user concerned or to ensure the centralized preparation of certain drugs. Sections 27.1 and 27.2 apply with the necessary modifications when information is communicated for those purposes to another institution, a body or another person.

In the case of an agreement entered into between an institution and a community organization referred to in Title II of this Part, the agreement must be consistent with the orientations, policies and approaches of the community organization.

In the case of an agreement referred to in subparagraph 2 of the first paragraph, the agreement shall not have the effect of granting the exclusive right to provide professional services or preventing the recruitment of professionals as projected in a medical staffing plan prepared by the regional board.

The agreement must be transmitted to the regional board.

1991, c. 42, s. 108; 1998, c. 39, s. 38; 2001, c. 43, s. 42; 2005, c. 32, s. 55.

108.1. In order to offer telehealth services to another institution, a body or another person, or to obtain such services from another institution, a body or another person, an institution must enter into an agreement to that effect with that other institution, that body or that other person. The agreement must set out

(1)  the precise nature of the services;

(2)  a description of the responsibilities of each party;

(3)  the conditions on which information may be exchanged for the purpose of assessing the telehealth act and processing complaints; and

(4)  the measures to be taken to ensure the confidentiality and security of the information communicated.

The fourth, fifth and sixth paragraphs of section 108 apply to such an agreement.

“Telehealth services” means a health or social services-related activity, service or system that is practised, provided or delivered in Québec from a distance for educational, diagnostic or treatment purposes or for purposes of research, clinical management or training, using information and communications technologies. However, telehealth services do not include consultations by telephone.

2005, c. 32, s. 56.

108.2. The health or social services provided by an institution in the form of telehealth services are considered provided at the place where the health or social services professional who was consulted practises.

Every institution and every health or social services professional involved in providing telehealth services must keep a record for each user or person to whom such services are provided, in accordance with the standards determined by regulation of the Government under paragraph 24 of section 505 in the case of an institution, and, in the case of a professional who practises elsewhere than in a facility maintained by an institution, in accordance with the standards governing record-keeping adopted by regulation or by-law of the Bureau of the order to which the professional belongs.

In this section, “health or social services professional” means a professional who provides health services or social services in Québec and who is a member of a professional order listed in Schedule I to the Professional Code (chapter C-26). A person training for a profession who is authorized to engage in professional activities reserved for members of such an order is considered a health or social services professional.

2005, c. 32, s. 56.

109. No physician or dentist is bound by an agreement referred to in section 108, 108.1 or 108.3 unless he has examined it and it is valid at the time he makes an application for appointment or renewal of appointment under section 237.

In addition, such an agreement must be consistent with an agreement made under section 19 of the Health Insurance Act (chapter A-29).

Within 30 days from the date of coming into force of the agreement, the institution shall send a copy of it to the representative organization concerned.

This section and sections 108, 108.1 and 108.3 do not apply to a physician or a dentist who, on 1 September 1993, practises in a centre operated by an institution for which no council of physicians, dentists and pharmacists has been established.

1991, c. 42, s. 109; 1998, c. 39, s. 39; 2005, c. 32, s. 57.

110. An institution may, after consulting the regional board and obtaining the authorization of the Minister,

(1)  enter into a contract of affiliation with a university for the purpose of offering teaching or research services, or amend or terminate such a contract;

(2)  enter into a service contract or agreement for the purpose of participating in university training or research programs.

An institution may enter into a contract of association with any other educational institution recognized by the Minister of Education, Recreation and Sports for the purpose of securing facilities to which students in the field of health and social services may go for probationary periods or professional training. The contract must be transmitted to the regional board.

The terms and conditions of the contracts and agreements referred to in the first or second paragraph must be consistent with the principles and general rules established by the Minister in cooperation with the Minister of Education, Recreation and Sports.

1991, c. 42, s. 110; 1993, c. 51, s. 55; 1994, c. 16, s. 50; 1998, c. 39, s. 40; 2005, c. 28, s. 195.

111. An institution may, on the conditions determined for that purpose by the Minister and according to law, enter into an agreement with a government other than that of Québec, or with any of its departments, any international organization or any agency of such a government or organization for the carrying out of its functions.

1991, c. 42, s. 111; 1994, c. 23, s. 1.

112. With a view to furthering the integration of services, the Minister may, after consultation with the regional board,

(1)  determine the supra-regional vocation of an institution with regard to certain highly specialized services it offers;

(2)  limit to certain institutions the function of offering certain services or dispensing certain medicines he determines.

1991, c. 42, s. 112; 1995, c. 28, s. 1.

113. No institution may offer new services which would require professional resources or highly specialized equipment determined by the Minister, or acquire highly specialized equipment determined by the Minister, before obtaining his authorization in writing. The Minister shall consult the regional board before granting his authorization.

1991, c. 42, s. 113.

114. A public institution may

(1)  operate a day care centre, a nursery school or a stop over centre, in accordance with the Act respecting childcare centres and childcare services (chapter C-8.2) and the regulations;

(2)  where it has been designated by the Minister of Child and Family Welfare under section 45.1 of the said Act to be that Minister’s regional representative, act in that capacity and exercise the functions attached thereto;

(3)  exercise any power whose exercise is authorized by the Office des services de garde à l’enfance under the said Act;

(4)  make an agreement with the said Minister under section 10 of the Act respecting the Ministère de la Famille et de l’Enfance (chapter M-17.2).

1991, c. 42, s. 114; 1996, c. 16, s. 67; 1997, c. 58, s. 135.

115. An institution, within the scope of its objects and powers, may organize activities complementary to the health services or social services it provides.

It may hire staff and enter into agreements for that purpose. The cost of all complementary activities must, however, be recovered from the clientele or otherwise be financed by means of voluntary contributions paid for that purpose by third persons. The cost shall include the annual capital expenditures, in capital and interest, and, except for the activities determined by the Minister, that part of the general expenses which is borne by the operating budget of the institution.

1991, c. 42, s. 115.

116. No institution may furnish medicines other than those appearing on the list drawn up by the Minister for that purpose. The list shall include only medicines in respect of which a notice of compliance has been issued by the federal government for approved indications. It shall be updated periodically after consultation with the Conseil du médicament established under section 53 of the Act respecting prescription drug insurance (chapter A-29.01). The Régie de l’assurance maladie du Québec must publish the list and each of its updatings. The list and updatings come into force on the date of publication in the Gazette officielle du Québec, or on any later date fixed therein, of a notice from the Minister stating that the list is drawn up or updated and that the list or updating has been published by the Régie.

An institution in which a council of physicians, dentists and pharmacists is established may, in addition, furnish, for purposes of specific medical requirements, medicines other than those appearing on the list referred to in the first paragraph in respect of which a notice of compliance has been issued by the federal government. In such case, the physician or dentist wishing to use or prescribe such medicines must request the opinion of the council of physicians, dentists and pharmacists. Where the opinion is favourable, it shall be transmitted to the Conseil du médicament.

In addition, an institution in which a council of physicians, dentists and pharmacists is established may furnish for exceptional treatment medicines other than those appearing on the list referred to in the first paragraph, even though no notice of compliance has been issued in respect of such medicines by the federal government, or medicines, whether or not they appear on the list, which are used for indications which are recognized but not approved. In such case, the physician or dentist wishing to use or prescribe such medicines must obtain the written authorization of the council of physicians, dentists and pharmacists.

In case of emergency, a physician or a dentist may use or prescribe a medicine referred to in the second or third paragraph before obtaining the opinion or written authorization of the council of physicians, dentists and pharmacists. He must, however, obtain, as soon as possible, the opinion or required authorization and justify both the urgency of using or prescribing the medicine and his decision to use or prescribe it.

1991, c. 42, s. 116; 1996, c. 32, s. 109; 1999, c. 89, s. 53; 2002, c. 27, s. 41.

117. An institution which operates a hospital centre designated as a university hospital centre or university institute or which manages a research centre or research institute recognized by the Fonds de la recherche en santé du Québec or which operates a centre designated as an affiliated university centre and which, under the terms of its contract of affiliation, takes part in clinical and basic research activities may furnish medicines on conditions and in circumstances prescribed by regulation.

1991, c. 42, s. 117; 1992, c. 21, s. 70.

118. In addition to the limits fixed in paragraph 2 of section 112, the Minister may, by regulation, determine, in respect of a medicine, the cases, conditions and circumstances of its use, after consulting the Ordre professionnel des médecins du Québec, the Ordre des pharmaciens du Québec and the Conseil du médicament.

1991, c. 42, s. 118; 1994, c. 40, s. 457; 2002, c. 27, s. 41.

118.1. Force, isolation, mechanical means or chemicals may not be used to place a person under control in an installation maintained by an institution except to prevent the person from inflicting harm upon himself or others. The use of such means must be minimal and resorted to only exceptionally, and must be appropriate having regard to the person’s physical and mental state.

Any measure referred to in the first paragraph applied in respect of a person must be noted in detail in the person’s record. In particular, a description of the means used, the time during which they were used and a description of the behaviour which gave rise to the application or continued application of the measure must be recorded.

Every institution must adopt a procedure for the application of such measures that is consistent with ministerial orientations, make the procedure known to the users of the institution and evaluate the application of such measures annually.

1997, c. 75, s. 49.

CHAPTER III ORGANIZATION OF INSTITUTIONS

DIVISION I BOARDS OF DIRECTORS OF PUBLIC INSTITUTIONS

§ 1 . — Establishment

119. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional county municipality and operating a residential and long-term care centre, or both a residential and long-term care centre and a general and specialized hospital centre with less than 50 beds.

For the purposes of this section, in areas where there is no regional county municipality, the territory concerned shall be the territory served by an institution which operates a local community service centre, unless the regional board, after taking into account the criteria mentioned in section 128, proposes another territory. Every such proposal requires the approval of the Minister.

1991, c. 42, s. 119; 1992, c. 21, s. 70.

120. A board of directors shall be established to administer all institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for mentally impaired persons.

1991, c. 42, s. 120.

121. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for persons with a physical impairment.

However, for the application of this section as regards the territory of the regional board established for the Montréal Centre region, the Minister may, on a proposal of the regional board, determine the organization referred to in the first paragraph otherwise than on the basis of the territory of the regional board.

1991, c. 42, s. 121; 1996, c. 36, s. 1.

122. (Replaced).

1991, c. 42, s. 122; 1996, c. 36, s. 1.

123. (Replaced).

1991, c. 42, s. 123; 1996, c. 36, s. 1.

124. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for persons who suffer from alcoholism or other problems of addiction.

1991, c. 42, s. 124.

125. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional board and operating the following centres:

(1)  a child and youth protection centre;

(2)  a rehabilitation centre for young persons with adjustment problems or for mothers with adjustment problems.

For the application of this section to the territory of the regional board established for the Montréal Centre region, the Minister shall determine otherwise than on the basis of the territory of the regional board, on a proposal submitted by the latter, the organization provided for in the first paragraph so as to permit the operation, by at least two institutions, of child and youth protection centres and the provision, by either of them, of services in the English language for English-speaking persons of the region.

1991, c. 42, s. 125; 1992, c. 21, s. 10.

126. A board of directors shall be established to administer an institution which operates a general and specialized hospital centre with less than 50 beds, a local community service centre or an institution designated as a health care centre.

The same applies to an institution which operates a general and specialized hospital centre with 50 beds or more or a psychiatric hospital centre and to an institution which operates both a residential and long-term care centre and a general and specialized hospital centre with 50 beds or more.

However, a specific board of directors shall be established to administer an institution which operates a general and specialized hospital centre designated as a university hospital centre, a university institute or an affiliated university centre.

1991, c. 42, s. 126; 1992, c. 21, s. 70; 2001, c. 24, s. 5.

126.1. In order to develop a network of continuous service for users while protecting the mission of the institutions concerned, a regional board may, after consulting the institutions concerned, propose to the Minister that the following institutions be administered by the same board of directors: an institution operating a local community service centre and one or more institutions operating either a residential and long-term care centre or both a residential and long-term care centre and a hospital centre with less than 50 beds providing only emergency care and general care and related consultations, or only such a hospital centre, if all the institutions have their head offices in the territory of the institution operating the local community service centre.

The Minister may, if of the opinion that the circumstances warrant it, allow the measures provided for in the first paragraph to be applicable as well to an institution operating a general and specialized hospital centre with 50 beds or more.

Where warranted by circumstances, such as the density of the population served or the organization of the services established on the basis of policies determined by the Minister, a regional board may, after consulting the institutions concerned, propose to the Minister that two or more institutions operating a local community service centre be administered by the same board of directors if they have their head offices in the territory of the same regional county municipality.

1996, c. 36, s. 2; 2001, c. 24, s. 6.

126.2. A regional board may, after consulting the institutions concerned, proposes to the Minister that two or more institutions operating a general and specialized hospital centre with 50 or more beds and having their head offices in the territory of the regional board, be administered by the same board of directors.

The Minister may, if of the opinion that the circumstances warrant it, allow that the measures provided for in the first paragraph be applicable even if one of the institutions operates a general and specialized hospital centre with less than 50 beds.

In force: 2002-08-01

The first paragraph does not apply to an institution referred to in the third paragraph of section 126.

1996, c. 36, s. 2; 2001, c. 24, s. 7.

126.2.1. The Minister may, on the Minister’s own initiative and after consulting the regional board and the institutions concerned, apply, after the time fixed by the Minister, the measures provided for in sections 126.l and 126.2.

2001, c. 24, s. 8.

126.3. Every decision made by the Minister pursuant to section 126.1 or 126.2 must be approved by the Government, which shall determine the day and month when the elections and designations of the persons referred to in sections 135 and 137 are to take place.

The Minister shall table every order made under the first paragraph before the National Assembly within 30 days of the day on which it is made or, if the National Assembly is not sitting, within 30 days of resumption.

1996, c. 36, s. 2; 2001, c. 24, s. 9.

126.4. If the election or designation of a member pursuant to section 126.3 does not take place, the regional board shall make the apppointment within the following 30 days.

The invitation to the population for the purposes of the election held under section 135 shall be made jointly by the boards of directors of the institutions concerned.

Notwithstanding the first paragraph of section 149, the terms of office of the members of the first board of directors established pursuant to section 126.1 or 126.2 shall, for certain members, run only until the month of October or November of the year in which an election is held under section 135, and for the remaining members, until elections, designations and cooptations have taken place under sections 137 and 138.

From the thirtieth day following the day on which the cooptation referred to in section 138 is completed, the institutions concerned by a decision of the Minister made pursuant to section 126.1 or 126.2 shall cease to be administered by the boards of directors established pursuant to section 119 or 126, as the case may be, and shall begin to be administered by the first boards of directors established pursuant to section 126.1 or 126.2, as the case may be.

1996, c. 36, s. 2; 1998, c. 39, s. 41; 2001, c. 24, s. 10.

126.5. The Government may, if it considers that the circumstances so require and in order to ensure that a decision made by the Minister under section 126.2 is implemented in the best possible conditions, allow the Minister to designate provisional members for a maximum period of two years after consulting the institutions concerned.

From the tenth day following the day on which the provisional members are designated, the institutions concerned shall cease to be administered by the boards of directors established pursuant to section 126 and shall be administered by the provisional members.

The elections and designations of persons referred to in sections 135 and 137 for the purpose of replacing the provisional members must take place not later than 30 days before the expiry of their terms.

1996, c. 36, s. 2; 1998, c. 39, s. 42; 2001, c. 24, s. 11.

127. Where, by reason of the centres it operates and according to sections 119 to 126, an institution could be administered by more than one board of directors, the Minister shall determine, after consulting the regional board, which board of directors will administer the institution.

For the purposes of sections 183 to 208, the institution is deemed to operate only the centre corresponding to the type of board of directors that must be established in accordance with the Minister’s decision.

1991, c. 42, s. 127; 1998, c. 39, s. 43.

128. A regional board may propose to the Minister that he modify the organizational structure provided for in sections 119 to 126 where the nature or size of the territory or the nature, the number, the special characteristics or the capacity of the centres situated in the territory, the type of clientele served, the density of the population served or the sociocultural, ethnocultural or linguistic characteristics of part of the population or the institutions warrant it. The regional board shall, more particularly, take into account the institutions recognized under section 29.1 of the Charter of the French language (chapter C-11).

The modifications must be approved by the Government.

The Minister shall table every order made under the second paragraph before the National Assembly within 30 days after its adoption if the Assembly is in session or, if it is not sitting, within 30 days after resumption.

1991, c. 42, s. 128; 1994, c. 23, s. 2; 1996, c. 36, s. 3.

§ 2 . — Composition of the board

1.  — Mode of appointment of members

129. The board of directors of the institutions referred to in section 119 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  five persons elected by the population at the election held under section 135 ;

(2)  two persons designated by the users’ committees of the institutions ;

(3)  one person designated by and from among the physicians of the regional department of general medicine practising in the territory concerned ;

(4)  one person designated by and from among the members of the council of nurses of the institutions ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institutions ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institutions concerned ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  three persons designated by the regional board and having their principal residence in the territory concerned, two being recognized for their experience and management skills and the third being from the professional community in the health and social services sector ;

(9)  two persons designated by the members referred to in paragraphs 1 to 8, one being chosen from a list of names provided by the community organizations in the territory concerned and the other from a list of names provided by the socio-economic organizations of the territory ;

(10)  the executive director of the institutions concerned.

1991, c. 42, s. 129; 1994, c. 40, s. 457; 1996, c. 36, s. 4; 1998, c. 39, s. 44; 2001, c. 24, s. 12.

129.1. The board of directors of the institutions referred to in each of sections 120, 121 and 124 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  three persons elected by the population at the election held under section 135 ;

(2)  one person designated by the users’ committees of the institutions ;

(3)  one person designated by and from among the members of the multidisciplinary council of the institutions ;

(4)  one person designated by the boards of directors of the region’s institutions referred to in the first paragraph of section 126 and section 126.1 and chosen from among the members of those boards ;

(5)  where applicable, one person designated by the boards of directors of the regional boards concerned by that supra-regional vocation if one or more of the institutions has or have a supra-regional vocation determined by the Minister pursuant to paragraph 1 of section 112 ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institutions concerned ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  three persons designated by the regional board, two practising a profession in the field of rehabilitation and the third exercising functions in the educational sector ;

(9)  three persons designated by the members referred to in paragraphs 1 to 8 and chosen from a list of names provided by the community organizations of the region operating in the field of rehabilitation or social integration ;

(10)  the executive director of the institutions concerned.

2001, c. 24, s. 13.

130. The board of directors of the institutions referred to in section 125 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  three persons elected by the population at the election held under section 135 ;

(2)  one person designated by the users’ committees of the institutions ;

(3)  one person designated by and from among the members of the multidisciplinary council of the institutions ;

(4)  one person designated by the boards of directors of the region’s institutions referred to in the first paragraph of section 126 and section 126.1 and chosen from among the members of those boards ;

(5)  where applicable, one person designated by the boards of directors of the regional boards concerned by that supra-regional vocation if one or more of the institutions has or have a supra-regional vocation determined by the Minister pursuant to paragraph 1 of section 112 ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institutions concerned ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)   four persons designated by the regional board, one practising a profession specific to the youth sector, and the others being from the childcare services sector, the judicial sector and the school sector, respectively ;

(9)  three persons designated by the members referred to in paragraphs 1 to 8 and chosen from a list of names provided by the community organizations of the region operating in the field of rehabilitation or social integration ;

(10)  the executive director of the institutions concerned.

1991, c. 42, s. 130; 1994, c. 40, s. 457; 1996, c. 36, s. 5; 1998, c. 39, s. 45; 2001, c. 24, s. 14.

131. The board of directors of the institutions referred to in the first paragraph of section 126 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  five persons elected by the population at the election held under section 135 ;

(2)  where applicable, one person designated by the users’ committee of the institution ;

(3)  one person designated by and from among the physicians of the regional department of general medicine practising in the territory served by the institution or, in the case of an institution which operates a hospital centre, in the territory of the regional county municipality or in the territory served by an institution which operates a local community service centre and in which the head office of that institution is located ;

(4)  one person designated by and from among the members of the council of nurses of the institution ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institution ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institution ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  where applicable, one person designated by and from among the council of midwives of the institution ;

(9)  three persons designated by the regional board and having their principal residence in the territory determined in paragraph 3, two being recognized for their experience and management skills and the third being from the professional community in the health and social services sector ;

(10)  two persons designated by the members referred to in paragraphs 1 to 9, one being chosen from a list of names provided by the community organizations in the territory determined in paragraph 3 and the other from a list of names provided by the socio-economic organizations of the territory ;

(11)  the executive director of the institution.

1991, c. 42, s. 131; 1992, c. 21, s. 11; 1992, c. 21, s. 70; 1994, c. 40, s. 457; 1996, c. 36, s. 6; 1998, c. 39, s. 46; 1999, c. 24, s. 27; 2001, c. 24, s. 15.

131.1. The board of directors of the institutions referred to in section 126.1 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  five persons elected by the population at the election held under section 135 ;

(2)  where applicable, two persons designated by the users’ committees of the institutions ;

(3)  one person designated by and from among the physicians of the regional department of general medicine practising in the territory concerned ;

(4)  one person designated by and from among the members of the council of nurses of the institutions ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institutions ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institutions concerned ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  where applicable, one person designated by and from among the council of midwives of the institutions ;

(9)  three persons designated by the regional board and having their principal residence in the territory concerned, two being recognized for their experience and management skills and the third being from the professional community in the health and social services sector ;

(10)  two persons designated by the members referred to in paragraphs 1 to 9, one being chosen from a list of names provided by the community organizations in the territory concerned and the other from a list of names provided by the socio-economic organizations of the territory ;

(11)  the executive director of the institutions concerned.

1996, c. 36, s. 7; 1998, c. 39, s. 47; 2001, c. 24, s. 16.

132. The board of directors of an institution referred to in the second paragraph of section 126 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  three persons elected by the population at the election held under section 135 ;

(2)  where applicable, one person designated by the users’ committee of the institution ;

(3)  one person designated by and from among the council of physicians, dentists and pharmacists of the institution ;

(4)  one person designated by and from among the members of the council of nurses of the institution ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institution ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institution ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  where applicable, one person designated by the boards of directors of the regional boards concerned by that supra-regional vocation if the institution has a supra-regional vocation determined by the Minister pursuant to paragraph 1 of section 112 ;

(9)  one person designated by the boards of directors of the region’s institutions referred to in section 119, the first paragraph of section 126 and section 126.1 and chosen from among the members of those boards ;

(10)  two persons recognized for their management skills and designated by the regional board ;

(11)  three persons designated by the members referred to in paragraphs 1 to 10 to ensure better representation on the board of directors of the sociocultural, ethnocultural, linguistic or demographic composition of the communities served by the institution ; however, in the case of an institution, other than an institution that operates a psychiatric hospital centre designated as a university institute, that has entered into a contract of affiliation with a university for the purpose of offering teaching or research services, a fourth person is to be designated from the university community ;

(12)  the executive director of the institution.

1991, c. 42, s. 132; 1992, c. 21, s. 12; 1992, c. 21, s. 70; 1996, c. 36, s. 8; 1998, c. 39, s. 48; 2001, c. 24, s. 17.

132.1. The board of directors of the institutions referred to in section 126.2 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  three persons elected by the population at the election held under section 135 ;

(2)  where applicable, one person designated by the users’ committees of the institutions ;

(3)  one person designated by and from among the council of physicians, dentists and pharmacists of the institutions ;

(4)  one person designated by and from among the members of the council of nurses of the institutions ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institutions ;

(6)  where applicable, one person designated by the boards of directors of the foundations of the institutions concerned ;

(7)  where applicable, one person designated by the members of a legal person designated under section 139 ;

(8)  where applicable, one person designated by the boards of directors of the regional boards concerned by that supra-regional vocation if one or more of the institutions has or have a supra-regional vocation determined by the Minister pursuant to paragraph 1 of section 112 ;

(9)  one person designated by the boards of directors of the region’s institutions referred to in section 119, the first paragraph of section 126 and section 126.1 and chosen from among the members of those boards ;

(10)   two persons recognized for their management skills and designated by the regional board ;

(11)  three persons designated by the members referred to in paragraphs 1 to 10 to ensure better representation on the board of directors of the sociocultural, ethnocultural, linguistic or demographic composition of the communities served by the institution ; however, if one of the institutions has entered into a contract of affiliation with a university for the purpose of offering teaching or research services, a fourth person is to be designated from the university community ;

(12)   the executive director of the institutions concerned.

1996, c. 36, s. 9; 1998, c. 39, s. 49; 2001, c. 24, s. 18.

132.2. For the purposes of paragraph 6 of each of sections 129 to 132.1 and 133, a “foundation of an institution” means a legal person established for non-profit purposes whose object is, essentially, to collect contributions made for the benefit of an institution designated by name in the constituting act of the foundation or of a new institution resulting from the amalgamation or conversion of the designated institution, or whose principal object is to collect contributions to be used, for a purpose or purposes corresponding to those mentioned in section 272, in the pursuit of all or part of the mission of such an institution.

1998, c. 39, s. 50; 2001, c. 24, s. 19.

132.3. All the lists of names referred to in paragraph 9 of each of sections 129, 129.1 and 130 and in paragraph 10 of each of sections 131 and 131.1 must tend towards gender parity.

2001, c. 24, s. 20.

133. The board of directors of an institution referred to in the third paragraph of section 126 shall be composed of the following persons, who shall be members of the board as and when they are designated :

(1)  two persons elected by the population at the election held under section 135 ;

(2)  where applicable, one person designated by the users’ committee of the institution ;

(3)  one person designated by and from among the council of physicians, dentists and pharmacists of the institution ;

(4)  one person designated by and from among the members of the council of nurses of the institution ;

(5)  one person designated by and from among the members of the multidisciplinary council of the institution ;

(6)  where applicable, two persons or, if paragraph 7 cannot be applied, three persons designated by the boards of directors of the foundations of the institution ;

(7)  where applicable, two persons designated by the members of the legal person referred to in section 139 ;

(8)   four persons or, where the institution operates a hospital centre designated as an affiliated university centre, three persons designated by the universities with which the institution is affiliated ; one person must be from a faculty of medicine, another from another faculty or school in the health sector and the third person must be a medical resident and be designated by and from among the medical residents practising at the hospital centre ;

(9)  two persons recognized for their management skills, one designated by the regional board concerned and the other designated by the boards of directors of the regional boards of the other regions served by the institution ;

(10)  one person recognized for his or her management skills and designated by the Government ;

(11)  four persons designated by the members referred to in paragraphs 1 to 10 to provide the board of directors with better representation of the sociocultural, ethnocultural, linguistic or demographic composition of the communities served by the institution ;

(12)   the executive director of the institution.

1991, c. 42, s. 133; 1992, c. 21, s. 70; 1996, c. 36, s. 10; 2001, c. 24, s. 21.

133.0.1. For the purposes of paragraph 5 of each of sections 129, 131 to 132.1 and 133 and of paragraph 3 of each of sections 129.1 and 130, the persons who perform nursing assistant activities for an institution are deemed to be members of the institution’s multidisciplinary council.

2001, c. 43, s. 43.

133.1. The composition of the board of directors of an institution, other than an institution referred to in the third paragraph of section 126, which operates a centre designated as a university institute or an affiliated university centre shall continue to be governed by the relevant provisions of sections 129 to 132.

Such a board of directors shall also include

(1)  where the institution operates a centre designated as a university institute, two persons designated by the universities with which the institution is affiliated ; those persons must be from faculties or schools in the fields concerned by the mission of the centre operated by the institution and designated as a university institute ;

(2)  where the institution operates a centre designated as an affiliated university centre, one person designated by the universities with which the institution is affiliated ; that person must be from a faculty or school in the field concerned by the mission of the centre operated by the institution and designated as an affiliated university centre.

In addition, those persons shall participate in the cooptation provided for in paragraph 9 of sections 129, 129.1 and 130, paragraph 10 of sections 131 and 131.1 or paragraph 11 of section 132, as the case may be.

2001, c. 24, s. 22.

133.2. New members may be designated as soon as one of the following situations occurs:

(1)  the provisions of section 133.1 apply following the designation, by the Minister, of a centre as a university institute or an affiliated university centre ;

(2)  the Minister assigns a supra-regional vocation to an institution pursuant to paragraph 1 of section 112;

(2.1)  a users’ committee is established pursuant to the second paragraph of section 209;

(3)  a foundation of an institution within the meaning of section 132.2 is established;

(4)  paragraph 7 of section 133 cannot be applied, thereby enabling a member to be added under paragraph 6 of that section.

The designation of such persons shall be carried out in accordance with the procedure set out in section 137.

The term of office of a person designated pursuant to this section shall end, notwithstanding section 149, at the same time as the term of office of the other members of the board of directors.

1996, c. 36, s. 11; 1998, c. 39, s. 51; 2001, c. 24, s. 23.

134. (Repealed).

1991, c. 42, s. 134; 1996, c. 36, s. 12; 1998, c. 39, s. 52; 2001, c. 24, s. 24.

135. Every institution shall, every three years, on such day in the month of October or November as the Minister determines, invite the population to elect the persons referred to in paragraph 1 of each of sections 129 to 132.1 and 133, as the case may be. No minor is entitled to vote.

In addition to the restrictions and limitations set out in sections 150 and 151, no person may be a candidate at more than one election held in accordance with the first paragraph. A person may vote only in the region in which he has his principal residence, and may vote only once at each of the following elections:

(1)  an election held by an institution operating a local community service centre serving the population of the territory in which the person’s principal residence is situated;

(2)  one of the elections held in the region to elect members to the board of directors of an institution referred to in section 125;

(3)  one of the elections held in the region to elect members to the board of directors of an institution referred to in section 119;

(4)  one of the elections held in the region to elect members to the board of directors of an institution referred to in sections 120, 121 and 124;

(5)  one of the elections held in the region to elect members to the board of directors of an institution referred to in sections 132 and 132.1;

(6)  one of the elections held in the region to elect the members of the board of directors of an institution referred to in section 133.

The mechanisms whereby candidates may address the population before an election, and the election procedure to be followed shall be determined by by-law of the regional board, as well as the standards relating to advertising, financing, the powers and duties of election officers and campaign literature. The by-law must be submitted to the Minister for approval; once approved, it shall come into force on the date of its publication in the Gazette officielle du Québec.

1991, c. 42, s. 135; 1992, c. 21, s. 13; 1996, c. 36, s. 13; 1998, c. 39, s. 53; 2001, c. 24, s. 25.

136. (Repealed).

1991, c. 42, s. 136; 1996, c. 36, s. 14; 1998, c. 39, s. 54.

137. The regional board shall, by by-law, determine the procedure for designating the persons referred to in paragraphs 2 to 7 of each of sections 129, 129.1 and 130, paragraphs 2 to 8 of each of sections 131, 131.1 and 133, paragraphs 2 to 9 of each of sections 132 and 132.1 or the second paragraph of section 133.1, as the case may be.

Designations under the first paragraph shall take place on the date fixed by the regional board but within the 30 days preceding the date fixed by the Minister for the holding of an election pursuant to section 135; however, designations under paragraph 4 of each of sections 129.1 and 130 and paragraph 9 of each of sections 132 and 132.1 shall take place during the 30 days following the holding of such an election.

1991, c. 42, s. 137; 1992, c. 21, s. 14; 1996, c. 36, s. 15; 1998, c. 39, s. 55; 2001, c. 24, s. 26.

138. Once the persons referred to in paragraph 8 of each of sections 129, 129.1 and 130, paragraph 9 of each of sections 131 and 131.1, paragraph 10 of each of sections 132 and 132.1, paragraphs 9 and 10 of section 133 and in sections 135 and 137 are designated, those persons shall, within the next thirty days, proceed with cooptation provided for in paragraph 9 of each of sections 129, 129.1 and 130, paragraph 10 of each of sections 131 and 131.1 or paragraph 11 of each of sections 132, 132.1 and 133, as the case may be.

Those persons must, in proceeding with the cooptation, enable persons whose competence and qualifications are judged to be useful for the administration of the institutions concerned to become members of the board of directors, ensure better representation of the different parts of the territory, and better sociocultural, ethnocultural, linguistic or demographic representation of the population served by the institutions on the board of directors and the most equitable representation possible of women and men.

The cooptation provided for in paragraph 9 of section 130 shall, in particular, enable at least one person who is under 35 years of age to become a member of the board of directors, should there be no such person on the board.

1991, c. 42, s. 138; 1996, c. 36, s. 16; 1998, c. 39, s. 56; 2001, c. 24, s. 27.

139. The Minister shall designate, from among the legal persons referred to in paragraph 1 of section 98 which own all or part of the immovables used for the activities of the institution, those whose members may, where applicable, take part in the designation of the persons referred to in paragraph 7 of each of sections 129 to 132.1 and 133, as the case may be.

The Minister must designate such a legal person if the latter proves to him that the acquisition or construction or the work performed on the immovables of the legal person has been financed by funds other than funds provided, in whole or in part, by government subsidy or other than funds provided entirely by public subscriptions and that the investments have not been the subject of a reimbursement or compensation.

1991, c. 42, s. 139; 1992, c. 21, s. 15; 1996, c. 36, s. 17; 2001, c. 24, s. 28.

140. A legal person referred to in section 139 may appeal to the Court of Québec from a decision rendered by the Minister refusing it the designation provided for in the said section.

1991, c. 42, s. 140; 1996, c. 36, s. 51.

141. Appeals are brought by means of a motion filed, within 30 days of the Minister’s decision, at the office of the Court of Québec in the judicial district where the head office of the institution is situated.

The motion must first be served on the Minister.

Service shall be governed by the Code of Civil Procedure (chapter C-25).

1991, c. 42, s. 141.

142. Within 10 days of the service of the motion on the Minister, the latter shall send the record relating to his decision to the office of the court.

1991, c. 42, s. 142.

143. Appeals shall be heard and decided by preference.

1991, c. 42, s. 143.

144. Subject to any additional proof it may require, the court shall render its decision on the record sent to it by the Minister after allowing the parties to express their views.

1991, c. 42, s. 144.

145. The Court of Québec may, in the manner prescribed by the Courts of Justice Act (chapter T-16), adopt the rules of practice deemed necessary for the purposes of sections 141 to 144.

1991, c. 42, s. 145.

146. The decision of the Court of Québec is final and without appeal.

1991, c. 42, s. 146.

147. If a position cannot be filled by the application of section 135, 137 or 138, the regional board shall appoint a person to the position within 60 days.

1991, c. 42, s. 147; 1998, c. 39, s. 57.

148. Any interested person may apply to the Administrative Tribunal of Québec to contest or demand the annulment of any election held pursuant to this subdivision.

The motion must be presented within 60 days of the date on which the results of the election are known.

On receipt of the motion, the secretary of the Tribunal shall send a copy to the person against whom the proceedings are brought and to the Minister of Health and Social Services. The Minister may intervene at any stage in the proceeding and in such case is a party thereto.

The Tribunal may confirm or annul the election or declare another person duly elected.

Where the Tribunal annuls the election of a member without declaring another person duly elected, a new election must be held without delay.

A member so elected shall remain in office for the unexpired portion of the term of office of the member whose election is annulled.

1991, c. 42, s. 148; 1997, c. 43, s. 724.

2.  — Terms of office and qualifications of members

149. The term of office of a member of a board of directors other than the executive director is three years.

The members shall remain in office notwithstanding the expiry of their terms until they are designated again, reelected or replaced.

1991, c. 42, s. 149; 2001, c. 24, s. 29.

150. The following persons cannot be members of a board of directors:

(1)  persons not resident in Québec;

(2)  minors;

(3)  persons under tutorship or curatorship;

(4)  persons convicted in the preceding five years of a crime punishable by three years of imprisonment or more;

(5)  persons forfeited of office as members of the board of directors of an institution or regional board in the preceding three years, pursuant to paragraph 2 of section 498;

(6)  persons convicted of an offence against this Act or the regulations in the preceding three years.

1991, c. 42, s. 150.

151. No person employed by the Ministère de la Santé et des Services sociaux, a regional board, an institution or any other organization providing services related to the field of health and social services and receiving subsidies from a regional board or the Minister, or employed by the Régie de l’assurance maladie du Québec or remunerated by the Régie, or a person practising under a service contract entered into pursuant to section 259.2, may vote or be elected at an election held under section 135.

Scholarships, subsidies or sums of money granted or paid under a research contract are not deemed to be remuneration for the purposes of the first paragraph.

A person employed by an institution or practising a profession in a centre operated by an institution may be designated as member of the board of directors of the institution only in accordance with the provisions of paragraphs 3 to 5 of sections 129, 129.1, 130, 132, 132.1 and 133 and paragraphs 3 to 5 and 8 of sections 131 and 131.1, respectively. The person may be designated as member of the board of directors of any other institution.

No member of a legal person designated under paragraph 7 of each of sections 129 to 132.1 and 133 may be elected during the election held under section 135.

1991, c. 42, s. 151; 1996, c. 36, s. 18; 1998, c. 39, s. 58; 1999, c. 24, s. 28; 1999, c. 89, s. 53; 2001, c. 24, s. 30.

152. A person ceases to be a member of a board of directors upon becoming disqualified for designation or election as such.

In addition, a person elected pursuant to section 135 shall cease to be a member of the board of directors upon becoming disqualified pursuant to the first or the fourth paragraph of section 151.

1991, c. 42, s. 152; 1996, c. 36, s. 19; 1998, c. 39, s. 59; 2001, c. 24, s. 31.

153. Any member of a board of directors may resign by transmitting a notice in writing of his intention to the secretary. A vacancy occurs upon acceptance of the resignation by the board of directors.

1991, c. 42, s. 153.

154. Any member of a board of directors, other than the executive director, who has a direct or indirect interest in an undertaking which causes his personal interest to conflict with the interest of the board or of any of the institutions under its administration must, under pain of forfeiture of office, disclose that interest in writing to the board of directors and abstain from sitting on the board and from participating in any deliberation or decision on any question relating to the undertaking in which he has that interest.

The fact that a member of the board of directors is a minority shareholder of a legal person operating an undertaking referred to in this section does not constitute a conflict of interest if the shares of the legal person are listed on a recognized stock exchange and if the member of the board of directors concerned is not an insider of the legal person within the meaning of section 89 of the Securities Act (chapter V-1.1).

1991, c. 42, s. 154; 1996, c. 36, s. 51.

155. No action for forfeiture of office under section 154 may be brought except by the regional board concerned, by the institution concerned or by the Minister.

Any person who is aware of a situation described in section 154 may report it to the regional board, the institution or the Minister.

1991, c. 42, s. 155.

156. Any vacancy occurring after the election or designation of a member of a board of directors shall be brought to the attention of the regional board and filled, for the unexpired portion of the term of office of the member to be replaced, as follows:

(1)  in the case of a member referred to in paragraph 8 of sections 129, 129.1 and 130, paragraph 9 of sections 131 and 131.1, paragraph 10 of sections 132 and 132.1 and paragraphs 9 and 10 of section 133, in accordance with the procedure described for the designation of that member ;

(2)  in the case of a member referred to in paragraphs 2 to 5 of sections 129, 132, 132.1 and 133, paragraphs 2 and 3 of sections 129.1 and 130 and in paragraphs 2 to 5 and 8 of sections 131 and 131.1, every vacancy occurring less than two years after a designation shall be filled in accordance with the procedure prescribed for the designation of that member ;

(3)  in every other case, the members of the board of directors remaining in office shall fill the vacancy by resolution provided the person thus designated has the qualifications required to be a member of the board of directors in the same capacity as the member being replaced, and provided the designation, where applicable, takes into account the cases of ineligibility set out in the first and fourth paragraphs of section 151. The board of directors shall inform the regional board of the designation.

If the board of directors fails to fill a vacancy in accordance with subparagraph 2 or 3 of the first paragraph within the next 120 days, the vacancy may be filled by the regional board.

Any unexplained absence from a number of regular and consecutive sittings of the board of directors determined in the rules of internal management, in the cases and circumstances provided therein, also constitutes a vacancy.

1991, c. 42, s. 156; 1996, c. 36, s. 20; 2001, c. 24, s. 32; 2005, c. 32, s. 85.

§ 3 . — Operation

1.  — Chairman, vice-chairman and secretary

157. Each year, the members of a board of directors shall elect a chairman, a vice-chairman and a secretary from among their number.

1991, c. 42, s. 157.

158. The chairman of the board of directors shall preside over the sittings, see that good order is maintained and assume all other duties assigned to him by by-law of the board.

The vice-chairman shall replace the chairman when the chairman is absent or unable to act.

1991, c. 42, s. 158; 1999, c. 40, s. 269.

159. In no case may the chairman or the vice-chairman of the board of directors be a person employed by the institution or any of the institutions administered by the board, or a physician, dentist, pharmacist or midwife practising in one of the centres operated by the institution.

1991, c. 42, s. 159; 1999, c. 24, s. 29.

2.  — Sittings

160. The procedure for calling sittings of the board of directors shall be determined by by-law of the board.

1991, c. 42, s. 160.

161. The sittings of a board of directors are public; the board of directors may, however, order that a sitting be held in camera, particularly where it considers it expedient to avoid causing any harm to a person and at the time of deliberations on the negotiation of conditions of employment; the decisions made at sittings held in camera are public, subject to the protection of personal information contained therein.

The board of directors must allow for a question period at each sitting.

The documents submitted or transmitted to the board of directors and the information furnished at public sittings as well as the minutes of those sittings are public, subject to the protection of personal information contained therein.

1991, c. 42, s. 161.

161.1. A member of the board of directors may, where a quorum of members is physically present at the place where a meeting of the board of directors is to be held and where a majority of those members have consented thereto, participate in the meeting by means of videoconferencing, telephone or other communications equipment by means of which all persons participating in the meeting can hear each other. In such a case, the member is deemed to have attended the meeting.

The minutes of such a meeting must mention

(1)  the fact that the meeting was held with the assistance of the communications equipment they indicate;

(2)  the name of the members physically present at the meeting, and the names of the members who agreed to the use of the communications equipment;

(3)  the name of the member who participated in the meeting using the communications equipment.

1998, c. 39, s. 60.

162. A majority of the members in office of a board of directors, including the chairman or the vice-chairman, constitutes a quorum at sittings of the board.

1991, c. 42, s. 162; 2005, c. 32, s. 86.

163. Subject to section 201, the decisions of the board of directors are taken by a majority of the votes cast by the members present.

In the case of a tie, the chairman of the board or the vice-chairman has a casting vote.

1991, c. 42, s. 163.

164. In emergencies, a resolution in writing signed by all the members of the board of directors has the same force as if it had been passed at a sitting.

The resolution shall be deposited at the next sitting and kept with the minutes of the sittings of the board of directors.

The members of the board of directors may also, in emergencies, if there is a quorum and if all the members have consented thereto, participate in a special meeting by way of a telephone conference call.

The minutes of such a meeting must mention the fact that the meeting was held by way of a telephone conference call, and that all the members who participated in the meeting agreed to the procedure. The decisions made at the meeting must be tabled at the following public meeting.

1991, c. 42, s. 164; 1998, c. 39, s. 62.

3.  — Reimbursement of expenses

165. Members of a board of directors are not remunerated. However, they are entitled to the reimbursement of expenses incurred in the performance of their duties on the conditions and to the extent determined by the Government.

1991, c. 42, s. 165.

4.  — Documents and records

166. The minutes of the sittings of the board of directors, approved by it and signed by the chairman and the secretary, are authentic. The same applies to documents and copies or extracts issued by the institution or forming part of its records if certified true by the chairman of the board or the secretary.

1991, c. 42, s. 166.

167. Where the board of directors is established under any of sections 119 to 125 or under section 126.1 or 126.2, the minutes shall indicate which institutions, among the institutions it administers, are bound by a decision of the board. Failing such an indication, the decision shall be binding on all such institutions.

1991, c. 42, s. 167; 1996, c. 36, s. 21; 1999, c. 40, s. 269.

168. Every institution must keep and maintain at its head office a register of the name, address and occupation of every member of the board of directors and, if the institution is a legal person within the meaning of paragraph 1 of section 98, of every member of the legal person, and books containing the by-laws of the institution, the minutes of the sittings of the board of directors and, where applicable, those of the meetings of the members of the legal person.

The board of directors established in accordance with any of sections 119 to 125 or established in accordance with section 126.1 or 126.2 shall determine, by resolution, at which of the head offices of the institutions under its administration its minutes, its correspondence and any other document binding several of these institutions shall be kept. A certified copy of the minutes and decisions shall, however, be transmitted and kept at the head office of each of the other institutions.

1991, c. 42, s. 168; 1996, c. 36, s. 22.

169. No instrument, document or writing binds an institution unless it is signed by the chairman of the board of directors, the executive director or, to the extent determined by by-law of the board, by a member of the personnel of that institution.

1991, c. 42, s. 169.

§ 4 . — Powers and obligations of the board of directors

170. The board of directors shall manage the affairs and exercise all the powers of every institution under its administration, except the powers assigned to the members of a legal person designated by the Minister pursuant to section 139, which may be exercised in accordance with the provisions of subdivision 5 of this division.

1991, c. 42, s. 170; 1992, c. 21, s. 17; 1996, c. 36, s. 51.

171. The board of directors shall establish priorities and orientations for every institution under its administration and see to it that they are observed.

Priorities shall focus on the physical and mental health needs as well as on the social needs to be satisfied, the populations to be served and the services to be provided.

Priorities must take account of the distinctive geographical, linguistic, sociocultural and socioeconomic characteristics of the users and of the human, material and financial resources put at the disposal of the institution.

In addition, the priorities must conform to the medical and dental staffing plan approved by the regional board under section 378 and with the regional service organization plans provided for in section 347.

1991, c. 42, s. 171.

172. The board of directors must in addition, for every institution under its administration, ensure

(1)  the pertinence, quality, safety and effectiveness of the services provided;

(2)  respect for users’ rights and promptness in processing users’ complaints;

(3)  economical and efficient use of human, material and financial resources;

(4)  the participation, motivation, enrichment, maintenance of professional standards and development of human resources.

1991, c. 42, s. 172; 2002, c. 71, s. 7.

173. The board of directors must,

(1)  appoint the executive director and senior management officers;

(2)  appoint the local service quality commissioner in accordance with the provisions of section 30;

(3)  appoint physicians and dentists, assign a status and grant privileges to them and determine the obligations to be attached to such privileges;

(4)  appoint pharmacists and assign a status to them, where pertinent;

(4.1)  enter into service contracts in accordance with section 259.2 whenever required;

(5)  allocate financial resources to every institution under its administration and determine the portion of those financial resources that is to be reserved for the payment of family-type resources and intermediate resources attached to the institutions.

1991, c. 42, s. 173; 1998, c. 39, s. 63; 1999, c. 24, s. 30; 1998, c. 39, s. 63; 2001, c. 43, s. 44.

174. The members of the board of directors shall, within the scope of the powers conferred on them, exercise the care, prudence, diligence and skill that a reasonable person would exercise in similar circumstances; they must also act with honesty, loyalty and in the interest of the institution or, as the case may be, of the group of institutions administered by them and of the population served.

1991, c. 42, s. 174.

175. Each institution shall assume the defence of any member of its board of directors who is prosecuted by a third person for an act done in the performance of his duties.

In penal or criminal proceedings, however, the institution shall assume the payment of the expenses of a member of the board of directors only where he had reasonable grounds to believe that his conduct was in conformity with the law, or if he has been freed or acquitted or if the proceedings have been withdrawn or dismissed.

1991, c. 42, s. 175.

176. The board of directors shall meet at least six times a year. It must also meet at the request of the chairman or at the written request of one-third of its members in office.

1991, c. 42, s. 176; 2001, c. 24, s. 33.

177. Every board of directors must, at least once a year, hold a public information meeting to which it shall invite the population. The meeting may be held at the same time as a meeting held pursuant to section 176.

Public notice of at least 15 days of the date, time and place of the sitting must be given to the population by the board of directors.

At the meeting, the members of the board of directors must present to the population, in accordance with the regulation made by the Minister under section 487.1, such items of information as are prescribed with respect to the report of activities and the annual financial report of every institution under the administration of the board. They must also justify their priorities and new orientations established under section 171 and answer questions put to them with respect to the annual financial report, the management of each institution under the administration of the board of directors and the services provided by each of the institutions.

The report on the application of the complaint examination procedure and the improvement of the quality of services referred to in section 76.10 shall also be presented to the population at that public information meeting.

The procedure for calling and conducting the meeting shall be determined by by-law of the institution.

1991, c. 42, s. 177; 1998, c. 39, s. 64; 2001, c. 43, s. 45.

178. The board of directors may hold several public information meetings if it considers that the size of the territory, the number of institutions under its administration, the density of the population invited to attend or the nature of the services provided to the users justifies the holding of several meetings. However, only one such meeting may be held at the same time as a meeting held pursuant to section 176.

1991, c. 42, s. 178; 1998, c. 39, s. 65.

179. Where the institution is a legal person referred to in paragraph 1 of section 98, the board of directors must see to it that the members of the legal person adopt a by-law to determine the conditions of admission of their members, their rights and obligations and the criteria or conditions relating to their resignation, suspension or exclusion.

If the members of the legal person fail to do so, the board of directors shall act in their stead.

An amendment to the by-law must, to become effective, be submitted to the board of directors for approval.

1991, c. 42, s. 179; 1996, c. 36, s. 51.

180. Where the institution is a legal person designated by the Minister under section 139, the board of directors must notify the members of the legal person of any measure that may entail a reduction in the value or a change in the destination of the immovables of the institution.

The board of directors cannot alienate an immovable of such an institution or change its use except with the approval of at least two-thirds of the votes cast by the members of the legal person.

1991, c. 42, s. 180; 1996, c. 36, s. 51.

181. The board of directors may, by by-law, establish the councils and committees necessary for the pursuit of its objects and determine their composition, functions, powers and duties, and the rules governing the administration of their affairs and their internal management.

The board of directors may delegate its powers to any council or committee, except those powers which the board of directors may exercise only by by-law.

1991, c. 42, s. 181.

§ 5 . — Representation of the members of certain legal persons

1992, c. 21, s. 18; 1996, c. 36, s. 51.

181.1. The members of a legal person designated by the Minister pursuant to section 139 may, by by-law, form a board of governors or a board of delegates to represent them, and determine the composition, the rules of internal management and the functions and duties of such a board, as well as the method of appointment, the term of office, and the method of dismissal of a governor or delegate.

The first paragraph of section 168 applies, with the necessary modifications, to governors or delegates and to the minutes of their meetings.

Notices which must be sent to members of the legal person are validly sent if addressed to the board of governors or delegates.

1992, c. 21, s. 18; 1996, c. 36, s. 51.

181.2. The by-law made pursuant to section 181.1 may provide that the exercise of the powers assigned to the members of the legal person under sections 129 to 132.1, 133, 179, 180, 262.1, 327, 330 and 550 may be entrusted to the board of governors or delegates.

1992, c. 21, s. 18; 1996, c. 36, s. 23; 2001, c. 24, s. 34.

DIVISION II ADMINISTRATION OF PRIVATE INSTITUTIONS

182. The functions, duties and responsibilities entrusted to a board of directors under sections 29 to 34, 38, 39, 171 to 173, 183.1, 188, 190, 192, 212, 214 and 216 or under any provision of subdivision 11 of Division III of this chapter shall be carried out, in the case of a private institution, by its board of directors.

In the case of an unincorporated private institution, the functions, duties and responsibilities shall be carried out by the holder of the operating permit.

1991, c. 42, s. 182; 1992, c. 21, s. 19; 2001, c. 43, s. 46; 2002, c. 71, s. 8.

DIVISION II.1 MANAGEMENT AND REPORTING

2001, c. 24, s. 35.

§ 1 . — Management and accountability agreement

2001, c. 24, s. 35.

182.1. Each public institution must enter into a management and accountability agreement with the regional board.

In the case of an institution referred to in the third paragraph of section 126, however, the Minister must be a party to the agreement.

2001, c. 24, s. 35.

182.2. A management and accountability agreement must contain

(1)  a definition of the mission and strategic directions of the institution ;

(2)  an annual action plan describing the objectives for the first year of the agreement, the measures to be taken to achieve them and the available resources, and an undertaking to produce such a plan on an annual basis ;

(3)  the main indicators to be used in measuring the results ;

(4)  an undertaking to produce, at the end of each year, a management report describing the results achieved.

2001, c. 24, s. 35.

182.3. A management and accountability agreement is a public document which the regional board shall transmit to the Minister.

2001, c. 24, s. 35.

182.4. The executive director of the institution having entered into a management and accountability agreement must ensure that the mission and strategic directions of the institution are complied with, and that the institution achieves its annual objectives within the management framework applicable to it using the resources allocated to it.

2001, c. 24, s. 35.

182.5. The regional board is, after entering into a management and accountability agreement, empowered to exercise supervision and control over the achievement of the objectives of the institution.

The board of directors of the institution and, in the case of an agreement under the second paragraph of section 182.1, the Minister are also empowered to exercise supervision and control.

2001, c. 24, s. 35.

182.6. A board of directors of an institution that considers that the executive director has not complied with the management and accountability agreement may take measures such as suspending the appointment of the executive director for a determined term, reducing the term of appointment or dismissing or replacing the executive director.

In addition, the regional board may suspend or cancel the management and accountability agreement. The regional board shall notify the Minister immediately of the suspension or cancellation.

2001, c. 24, s. 35.

§ 2 . — Reporting

2001, c. 24, s. 35.

182.7. Every institution must prepare an annual management report.

The report must include

(1)  a presentation of the results obtained, measured against the objectives fixed in the management and accountability agreement ;

(2)  a statement by the executive director of the institution concerning the reliability of the data and of the monitoring mechanisms ;

(3)  any other particular or information determined by the Minister.

The annual management report of the institution shall be transmitted to the regional board, which shall communicate it to the Minister.

2001, c. 24, s. 35.

182.8. The annual management report shall replace the annual report of activities that is required under section 278 if the annual management report contains the information required to be included in the annual report of activities.

2001, c. 24, s. 35.

DIVISION III HUMAN RESOURCES

§ 1 . — Organization plan

183. Every institution must prepare an administrative, professional and scientific organization plan. The plan shall describe the administrative structure of the institution, its divisions, services and departments as well as the clinical programs of the institution.

The organization plan of an institution shall indicate, on the recommendation of the council of physicians, dentists and pharmacists, which department or service is responsible for the medical, pharmaceutical or dental acts of a clinical program, or, on the recommendation of the medical service referred to in section 186, which department or service is responsible for the medical acts of that clinical program.

The organization plan must be transmitted on request to the regional board or to the Minister.

The organization plan must be reviewed at least once every three years.

1991, c. 42, s. 183; 1998, c. 39, s. 66.

183.1. The organization plan of an institution must also provide for the creation of a risk and quality management committee.

The number of members of that committee and the rules governing its functioning shall be determined by by-law of the board of directors of the institution.

The composition of the committee shall ensure a balanced representation of the employees of the institution, of users, of the persons practising in a centre operated by the institution and, if applicable, of the persons who, under a service contract, provide services to users on behalf of the institution. The executive director or the person the executive director designates shall be ex officio a member of the committee.

2002, c. 71, s. 9.

183.2. The functions of the committee include seeking, developing and promoting ways to

(1)  identify and analyze the risk of incidents or accidents in order to ensure the safety of users and, in particular in the case of nosocomial infections, prevent such risks and reduce their recurrence;

(2)  make sure that support is provided to the victim and the close relatives of the victim; and

(3)  establish a monitoring system including the creation of a local register of incidents and accidents for the purpose of analyzing the causes of incidents and accidents, and recommend to the board of directors of the institution measures to prevent such incidents and accidents from recurring and any appropriate control measures.

For the purposes of this section and sections 233.1, 235.1 and 431 and unless the context indicates otherwise,

“incident” means an action or situation that does not have consequences for the state of health or welfare of a user, a personnel member, a professional involved or a third person, but the outcome of which is unusual and could have had consequences under different circumstances.

2002, c. 71, s. 9; 2005, c. 32, s. 95.

183.3. The answers given by a person in the course of risk management activities, including any information or document supplied in good faith by the person in response to a request of a risk and quality manager or a risk and quality management committee may not be used or be admitted as evidence against the person or against any other person in a judicial proceeding or a proceeding before a person or body exercising adjudicative functions.

Notwithstanding any inconsistent provision, a risk and quality manager or a member of a risk and quality management committee may not be compelled to make a deposition in a judicial proceeding or a proceeding before a person or body exercising adjudicative functions concerning any confidential information obtained in the exercise of his or her functions, or to produce a document containing such information, except to confirm its confidential nature.

Nothing contained in a risk and quality management record, including the conclusions with reasons and any related recommendations, may be construed as a declaration, recognition or extrajudicial admission of professional, administrative or other misconduct capable of establishing the civil liability of a party in a judicial proceeding.

2002, c. 71, s. 9.

183.4. Notwithstanding the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A‐2.1), the records and minutes of a risk and quality management committee are confidential.

No person may have access to the minutes of a risk and quality management committee except the members of the committee, the representatives of accreditation bodies in the exercise of functions pertaining to the accreditation of the health services and social services provided by institutions or the representatives of a professional order in the exercise of the functions assigned to them by law.

2002, c. 71, s. 9.

184. The organization plan of a hospital centre must, in addition, provide for the formation of clinical departments and services. The plan must indicate the number of general practitioners, specialists in each specialty, dentists and dental specialists who may practise in each department and service. These elements must be determined taking into account the permit of the institution operating the hospital centre, the financial resources at its disposal and the regional service organization plans drawn up by the regional board, as well as the expansion or reduction objectives referred to in section 377.

The part of the organization plan referred to in the first paragraph must be transmitted to the regional board for approval in accordance with section 378 after having been referred for consultation to the council of physicians, dentists and pharmacists if any, and, in the case of a hospital centre designated as a university hospital centre or university institute, after consultation with the university with which the institution is affiliated. Once approved by the regional board, the said part of the organization plan shall constitute the medical and dental staffing plan of the institution.

The medical and dental staffing plan must be reviewed at least once every three years and shall continue in force until the regional board decides on its revision.

1991, c. 42, s. 184; 1992, c. 21, s. 70; 1998, c. 39, s. 67.

185. With the exception of hospital centres operated by institutions designated by government order, the organization plan of every hospital centre must also provide for the formation of a clinical department of general medicine which must be under the responsibility of a general practitioner.

1991, c. 42, s. 185; 1992, c. 21, s. 70; 1998, c. 39, s. 68.

186. The organization plan of a local community service centre, rehabilitation centre or residential and long-term care centre must also specify the number of physicians and dentists who may practise in the centre, according to the permit of the institution, the financial resources at its disposal and the regional service organization plans drawn up by the regional board, together with the expansion and reduction objectives referred to in section 377.

If at least one physician practises in the centre, the organization plan must provide for the formation of a medical service or the appointment of a physician in charge of medical care. However, in the case of an institution operating a residential and long-term care centre for which a council of physicians, dentists and pharmacists has been established pursuant to section 213, the organization plan must provide for the formation of a clinical department of general medicine, the formation of a medical service or the appointment of a physician responsible for medical care.

The second paragraph does not apply where an institution operating a residential and long-term care centre is otherwise bound to form a clinical department of general medicine pursuant to section 185.

The medical service shall be composed of the physicians practising in the centre and shall be directed by the physician who is the head of the medical service.

The mode of appointment, qualifications and functions of medical service heads and of physicians in charge shall be determined by regulation under paragraph 13 of section 505. Where necessary, the second paragraph of section 214 shall apply, with the necessary modifications, to the medical service or the physician in charge, regarding the functions determined by that regulation.

This part of the organization plan, after having been referred for consultation to the council of physicians, dentists and pharmacists, the medical service, or the physician in charge, as the case may be, must be sent to the regional board for approval in accordance with section 378. Once approved by the regional board, the said part of the organization plan shall constitute the medical and dental staffing plan of the institution.

If the centre is designated as a university institute, this part of the organization plan must be prepared after consultation with the university with which the institution is affiliated.

The medical and dental staffing plan must be reviewed at least once every three years and shall continue in force until the regional board decides on its revision.

1991, c. 42, s. 186; 1992, c. 21, s. 20; 1998, c. 39, s. 69.

187. The organization plan of every institution must also provide for any element required under this Act or a regulation made under subparagraphs 11 and 13 of the first paragraph of section 505.

1991, c. 42, s. 187.

§ 2 . — Clinical department heads

188. Every clinical department formed in a hospital centre shall be directed by its head who must be a physician, dentist or pharmacist, except for the clinical biochemistry department whose head may be a clinical biochemist.

The clinical department head shall be appointed for not more than four years by the board of directors after consulting the physicians, dentists and pharmacists and, where applicable, the clinical biochemists practising in the department, the director of professional services and the council of physicians, dentists and pharmacists.

In the case of a centre designated as a university hospital centre or university institute, the board of directors must also consult the university with which the institution is affiliated according to the terms of the contract of affiliation entered into in accordance with section 110.

1991, c. 42, s. 188; 1992, c. 21, s. 70.

189. The head of a clinical department, under the authority of the director of professional services, shall have the following responsibilities:

(1)  coordinating, subject to the responsibilities of the council of physicians, dentists and pharmacists in accordance with section 214, the professional activities of the physicians, dentists and pharmacists in his department and of the clinical biochemists, if any;

(2)  managing the medical and dental resources and, if a clinical department of pharmacy is formed in the centre, the pharmaceutical resources of his department and, to the extent provided by regulation under paragraph 13 or 14 of section 505, the other resources;

(3)  drawing up, for his department, rules governing the use of medical and dental resources and of material resources used by physicians and dentists; if a clinical department of pharmacy is formed in the centre, he shall be responsible for drawing up rules governing the use of the pharmaceutical resources and material resources of his department;

(4)  managing, in the case of the head of the clinical department of radiology, the head of the clinical department of medical biology laboratories or the head of the clinical department of pharmacy, the resources of his clinical department to the extent provided for in the regulation referred to in subparagraph 2 of this section. The Government may in such regulation provide for the management of part or all of the resources of a clinical department of radiology, of a clinical department of medical biology laboratories or of a clinical department of pharmacy being entrusted by the director of professional services to a person other than the heads of those clinical departments;

(5)  drawing up a duty roster in accordance with the by-laws of the council of physicians, dentists and pharmacists as approved by the board of directors, and seeing to its enforcement;

(6)  ensuring an appropriate distribution of medical and dental care and of pharmaceutical services in his department;

(7)  seeing that the rules governing the use of resources drawn up by him for his department are complied with and informing the director of professional services or the council of physicians, dentists and pharmacists of any breach of those rules by a physician, dentist or pharmacist, if the case arises.

The rules governing the use of resources drawn up under subparagraph 3 of the first paragraph must include administrative sanctions which may have the effect of limiting or suspending the right of a physician or dentist to use the resources of the institution. However, such sanctions cannot be considered as a breach of the privileges granted by the board of directors to the physician or dentist, as the case may be.

Where no head of a clinical department is designated, the responsibilities listed in the first paragraph shall be exercised by the director of professional services.

Where the head of a clinical department neglects to draw up rules governing the use of resources, the executive director may request that the director of professional services draw up such rules.

1991, c. 42, s. 189.

190. The head of a clinical department is accountable to the council of physicians, dentists and pharmacists for

(1)  supervising the manner in which medicine, dentistry and pharmacy are practised in his department;

(1.1)  where applicable, supervising, subject to the responsibilities of the director of nursing care under subparagraphs 1 and 1.1 of the first paragraph of section 207, the activities referred to in the second paragraph of section 31 of the Medical Act (chapter M‐9) that are engaged in by nurses or other professionals of the department who are authorized to engage in those activities by a regulation of the Bureau of the Collège des médecins du Québec;

(2)  drawing up, for his department, rules governing medical and dental care and rules governing the use of medicines which take into account the necessity of providing adequate services to users and the organization and available resources of the institution;

(3)  giving his opinion on the privileges and status to be granted to a physician or dentist upon an application for appointment or renewal of appointment and on the obligations attached to the enjoyment of such privileges and, if a clinical department of pharmacy is formed in the hospital centre, giving his opinion on the status to be granted to a pharmacist upon an application for appointment.

Notwithstanding the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A‐2.1), all records concerning the exercise of the roles described in subparagraphs 1 and 1.1 of the first paragraph shall be confidential. No person may have access to them except the council of physicians, dentists and pharmacists, the Administrative Tribunal of Québec or the representatives of a professional order in the performance of the duties assigned to it by law.

The rules drawn up under subparagraph 2 of the first paragraph must provide that the professional practice of physicians, dentists and pharmacists of clinical departments adhere to a single set of rules.

Where no clinical department head is designated or where the clinical department head is not a physician, dentist or pharmacist, the responsibilities listed in the first paragraph shall be exercised by the council of physicians, dentists and pharmacists.

Where the head of a clinical department neglects to draw up rules governing medical and dental care and rules governing the use of medicines, the board of directors may request that the council of physicians, dentists and pharmacists draw up such rules.

1991, c. 42, s. 190; 1992, c. 21, s. 70; 1994, c. 40, s. 457; 1997, c. 43, s. 725; 2002, c. 33, s. 24.

191. The rules governing the use of resources drawn up under subparagraph 3 of the first paragraph of section 189 must, in particular, provide that no bed may be reserved for a particular physician or dentist for users he treats and that in cases of necessity, the director of professional services or, if there is no such director, the physician designated for that purpose by the executive director may designate a department or service in which a bed must be put at the disposal of a user.

1991, c. 42, s. 191.

192. The rules governing the use of resources drawn up under subparagraph 3 of the first paragraph of section 189 shall come into force after having been approved by the board of directors which beforehand must have obtained the opinion of the council of physicians, dentists and pharmacists, where such a council exists.

The rules governing medical and dental care and the rules governing the use of medicines drawn up under subparagraph 2 of the first paragraph of section 190 shall come into force after having been approved by the board of directors which beforehand must have obtained the recommendation of the council of physicians, dentists and pharmacists, where such council exists and, as regards the rules governing medical care and the rules governing the use of medicines applicable to nurses authorized to engage in activities referred to in section 36.1 of the Nurses Act (chapter I‐8), the recommendation of the council of nurses.

1991, c. 42, s. 192; 2002, c. 33, s. 25.

§ 3 . — Executive director of a public institution

193. The executive director of a public institution shall be appointed by the members of the board of directors of that institution, after consulting the regional board. Where the board of directors administers more than one institution, the executive director shall also act as the executive director of each of the institutions.

Where the executive director is absent or unable to act, the person designated for that purpose by the board of directors shall exercise the functions and powers of the executive director.

1991, c. 42, s. 193; 1992, c. 21, s. 21; 1998, c. 39, s. 70; 2001, c. 24, s. 36.

193.1. (Repealed).

1996, c. 36, s. 24; 1998, c. 39, s. 71.

194. The executive director, under the authority of the board of directors, is responsible for the administration and operation of every institution under the administration of the board and is responsible for the day-to-day management of its activities and resources. The executive director shall account for his management to the board of directors.

The executive director shall see to it that the decisions of the board of directors are carried out and that all the information the board of directors requires or needs in order to assume its responsibilities is transmitted to it.

1991, c. 42, s. 194; 2001, c. 24, s. 37.

195. The executive director of each institution must, in addition to performing the duties listed in section 194, see that the clinical activity taking place in the centre is coordinated and supervised.

1991, c. 42, s. 195.

196. Where a board of directors administers several institutions, the executive director must ensure the follow-up of decisions of the board of directors with regard to issues requiring inter-institutional coordination and advise the board of directors on the following matters:

(1)  the development of integrated processing policies in respect of issues of general importance to institutions such as capital investment, human resources, information systems and budget control;

(2)  the possible impact on a particular institution of decisions relating to common issues;

(3)  the possible impact of any decision relating to a particular institution on any other institution administered by the board.

1991, c. 42, s. 196.

197. The executive director shall not, under pain of forfeiture of office, have a direct or indirect interest in an enterprise placing his personal interest in conflict with that of the institution. However, forfeiture of office is not incurred if such an interest devolves to him by succession or gift, provided that he renounces it or that, having informed the board of directors, he disposes of it within the time fixed by the board.

An executive director who is forfeited of office becomes disqualified from holding any office or employment as a member of the managerial staff of any public institution or regional board for the period of disqualification determined in the judgment. That period shall not exceed three years.

The board of directors, on ascertaining that the executive director is in a position of conflict of interest, shall take measures to institute proceedings for forfeiture of office against him. It shall also, within 10 days, inform the regional board in writing of the situation, specifying the nature of the case and the measures it has taken.

The second paragraph of section 154, applies, with the necessary modifications to the executive director.

Section 155 applies to proceedings for forfeiture of office.

1991, c. 42, s. 197.

198. Every executive director must, within 60 days after his appointment, file with the board of directors a written statement mentioning any pecuniary interest he has in legal persons, partnerships or enterprises which may enter into a contract with any institution. The statement must be updated within 60 days of the acquisition of such an interest by the executive director and, each year, within 60 days from the anniversary of his appointment.

The executive director must, in addition, file with the board of directors, a written statement mentioning the existence of any contract of professional services entered into with an institution by a legal person, a partnership or an enterprise in which he has a pecuniary interest, within 30 days after the contract is entered into.

1991, c. 42, s. 198.

199. The executive director shall, under pain of forfeiture of office, devote himself exclusively to the work of the institution and the duties of his office.

He may, however, hold another employment, office or function or provide another service if no remuneration or direct or indirect benefit whatever is paid or granted to him therefor.

He may also, with the authorization of the board of directors, hold or provide, outside the health and social services sector, another employment, office, function or service for which remuneration or direct or indirect benefit of any kind is paid or granted to him.

He may also, with the authorization of the regional board and the board of directors, hold or provide, within the health and social services sector, another employment, office, function or service for which remuneration or direct or indirect benefit of any kind is paid or granted to him. However, only the authorization of the board of directors is required in the case of an office or function held within an association grouping a majority of the institutions carrying out activities inherent in the mission of centres of the same type or within an association of executive directors of health services and social services recognized by order in council, for labour relations purposes, or within an institutional certification body.

He may also carry out any mandate entrusted to him by the Minister.

He may also hold an elective public office.

Section 155 applies to proceedings for forfeiture of office.

1991, c. 42, s. 199.

200. The board of directors must, on ascertaining that the executive director is violating any of the rules prescribed in section 199, suspend him without pay or take measures to institute proceedings for forfeiture of office against him, according to the seriousness of the contravention. It must also, within the following 10 days, inform the regional board and the Minister of the situation and indicate to them the nature of the case and the measures it has taken. A suspension imposed under this paragraph may vary from three to six months.

An executive director who is forfeited of office becomes disqualified from holding any office or employment as member of the managerial staff of any public institution or regional board for the period of disqualification determined in the judgment. That period shall not exceed three years.

1991, c. 42, s. 200.

201. The board of directors shall not appoint or dismiss the executive director except by way of a resolution adopted at a meeting called for that purpose by the vote of not less than two-thirds of its members.

The executive director cannot be present at a sitting of the board of directors of the institution while the board is discussing or deciding his dismissal, the reduction of the term of his appointment, suspension, remuneration, renewal of engagement or his other terms of employment.

1991, c. 42, s. 201; 2001, c. 24, s. 38.

§ 4 . — Director of professional services

202. A director of professional services must be appointed by every institution which operates a hospital centre and by the local authority. The director must be a physician and must be appointed after consultation with the council of physicians, dentists and pharmacists and, in the case of an institution operating a hospital centre designated as a university hospital centre or university institute, after consultation with the university with which the institution is affiliated.

A director of professional services may be appointed by any other institution.

1991, c. 42, s. 202; 1992, c. 21, s. 70; 2005, c. 32, s. 98.

203. Subject to the provisions of the organization plan of the institution and under the authority of the executive director, the director of professional services shall coordinate, with the other directors concerned, the professional and scientific activity of any centre operated by the institution.

1991, c. 42, s. 203.

204. Under the authority of the executive director, the director of professional services referred to in the first paragraph of section 202 must, in addition to the functions provided for in section 203,

(1)  direct, coordinate and supervise the activities of the clinical department heads which are provided for in section 189;

(2)  obtain the opinion of the clinical department heads on the administrative and financial consequences of the activities of the physicians and dentists of the various clinical departments;

(3)  apply the administrative sanctions provided for in the second paragraph of section 189 and inform thereof the council of physicians, dentists and pharmacists and the clinical department heads concerned;

(4)  supervise the operation of the committees of the council of physicians, dentists and pharmacists and ensure that the council monitors and assesses adequately the medical, dental and pharmaceutical acts performed in any centre operated by the institution;

(5)  take all necessary steps to ensure that any examination, autopsy or expertise required under the Act respecting the determination of the causes and circumstances of death (chapter R-0.2) is carried out;

(5.1)  discharge the obligations imposed by the Civil Code and the Public Curator Act (chapter C-81) regarding the protective supervision of incapable persons and mandates given by persons in anticipation of their incapacity;

(6)  carry out any other function provided for in the organization plan of the institution.

1991, c. 42, s. 204; 1998, c. 39, s. 72.

204.1. The director of professional services of an institution operating a general and specialized hospital shall, when a person whose death is imminent is a potential donor and, in accordance with the Civil Code, consent to the removal of organs or tissue from his body has been given, transmit with diligence to the agency or the person designated by the Minister all necessary medical information concerning the donor and the organs or tissue which could be removed.

The director of professional services shall be informed of such situations in accordance with the procedure established by the institution.

1993, c. 14, s. 1.

205. When an administrative sanction provided for in the second paragraph of section 189 is applied, the director of professional services must inform the physician or dentist of the grounds on which he based his decision and the physician or dentist may, if he disagrees with the decision, contest the decision before the Administrative Tribunal of Québec within 60 days of the date on which the decision was notified to him.

1991, c. 42, s. 205; 1997, c. 43, s. 726.

§ 5 . — Director of nursing care

1992, c. 21, s. 22.

206. A director of nursing care must be appointed by every institution operating a hospital centre and every local authority. A director of nursing care may be appointed by any other institution. The director of nursing care must be a nurse.

However, if there is no director of nursing care, the executive director shall designate a nurse to be in charge of nursing.

1991, c. 42, s. 206; 1992, c. 21, s. 23; 1992, c. 21, s. 70; 2005, c. 32, s. 99.

207. Under the authority of the executive director, the director of nursing care must, for each centre operated by the institution:

(1)  supervise and monitor the quality of nursing care dispensed in the centre;

(1.1)  where applicable, cooperate in the supervision of the activities referred to in section 36.1 of the Nurses Act (chapter I‐8);

(2)  ensure that rules governing nursing care which take into account the necessity of providing adequate and efficient services to the users as well as the organization and resources of the institution are drawn up;

(2.1)  where applicable, cooperate in determining the rules governing medical care and the rules governing the use of medicines applicable to nurses authorized to engage in activities referred to in section 36.1 of the Nurses Act;

(2.2)  where applicable, keep and update a register of the nurses authorized to engage in one or more of the activities referred to in section 36.1 of the Nurses Act;

(3)  promote the proper operation of the committees of the council of nurses and ensure that the nursing acts performed in the centre are properly assessed by the council.

Where there is no director of nursing care, these functions shall be carried out by the nurse in charge of nursing.

1991, c. 42, s. 207; 1992, c. 21, s. 23; 2002, c. 33, s. 26.

207.1. The director of nursing care may, for disciplinary reasons or on grounds of incompetence, particularly on the advice of the head of a clinical department or the director of professional services, limit or suspend a nurse’s right to engage in one or more of the activities referred to in section 36.1 of the Nurses Act (chapter I‐8) in the centre.

In urgent cases, if the director of nursing care is unable or fails to act, the head of a clinical department or the director of professional services may apply a measure referred to in the first paragraph for a period not exceeding five days. The head of a clinical department or the director of professional services shall notify the director of nursing care as soon as possible.

If the director of nursing care refuses to apply a measure referred to in the first paragraph, such a measure may be applied by the executive director of the institution after consultation with the council of physicians, dentists and pharmacists and the council of nurses.

The Ordre des infirmières et infirmiers du Québec must be informed of any measure applied under this section.

2002, c. 33, s. 27.

208. Subject to the provisions of a regulation under subparagraph 13 of the first paragraph of section 505 and under the authority of the executive director, the director of nursing care must, for each centre operated by the institution:

(1)  ensure appropriate distribution of nursing care in the centre;

(2)  plan, coordinate and evaluate nursing care in relation to the needs of the centre;

(3)  manage the human, material and financial resources under his governance;

(4)  carry out any other function for which provision is made in the organization plan.

1991, c. 42, s. 208; 1992, c. 21, s. 23.

§ 5.1 . — Midwifery services coordinator

1999, c. 24, s. 31.

208.1. Every institution that operates a local community service centre in which midwifery is practised shall appoint a midwifery services coordinator. The coordinator must be a midwife.

1999, c. 24, s. 31.

208.2. Under the authority of the executive director, the midwifery services coordinator must

(1)  supervise and assure the quality of the acts performed for the institution by midwives ;

(2)  define standards of care to be adhered to by midwives which take account of the necessity to provide appropriate and efficient services to the users and of the available resources of the institution ;

(3)  assume the functions provided for in the first paragraph of section 225.3, where applicable.

1999, c. 24, s. 31.

208.3. Subject to the provisions of the regulation made under subparagraph 13 of the first paragraph of section 505 and under the authority of the executive director, the midwifery services coordinator must

(1)  ensure appropriate distribution of the midwifery services dispensed for the institution ;

(2)  coordinate midwifery services in relation to the needs of the institution ;

(3)  assume the functions provided for in section 225.4, where applicable ;

(4)  assume any other function for which provision is made in the organization plan.

1999, c. 24, s. 31.

§ 6 . — Users’ committee

209. Each institution must set up a committee for the users of its services and, in the case of a public institution or of a private institution which is a party to an agreement under section 475, allocate to it the special budget provided for that purpose in its operating budget or, in the case of a private institution which is not a party to an agreement, the amount paid for that purpose by the Minister.

If the institution operates a centre offering in-patient services, it must set up an in-patients’ committee in each of the centre’s facilities.

The users’ committee is composed of at least five members elected by the users of the institution and of a representative designated by and from among the in-patients’ committees set up under the second paragraph.

The majority of the members must be users. However, if it is not possible to have a majority of users on the committee, the users may elect another person of their choice, provided that the person does not work for the institution or practise a profession in a centre operated by the institution.

An in-patients’ committee is composed of at least three members elected by the in-patients of the facility in conformity with the conditions set out in the fourth paragraph.

1991, c. 42, s. 209; 1992, c. 21, s. 24; 1992, c. 21, s. 70; 1998, c. 39, s. 73; 2005, c. 32, s. 100.

209.1. The term of office of the members of the users’ committee and the members of an in-patients’ committee may not exceed three years.

2005, c. 32, s. 101.

210. No person under curatorship may be a member of a users’ committee or an in-patients’ committee.

1991, c. 42, s. 210; 2005, c. 32, s. 102.

211. The executive director of the institution must foster the proper functioning of the users’ committee and of any in-patients’ committee and inform, in writing, every user of the existence of the committees.

He must make a room available for the committees’ activities and make it possible for their records to be kept confidential.

1991, c. 42, s. 211; 2005, c. 32, s. 103.

212. The functions of the users’ committee are

(1)  to inform users of their rights and obligations;

(2)  to foster the improvement of the quality of the living conditions of users and assess the degree of satisfaction of users with regard to the services obtained from the institution;

(3)  to defend the common rights and interests of users or, at the request of a user, his rights and interests as a user before the institution or any competent authority;

(4)  to accompany and assist a user, on request, in any action he undertakes, including the filing of a complaint in accordance with Divisions I, II and III of Chapter III of Title II of this Act or the Act respecting the Health and Social Services Ombudsman (chapter P-31.1);

(5)  to ensure the proper operation of each of the in-patients’ committees, if applicable, and see that they have the resources necessary to exercise their functions.

In addition, the users’ committee must adopt operating rules, submit an annual report of its activities to the board of directors and, on request, transmit a copy of that report to the regional board.

1991, c. 42, s. 212; 1998, c. 39, s. 74; 2001, c. 43, s. 47; 2005, c. 32, s. 104.

212.1. An in-patients’ committee must exercise the functions set out in subparagraphs 1 to 3 of the first paragraph of section 212 for the users residing in the facility, and report to the users’ committee.

2005, c. 32, s. 105.

§ 7 . — Council of physicians, dentists and pharmacists

213. A council of physicians, dentists and pharmacists shall be established for every institution which operates one or more centres in which not fewer than five physicians, dentists or pharmacists are practising.

The council shall be composed of all the physicians, dentists and pharmacists practising in any centre operated by the institution who have the status required by regulation made under paragraph 3 of section 506.

The board of directors formed in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2 must, however, after consulting the physicians, dentists and pharmacists concerned and the executive committee of the councils of physicians, dentists and pharmacists, if any, provide for a single council of physicians, dentists and pharmacists to be instituted for all the institutions under its administration.

The council shall be composed of all the physicians, dentists and pharmacists practising in any centre operated by each institution and who have the status required by regulation referred to in the second paragraph.

1991, c. 42, s. 213; 1996, c. 36, s. 25; 2001, c. 24, s. 39.

214. In accordance with the by-laws of the institution, the council of physicians, dentists and pharmacists is, for each centre operated by the institution, responsible to the board of directors

(1)  for controlling and assessing the quality, including the pertinence, of the medical, dental and pharmaceutical acts performed in the centre;

(2)  for assessing and maintaining the professional standards of the physicians, dentists and pharmacists practising in the centre;

(3)  for making recommendations on the qualifications and competence of a physician or dentist who applies for appointment or the renewal of an appointment and on the privileges and the status to be granted to him;

(4)  for making recommendations on the qualifications and competence of a pharmacist who applies for appointment and on the status to be granted to him;

(5)  for giving its opinion on the disciplinary measures the board of directors should impose on physicians, dentists or pharmacists;

(6)  for making recommendations on the rules governing medical and dental care and on the rules governing the use of medicines applicable in the centre and formulated by each clinical department head;

(7)  for making recommendations on the obligations which may be attached to the enjoyment of the privileges granted to a physician or a dentist by the board of directors, in relation to the specific requirements of the centre, particularly those concerning

(a)  the participation of a physician or dentist in the clinical activities of the centre, including being on duty;

(b)  the participation of a physician or dentist in teaching and research activities, where the case arises;

(c)  the participation of a physician or dentist in professional, scientific, medical or administrative committees;

(d)  the participation of a physician or dentist in medical activities pursuant to an agreement referred to in sections 108 and 109;

(8)  for developing the modalities of a duty roster system ensuring, on a permanent basis, the availability of physicians, dentists and, where the case arises, pharmacists and clinical biochemists, according to the needs of the centre;

(9)  for giving its opinion on the professional aspects of the following questions:

(a)  the technical and scientific organization of the centre;

(b)  the rules governing the utilization of the resources referred to in subparagraph 3 of the first paragraph of section 189 and on the administrative sanctions to be included therein;

(10)  for making recommendations on the professional aspects of the appropriate distribution of medical and dental care and pharmaceutical services, and on the medical organization of the centre;

(11)  for carrying out any other function entrusted to it by the board of directors.

In exercising the functions described in subparagraphs 1 and 2 of the first paragraph and in exercising functions following the filing of a complaint in a case described in section 249, the council of physicians, dentists and pharmacists may, with the authorization of the board of directors, call on an expert from outside the institution. The expert shall have access to the user’s record in the same way as the council of physicians, dentists and pharmacists if the expert needs the information contained in the record for the exercise of his or her functions.

In exercising its functions, the council of physicians, dentists and pharmacists shall take into account the necessity of providing adequate and efficient services to users and the organization and available resources of the institution.

The council of physicians, dentists and pharmacists must report annually to the board of directors concerning the carrying out of its functions and its resulting opinions.

1991, c. 42, s. 214; 2001, c. 43, s. 48; 2005, c. 32, s. 107.

215. The council of physicians, dentists and pharmacists shall give its opinion to the executive director on the administrative aspects of the following questions:

(1)  the measures to be taken in order to ensure that the medical, dental and pharmaceutical services provided in the centre are complementary to those provided in a centre operated by another institution of the region and respond to the needs of the population to be served, taking into account the resources available and the necessity of providing adequate services;

(2)  the rules governing the utilization of resources referred to in subparagraph 3 of the first paragraph of section 189 and the administrative sanctions to be included therein;

(3)  the technical and scientific organization of the centre;

(4)  the appropriate distribution of medical and dental care and pharmaceutical services, and the medical organization of the centre;

(5)  any other question brought to its attention by the executive director.

1991, c. 42, s. 215.

216. The council of physicians, dentists and pharmacists may adopt by-laws concerning its internal management, the creation and operation of committees and the pursuit of its objects. The by-laws come into force after having been approved by the board of directors.

1991, c. 42, s. 216.

217. The responsibilities of the council of physicians, dentists and pharmacists shall be exercised by an executive committee composed of not fewer than five physicians, dentists or pharmacists designated by the council, of the executive director and of the director of professional services or, where a director of professional services has not been appointed, of the physician designated by the executive director.

The executive committee shall exercise all the powers of the council of physicians, dentists and pharmacists.

1991, c. 42, s. 217.

218. Notwithstanding the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A-2.1), the records and minutes of the council of physicians, dentists and pharmacists and of each of its committees are confidential.

However, a medical examiner and the members of the review committee established under section 51 may examine the professional record of a member of the council of physicians, dentists and pharmacists where the information contained in the record is needed for the exercise of their functions.

Moreover, the members of the board of directors may have access to relevant extracts from the professional record of a member of the council of physicians, dentists and pharmacists that contain information needed for the making of a decision regarding possible disciplinary measures against a physician, dentist or pharmacist in accordance with the procedure determined by a regulation under paragraph 2 of section 506.

No person may have access to the minutes of a committee of the council of physicians, dentists and pharmacists except the members of the committee, the members of the executive committee of the council, the Administrative Tribunal of Québec or the representatives of a professional order in the performance of the duties assigned to it by law.

No person may have access to the minutes of the council of physicians, dentists and pharmacists except the members of the council, the members of the executive committee of the council, the Administrative Tribunal of Québec or the representatives of a professional order in the performance of the duties assigned to it by law.

1991, c. 42, s. 218; 1994, c. 40, s. 457; 1997, c. 43, s. 727; 2001, c. 43, s. 49.

§ 8 . — Council of nurses

219. A council of nurses shall be established for every public institution operating one or more centres in which at least five nurses are employed.

The council is composed of all the nurses performing their duties in a centre operated by the institution.

The board of directors, established in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2, must, however, provide that a single council of nurses be established for all of the institutions under its administration.

Such a council is composed of all the nurses performing their duties in any of the centres operated by each of the institutions.

1991, c. 42, s. 219; 1992, c. 21, s. 25; 1996, c. 36, s. 26; 2001, c. 24, s. 40.

220. The council of nurses, in accordance with the by-laws of the institution and for each centre operated by the institution, is accountable to the board of directors for

(1)  assessing, generally, the quality of the nursing acts performed in the centre and, where applicable, in cooperation with the council of physicians, dentists and pharmacists, the quality of the activities referred to in section 36.1 of the Nurses Act (chapter I‐8) engaged in in the centre;

(2)  making recommendations on the rules of nursing care applicable to their members in the centre;

(2.1)  making recommendations on the rules governing medical care and the rules governing the use of medicines applicable to their members in the centre;

(3)  making recommendations on the proper distribution of care dispensed by their members in the centre;

(4)  assuming any other function entrusted to it by the board of directors.

The council of nurses must submit an annual report to the board of directors concerning the carrying out of its functions and its resulting opinions.

1991, c. 42, s. 220; 2002, c. 33, s. 28.

221. In accordance with the by-laws of the institution, the council of nurses shall, for each centre operated by the institution, give its opinion to the executive director on the following questions:

(1)  the scientific and technical organization of the centre;

(2)  the means to be used to assess and maintain the professional standards of nurses;

(3)  any other question brought to its attention by the executive director.

1991, c. 42, s. 221.

222. The council of nurses may adopt by-laws concerning its internal management, the creation and operation of committees and the pursuit of its objects. The by-laws come into force after having been approved by the board of directors.

1991, c. 42, s. 222.

223. The council of nurses must form a nursing assistants committee. The committee shall be composed of at least three persons selected by and from among the persons performing nursing assistant’s activities for the institution.

The functions of the committee are

(1)  to assess the quality of nursing care provided by persons performing nursing assistant’s activities for the institution;

(2)  to give its opinion on the means to be used to assess and maintain the professional standards of the group of persons performing nursing assistant’s activities for the institution;

(3)  make recommendations on the proper distribution of the care dispensed by persons performing nursing assistant’s activities for the institution.

The committee may adopt by-laws concerning its internal management, its operation and the pursuit of its objects. The by-laws come into force after having been approved by the executive committee of the council of nurses.

The nursing assistants committee shall report to the executive committee of the council of nurses.

1991, c. 42, s. 223; 1992, c. 21, s. 26; 2005, c. 32, s. 109.

224. The responsibilities of the council of nurses shall be exercised by an executive committee composed of at least four nurses designated by the council, the chairman and another member of the nursing assistants committee, the executive director and the director of nursing care or, if there is no director of nursing care, the nurse in charge of nursing care designated by the executive director.

The executive committee shall exercise all the powers of the council of nurses.

1991, c. 42, s. 224; 1992, c. 21, s. 27; 2005, c. 32, s. 110.

225. Every recommendation of the nursing assistants committee that is not accepted by the executive committee of the council of nurses must be forwarded to the board of directors of the institution accompanied with the reasons for its non-acceptance.

1991, c. 42, s. 225; 1992, c. 21, s. 28.

§ 8.1 . — Council of midwives

1999, c. 24, s. 32.

225.1. A council of midwives shall be established for every public institution which operates a local community service centre and has entered into a service contract pursuant to section 259.2 with not fewer than five midwives.

The council shall be composed of all the midwives who have entered into such a contract with the institution.

The board of directors formed in accordance with the third paragraph of section 126.1 must, however, determine that a single council of midwives is to be established for all the institutions under its administration.

1999, c. 24, s. 32; 2001, c. 24, s. 41.

225.2. Notwithstanding section 225.1, an institution may, on the joint recommendation of the midwives practising under a service contract entered into with the institution and of the council of physicians, dentists and pharmacists of the institution, designate the council of physicians, dentists and pharmacists to exercise the functions of the council of midwives established under section 225.3. In such a case, the midwives practising under a service contract shall form part of the council of physicians, dentists and pharmacists, and shall appoint three of their number to sit on the executive committee of the council if such a committee is formed. They shall participate in the deliberations of the council and of the executive committee, if any, but have the right to vote only on matters relating to the functions of the council of midwives.

1999, c. 24, s. 32.

225.3. In accordance with the regulations of the institution, the council of midwives is responsible to the board of directors for

(1)   monitoring and assessing, generally, the quality and pertinence of the acts performed by midwives for the institution ;

(2)  making recommendations on the standards of care to be adhered to by council members ;

(3)  making recommendations on the appropriate distribution of the services provided by council members ;

(4)  making recommendations on the qualifications and competence of a midwife who has submitted an application to the board of directors for the purpose of entering into a contract with the institution pursuant to section 259.2 ;

(5)  making recommendations on the obligations to be attached to the practice of midwifery under a service contract made pursuant to section 259.2 ;

(6)  assuming any other function assigned to it by the board of directors.

The council of midwives must report annually to the board of directors on the carrying out of its functions and its resulting opinions.

If there is no council of midwives and section 225.2 is not applied, the midwifery services coordinator shall carry out the functions described in the first paragraph.

1999, c. 24, s. 32.

225.4. In accordance with the by-laws of the institution, the council of midwives or, where there is no such council, the midwifery services coordinator, is responsible for advising the executive director on the following matters :

(1)  the scientific and technical organization of the local community service centre ;

(2)  the means to be used to assess and maintain the professional standards of midwives ;

(3)  any other matter submitted by the executive director.

1999, c. 24, s. 32.

225.5. The council of midwives may adopt by-laws concerning its internal management, the creation and operation of committees and the pursuit of its objects. The by-laws come into force after they are approved by the board of directors.

1999, c. 24, s. 32.

225.6. The responsibilities of the council of midwives shall be exercised by an executive committee composed of not fewer than three midwives, designated by the council, and the executive director.

The executive committee shall exercise all the powers of the council of midwives.

1999, c. 24, s. 32.

§ 9 . — Multidisciplinary council

226. A multidisciplinary council shall be established for each public institution, provided the institution operates one or more centres in which at least five people who qualify for membership in the council work.

The council shall be composed of all persons holding college or university diplomas who perform functions for the institution which are specific to the field of activity in which the diploma was granted and which are directly related to health services, social services, research or teaching, and of persons performing nursing assistants activities for the institution.

However, no physician, dentist, pharmacist or midwife may be a member of the multidisciplinary council.

Similarly, no nurse or person performing nursing assistants activities may be a member of the multidisciplinary council if a nursing council has been established for the institution.

The board of directors established in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2 must, however, provide that only one multidisciplinary council will be established for all the institutions under its administration. Such a council shall be composed of all the persons referred to in this section who perform their duties in one of the centres operated by the institutions.

1991, c. 42, s. 226; 1992, c. 21, s. 29; 1996, c. 36, s. 27; 1998, c. 39, s. 75; 1999, c. 24, s. 33; 2001, c. 24, s. 42.

227. Subject to the provisions of sections 214 and 220, the multidisciplinary council is accountable to the board of directors for

(1)  forming, whenever required, the joint committees needed to assess and improve the quality of the professional activities engaged in by any of its members in any centre operated by the institution;

(2)  making recommendations on the proper distribution of care and services dispensed by its members, taking into account the local conditions of practice required to ensure quality services in every centre operated by the institution;

(3)  carrying out any other function entrusted to it by the board of directors.

The multidisciplinary council must submit an annual report to the board of directors on the carrying out of its functions and its resulting opinions.

1991, c. 42, s. 227.

228. In accordance with the by-laws of the institution, the multidisciplinary council is, for each centre operated by the institution, accountable to the executive director for giving its opinion on the following questions:

(1)  the scientific and technical organization of the centre;

(2)  the means to be used to assess and maintain the professional standards of its members;

(3)  any other question brought to its attention by the executive director.

1991, c. 42, s. 228.

229. The multidisciplinary council may adopt by-laws concerning its internal management, the creation and operation of committees and the pursuit of its objects. The by-laws come into force after having been approved by the board of directors.

1991, c. 42, s. 229.

230. The responsibilities of the multidisciplinary council shall be exercised by an executive committee composed of at least three persons, elected by and from among the members of the council, who hold different positions and who, where applicable, are members of different professional orders, and of the executive director and the person he designates for such purpose.

1991, c. 42, s. 230; 1994, c. 40, s. 457.

§ 10 . — Staff

231. Every public or private institution under agreement must adopt a three-year staffing and personnel development action plan, with the participation of its employees and, if applicable, of the unions to which they belong. The action plan is communicated to all personnel members and sent to the agency.

The plan shall contain policies relating to the induction of the employees, their motivation, the enrichment of their tasks, the maintenance of their professional standards, subject to the responsibilities entrusted to the multidisciplinary council and to the council of nurses, where applicable, and policies relating to the assessment of their performance, their professional development, their mobility, the preparation of their successors and the development of their career.

The plan must be assessed and updated every year, with the participation of the employees of the institution and the unions to which they belong, where that is the case.

1991, c. 42, s. 231; 2005, c. 32, s. 113.

232. Every public institution must, once a year, hold a meeting with the personnel at which, among other topics, the priorities and orientations favoured by the board of directors for the purposes of section 171 shall be discussed.

1991, c. 42, s. 232.

233. Every institution must adopt a code of ethics which shall set out the rights of the users and the practices and conduct expected, with respect to the users, from the employees, the trainees, including medical residents, and the professionals practising in a centre operated by the institution.

The code of ethics must also set out the rules governing the use of the information referred to in sections 27.3 and 107.

The institution must give a copy of the code of ethics to every user who is an in-patient or who makes a request therefor.

1991, c. 42, s. 233; 2005, c. 32, s. 114.

233.1. Any employee of an institution, any person practising in a centre operated by an institution, any person undergoing training in such a centre or any person who, under a service contract, provides services to users on behalf of an institution must, as soon as possible after becoming aware of any incident or accident, report it to the executive director of the institution or to a person designated by the executive director. Such indidents or accidents shall be reported in the form provided for such purposes, which shall be filed in the user’s record.

The executive director of the institution or the person designated by the executive director shall report, in non-nominative form, all reported incidents or accidents to the regional board at agreed intervals or whenever the board so requires.

2002, c. 71, s. 10.

234. The board of directors of a public institution must, by by-law, determine the standards applicable to a senior management officer or middle management officer as regards conflict of interest as well as standards applicable to a senior management officer as regards exclusivity of office.

No senior management officer or middle management officer may contravene any of the standards prescribed pursuant to the first paragraph, under pain of sanctions which may go as far as dismissal.

1991, c. 42, s. 234; 1998, c. 39, s. 76.

235. The board of directors of a public institution must, by by-law, establish measures to prevent or put an end to the conflicts of interest that may arise from the awarding of a contract by the institution to a person employed by the institution or a person practising a profession in a centre operated by the institution, or from the awarding of a contract by the institution to an enterprise in which such a person has a direct or indirect interest.

1991, c. 42, s. 235; 1998, c. 39, s. 76.

235.1. The board of directors of an institution shall, by by-law, establish rules to be followed, on the occurrence of an accident, so that all the necessary information is disclosed to the user, to the representative of an incapable user of full age or, in the event of the user’s death, to the persons referred to in the first paragraph of section 23.

The board of directors shall also establish, in the same manner, support measures, including the appropriate care, to be made available to such a user, such a representative or such persons and measures to prevent such an accident from recurring.

2002, c. 71, s. 11.

236. A physician, dentist or midwife other than a member of the managerial staff of the institution is deemed not to be a member of the staff of the institution.

1991, c. 42, s. 236; 1999, c. 24, s. 34.

§ 11 . — Physicians, dentists and pharmacists

237. A physician or dentist wishing to practise at a centre operated by an institution must make an application for appointment or renewal of appointment to the executive director in the manner provided by regulation under paragraph 1 of section 506.

Except on notice to the contrary, a physician or dentist shall be deemed to have made an application for renewal of appointment on the same terms as his last application.

The executive director shall, in writing, inform the physician or dentist making an application for appointment of the state of the medical and dental staffing plan of the institution as approved by the regional board.

Where a council of physicians, dentists and pharmacists has been established for the institution, the executive director shall, before referring the application to the board of directors, obtain from the council of physicians, dentists and pharmacists a recommendation concerning the qualifications and competence of the physician or dentist, the status and privileges that should be granted to him by virtue of his appointment and the obligations that may be attached to the enjoyment of the privileges granted by the board of directors.

1991, c. 42, s. 237.

238. The decision of the board of directors to accept or refuse a physician’s or dentist’s application for appointment shall take into account the organization plan of the institution, the number of physicians and dentists authorized in the medical and dental staffing plan, the resources available, the specific requirements of the institution and, where applicable, the supra-regional vocation of the institution as determined by the Minister under section 112.

The board of directors may also refuse a physician’s or dentist’s application for appointment on the basis of the fact that the physician or dentist, in the course of the three preceding years, has failed to give the council the prior notice required under section 254.

The board of directors may also refuse a physician’s or dentist’s application for appointment on the basis of criteria of qualifications, scientific competence or conduct of the physician or dentist, having regard to the specific requirements of the institution.

An application for renewal of appointment may be refused by the board of directors only on the basis of criteria of qualifications, scientific competence or conduct of the physician or dentist, having regard to the specific requirements of the institution, and fulfilment of the obligations attached to the enjoyment of the privileges granted.

If the institution operates a centre designated as a university hospital centre or university institute, the board of directors must also consult the university with which the institution is affiliated.

1991, c. 42, s. 238; 1992, c. 21, s. 70; 1998, c. 39, s. 77.

239. Subject to sections 243.1 and 248, the board of directors may not, on pain of absolute nullity, grant privileges to a physician or dentist if the number of physicians or dentists authorized in the medical and dental staffing plan of the institution has been reached.

1991, c. 42, s. 239; 1998, c. 39, s. 78; 2001, c. 24, s. 43.

240. Except in the cases provided for in sections 243.1 and 248, the board of directors must, before granting a physician’s or dentist’s application for privileges, obtain the approval of the regional board ; the regional board must approve the application if it is in conformity with the medical and dental staffing plan of the institution, approved in accordance with section 378.

1991, c. 42, s. 240; 1998, c. 39, s. 79; 2001, c. 24, s. 44.

240.1. Where the regional board has reason to believe that privileges have been granted to a physician by an institution in contravention of section 240, the regional board shall conduct an inquiry in accordance with section 414 ; the regional board shall communicate the results of its inquiry to the Minister, the institution and the physician concerned.

2001, c. 24, s. 44.

240.2. Where the results of the inquiry show that the institution contravened section 240, the regional board may, for each month during which the physician is granted privileges in contravention of that section, reduce the operating budget of that institution by an amount equivalent to 1/12 of the annual average remuneration paid to a general practitioner or a medical specialist, as the case may be, by the Régie de l’assurance maladie du Québec in the preceding year.

Moreover, if the results of the inquiry show that the physician is a party to a contravention under section 240, the regional board may bring a proceeding to annul pursuant to section 239.

2001, c. 24, s. 44.

241. The board of directors shall transmit to the physician or dentist a decision in writing within 90 days after receipt of the application for appointment or renewal of appointment. In addition, the reasons for any refusal must be given in writing.

1991, c. 42, s. 241.

242. The resolution of the board of directors accepting a physician’s or dentist’s application for appointment or renewal of appointment must set out, in addition to the status assigned in accordance with the regulation made under paragraph 3 of section 506, the privileges and the period for which they are granted, the nature and range of the medical or dental activities that a physician or dentist will be allowed to engage in at the centre, and the undertaking of the physician or dentist to fulfil the obligations attached to the enjoyment of the privileges and determined on the recommendation of the council of physicians, dentists and pharmacists.

Where the institution operates a hospital centre, the resolution of the board of directors must also specify in which clinical department or service the privileges granted may be exercised.

Privileges are granted for a maximum period of three years. They are renewed for a minimum period of two years, unless the application for renewal is for a period of less than two years.

1991, c. 42, s. 242; 1992, c. 21, s. 70.

242.1. The resolution of the board of directors accepting a physician’s or dentist’s application for appointment must also specify that the appointment of the physician or dentist is in conformity with the medical and dental staffing plan of the institution approved by the regional board, that the regional board has approved the application of the physician or dentist in accordance with section 240 and that the physician or dentist has been informed of that approval.

2001, c. 24, s. 45.

243. The physician or dentist may not practise at the centre operated by the institution and enjoy the privileges granted to him by the board of directors on the terms set out in the resolution adopted by the board of directors unless the physician or dentist produces a document in which he or she acknowledges having read the resolution.

1991, c. 42, s. 243; 2002, c. 66, s. 5.

243.1. Where the appointment of a physician or dentist is intended solely to provide for the replacement of a physician or dentist whose appointment has been duly accepted by the board of directors but who is absent or temporarily unable to practise, the application for appointment is not subject to the provisions relating to the institution’s medical and dental staffing plan.

Any appointment made following such an application is valid only for the duration of the absence or inability to practise of the physician or dentist concerned and, notwithstanding any inconsistent provision of this subdivision, may not be the subject of an application for renewal.

1998, c. 39, s. 80.

244. The board of directors of an institution bound by a contract of affiliation to a university in accordance with section 110 shall assign the status of medical resident to a person holding a doctoral degree in medicine who is undergoing a post-doctoral training program at a centre operated by the institution.

1991, c. 42, s. 244.

245. Every three months the board of directors must inform the regional board of all applications for appointment or renewal of appointment that have been accepted by the board of directors.

1991, c. 42, s. 245.

246. A pharmacist wishing to practise at a centre operated by an institution must make an application for appointment to the executive director in the manner provided by regulation under paragraph 1 of section 506.

Where a council of physicians, dentists and pharmacists has been established for the institution, the executive director shall, before referring the application to the board of directors, obtain from the council of physicians, dentists and pharmacists a recommendation concerning the qualifications and competence of the pharmacist submitting the application.

1991, c. 42, s. 246.

247. The pharmacist may practise at the centre operated by the institution upon appointment by the board of directors. If the pharmacist practises at a centre where a council of physicians, dentists and pharmacists has been established, the board of directors shall grant him a status in accordance with the regulation made under paragraph 3 of section 506.

1991, c. 42, s. 247.

248. The director of professional services, the chairman of the council of physicians, dentists and pharmacists or the head of a clinical department may, in case of emergency, temporarily authorize a physician, dentist or pharmacist to practise at a centre operated by the institution. In such a case, the person who granted the authorization must immediately notify the executive director. The authorization is valid for a maximum period of three months and it is not renewable.

Where the time required for obtaining the authorization may be prejudicial to a user, any physician, dentist or pharmacist may, without such authorization, give the care or services required by the state of health of the user.

1991, c. 42, s. 248.

249. The board of directors may take disciplinary measures against a physician or dentist.

The disciplinary measures that may be taken include a reprimand, a change in status, the withdrawal of privileges, the suspension of status or privileges for a specific period and the cancellation of status or privileges. They may also include a recommendation that the physician or dentist serve a period of refresher training, take a refresher course or both, and may, if necessary, restrict or suspend some or all of the physician’s or dentist’s privileges for the duration of the refresher period.

Every disciplinary measure taken against a physician or dentist must give reasons and be based solely on lack of qualifications, scientific incompetence, negligence, misconduct, non-compliance with the by-laws of the institution, having regard to the specific requirements of the institution, or non-compliance with the terms set out in the resolution referred to in section 242.

The disciplinary measures must be imposed in accordance with the procedure prescribed by regulation under paragraph 2 of section 506.

The executive director must send a copy of the decision to the professional order concerned.

1991, c. 42, s. 249; 1994, c. 40, s. 457; 2001, c. 43, s. 50.

250. The board of directors of an institution may also take disciplinary measures against a pharmacist after having obtained the opinion of the council of physicians, dentists and pharmacists, if any.

Disciplinary measures range from reprimand to dismissal. They may include a recommendation that the pharmacist serve a period of refresher training, take a refresher course or both, and may, if necessary, restrict or suspend the pharmacist’s activities for the duration of the refresher period.

The fourth and fifth paragraphs of section 249 apply, with the necessary modifications, to disciplinary measures taken against a pharmacist.

1991, c. 42, s. 250; 2001, c. 43, s. 51.

251. The director of professional services, the chairman of the council of physicians, dentists and pharmacists, the head of the clinical department concerned or, if these persons are absent or unable to act, or fail to act, the executive director may, in case of emergency, suspend the privileges of a physician or dentist practising at the centre.

The director of professional services, the chairman of the council of physicians, dentists and pharmacists, the head of the clinical department of pharmacy or, if these persons are absent or unable to act, or fail to act, the executive director may, in case of emergency, suspend the status of a pharmacist practising at the centre.

A person who makes the decision to suspend the privileges of a physician or a dentist or the status of a pharmacist must immediately notify the chairman of the executive committee of the council of physicians, dentists and pharmacists and, within 48 hours, send him a report.

A suspension is valid until the board of directors has made a decision in that regard, but it may not exceed a period of 10 days.

1991, c. 42, s. 251; 1999, c. 40, s. 269.

252. A physician or dentist who is not satisfied with a decision rendered in his regard on the basis of criteria of qualification, scientific competence, conduct or concerning disciplinary measures may, within 60 days of the date on which the decision was notified to him, contest the decision before the Administrative Tribunal of Québec.

He may also apply to the Tribunal within 60 days of the expiry of the time prescribed in section 241, as if the decision were unfavourable, if no decision on his application for appointment has been sent to him within the time prescribed in that section.

1991, c. 42, s. 252; 1997, c. 43, s. 728.

253. A pharmacist who is not satisfied with a decision rendered in his regard under section 250 may, within 60 days of the date on which the decision was notified to him, contest the decision before the Administrative Tribunal of Québec.

1991, c. 42, s. 253; 1997, c. 43, s. 729.

254. A physician or dentist who decides to cease to practise in a centre must give prior notice of at least 60 days to the board of directors.

The decision of the physician or dentist becomes irrevocable upon receipt of the notice by the board of directors, and takes effect at the end of the period indicated in the notice.

1991, c. 42, s. 254.

255. Notwithstanding section 254, the board of directors may authorize a physician or dentist to cease to practise in the centre without prior notice or with notice of less than 60 days if it considers that his leaving does not affect the quality or adequacy of the medical or dental services offered to the population served by the centre.

1991, c. 42, s. 255.

256. The board of directors must, every three months, notify the regional board whenever a physician or a dentist has made the decision to cease to practise in accordance with sections 254 and 255.

1991, c. 42, s. 256.

257. A physician or dentist who ceases to practise in a centre without the authorization of the board of directors and without giving prior notice of at least 60 days or before the end of the period indicated in the notice becomes, from the date fixed by the Régie de l’assurance maladie du Québec, a non-participating professional for the purposes of the Health Insurance Act (chapter A-29) for a period equal to twice the number of days remaining of the notice given.

The board of directors shall forthwith inform the Régie that the physician or dentist has left, and shall indicate the period for which he becomes a non-participating professional.

Where, on the advice of the council of physicians, dentists and pharmacists, as the case may be, the board of directors believes that the departure of a physician or dentist may affect the quality or adequacy of the medical or dental services offered to the population served by a centre, it shall inform the Ordre professionnel des médecins du Québec or the Ordre professionnel des dentistes du Québec, as the case may be, in writing.

1991, c. 42, s. 257; 1994, c. 40, s. 457; 1999, c. 89, s. 53.

258. Every physician or dentist practising in a centre must hold a valid professional liability insurance policy for himself and his succession, accepted by the board of directors, and he must, each year, establish that the policy is in force.

However, a physician may fulfil his obligation under the first paragraph by furnishing each year to the board of directors proof that he is a member of the Canadian Medical Protective Association.

1991, c. 42, s. 258.

259. No institution may pay any remuneration or grant any direct or indirect benefit to a physician practising under the plan established by the Health Insurance Act (chapter A-29) for services insured under that plan which are provided in a centre it operates, nor may it pay any remuneration or grant any such benefit to that physician as consideration for the performance of any other activity in the centre, except to the extent prescribed by regulation of the Government made under subparagraph 22 of the first paragraph of section 505.

1991, c. 42, s. 259.

The following words are not in force:

“nor may it pay any remuneration or grant any such benefit to that physician as consideration for the performance of any other activity in the centre, except to the extent prescribed by regulation of the Government made under subparagraph 22 of the first paragraph of section 505”.

These words will come into force on the date to be fixed by order of the Government (1991, c. 42, s. 622).

259.1. The physicians and dentists who render services, in a centre operated by an institution, for the carrying out of managerial functions determined by a government regulation under the first paragraph of section 506.1 shall be paid under a program of which the administration is entrusted to the Régie de l’assurance maladie du Québec by the Government. Such services shall be remunerated in accordance with an agreement entered into under section 19 of the Health Insurance Act (chapter A-29).

1992, c. 21, s. 30; 1999, c. 89, s. 53.

§ 11.1 . — Midwives

1999, c. 24, s. 35.

259.2. A midwife who wishes to practise midwifery for an institution that operates a local community service centre designated by the regional board under section 347 must submit an application to the board of directors of the institution for the purpose of entering into a service contract with the institution.

The board of directors must, in such a case, obtain the recommendations referred to in subparagraph 4 of the first paragraph of section 225.3.

1999, c. 24, s. 35.

259.3. The board of directors shall accept or refuse the application of a midwife having regard to the organization plan of the institution and the resources available.

The board of directors may also refuse the application of a midwife on the basis of criteria relating to qualifications, competence or conduct.

1999, c. 24, s. 35.

259.4. The board of directors must transmit a written decision to the midwife within 90 days after receiving the application. If an application is refused, the reasons therefor must be given in writing.

1999, c. 24, s. 35.

259.5. A service contract entered into with a midwife pursuant to section 259.2 must specify the rights and obligations of the midwife that are attached to the practice of midwifery for the institution.

The contract shall be entered into for a term of not more than three years and is renewable upon its expiry. Mechanisms for the termination of the contract before its expiry and the circumstances allowing such termination must also be provided in the contract.

1999, c. 24, s. 35.

259.6. The board of directors may, after consultation with the council of midwives, the council of physicians, dentists and pharmacists or the midwifery services coordinator, as the case may be, take disciplinary measures against a midwife. The disciplinary measures that may be taken include a reprimand, modification or withdrawal of one or more rights under the contract and cancellation of the contract.

Every decision to take a disciplinary measure against a midwife must specify the reasons therefor and be based solely on lack of qualifications, incompetence, negligence, misconduct, non-compliance with the regulations of the institution or non-performance of the obligations determined in the contract.

Disciplinary measures must be taken in accordance with the procedure prescribed by a regulation of the Government made under section 506.2.

The executive director must send a copy of the decision to the professional order.

1999, c. 24, s. 35.

259.7. In urgent cases, the midwifery services coordinator, the chair of the council of midwives or, where section 225.2 applies, the chair of the council of physicians, dentists and pharmacists or, if such persons are absent or fail to act, the executive director may suspend a midwife’s right to practise under a service contract.

The person imposing the suspension must immediately inform the chair of the executive committee of the council of midwives or, where section 225.2 applies, the chair of the council of physicians, dentists and pharmacists, and send a report within 48 hours.

The suspension is valid until the board of directors has made a decision on the suspension, but may not exceed 10 days.

1999, c. 24, s. 35.

259.8. A midwife who is not satisfied with a decision rendered on the basis of criteria relating to qualifications, competence or conduct or with a decision concerning disciplinary measures may, within 60 days of receiving notification thereof, contest the decision before the Administrative Tribunal of Québec.

The midwife may also apply to the Tribunal within 60 days of the expiry of the time fixed in section 259.4, as if the decision were unfavourable, if no decision on the midwife’s application concerning the making of a service contract has been received by the midwife within the time fixed in that section.

1999, c. 24, s. 35.

259.9. Midwives practising under a service contract entered into pursuant to section 259.2 must hold, for themselves and their succession, a valid liability insurance policy, accepted by the board of directors, and they must, each year, furnish proof that the policy is in force.

However, midwives may satisfy the requirement of the first paragraph by furnishing each year to the board of directors proof of coverage under an equivalent liability insurance policy.

1999, c. 24, s. 35.

259.10. An institution that operates a local community service centre designated by the regional board under section 347 and that has entered into a service contract with a midwife pursuant to section 259.2 may enter into an agreement under section 108 with an institution operating a general and specialized hospital centre to allow the midwife to conduct deliveries and perform all other acts that may be required in the circumstances.

The agreement must determine the rights and obligations of the two institutions as regards the use by midwives of the premises and equipment of the institution operating the hospital centre, provide for cooperative arrangements between midwives and the physicians and nursing personnel practising in the hospital centre, and specify the admission and discharge procedures to be observed by midwives with respect to the women and children under their responsibility and any other administrative procedure necessary for the proper functioning of the agreement. The agreement must also establish the rules governing the application of section 259.7 with respect to a midwife performing an act in the hospital centre.

Notwithstanding the provisions of section 109, the agreement must also provide that all the physicians to whom the cooperative arrangements referred to in the second paragraph apply are bound by the agreement.

1999, c. 24, s. 35.

259.11. An institution that operates a local community service centre designated by the regional board under section 347 and that has entered into a service contract with a midwife pursuant to section 259.2 must enter into an agreement with an institution operating a general and specialized hospital centre to ensure that medical support is provided to the midwife when required and that the necessary measures are taken in order to provide the woman or child with the care and services required by their condition in the case of a medical consultation or transfer.

1999, c. 24, s. 35.

DIVISION IV MATERIAL AND FINANCIAL RESOURCES

§ 1 . — Rules relating to material resources

260. No public institution may, without having obtained the advice of the regional board concerned and prior authorization from the Minister and from the Conseil du trésor,

(1)  acquire, alienate, charge with a servitude or hypothecate an immovable;

(2)  build, enlarge, develop, convert, demolish, rebuild or make major repairs to its immovables, except in the cases provided for in paragraph 3 of section 263.

A public institution is not subject to the first paragraph as regards the disposition of any one of the following immovable real rights:

(1)  a superficiary right and the servitudes of right-of-way or support required by a public utility, a municipality or any other organization working in the general interest for the purposes of a cable telecommunications network, water distribution network, electric power line, petroleum product pipeline or waste water disposal system;

(2)  a superficiary right and the servitudes of water, snow and ice runoff required to legalize an encroachment resulting from the construction of a roof erected in contravention of the prescriptions of article 983 of the Civil Code of Québec (Statutes of Québec, 1991, chapter 64);

(3)  a superficiary right and the rights of use required to legalize a minor encroachment in accordance with article 992 of the Civil Code;

(4)  a servitude required to legalize an existing view not in conformity with the prescriptions of article 993 of the Civil Code.

A private institution under agreement is subject to the first paragraph, except to charge with a servitude or hypothecate an immovable or to dispose of one of the immovable real rights mentioned in the second paragraph.

1991, c. 42, s. 260; 1998, c. 39, s. 81.

261. The Conseil du trésor may, on the conditions and to the extent that it determines, delegate to the Minister all or some of the powers vested in it under section 260.

The deed of delegation shall be published in the Gazette officielle du Québec and shall come into force on the fifteenth day following the date of publication.

1991, c. 42, s. 261.

262. Every public institution shall identify, in a specific accounting item in its fixed assets fund, the net proceeds resulting from the alienation of an immovable. This sum, and the revenues therefrom, shall be used for any purpose that is consistent with the use of the fixed assets fund. If the institution obtains prior authorization from the Minister, which will be given on the recommendation of the regional board, the sum and the revenues may also be used to finance a specific operating expenditure of the institution.

1991, c. 42, s. 262.

262.1. Any institution which is a legal person designated by the Minister pursuant to section 139 may, with no other formality than those prescribed in sections 180 and 260, alienate any immovable surplus to requirements where the acquisition or construction or the work carried out on the immovable has been financed with funds other than funds provided, in whole or in part, by government subsidy and other than funds provided entirely by public subscription, provided that such investment has not been the subject of a reimbursement or compensation.

The proceeds from the alienation of the immovable and the income arising from the proceeds may be transferred, notwithstanding subparagraph 4 of the first paragraph of section 265, to a foundation of the institution referred to in section 271 to be used for any of the purposes mentioned in section 272, in accordance with that section, or, if the authorization obtained under section 260 so provides, to another non-profit legal person whose activities relate to the field of health and social services.

They may also be paid into a special fund of which the administration is entrusted to the members of the legal person, to be used for any of the purposes mentioned in section 272, in accordance with that section.

The rules set out in the second and third paragraphs also apply to funds constituted by the members of a legal person before 23 June 1992 and which have traditionally been administered by those members.

Any immovable surplus to requirements may also be tranferred, notwithstanding subparagraph 4 of the first paragraph of section 265, to a foundation of the institution referred to in section 271, or, if the authorization obtained under section 260 so provides, to another non-profit legal person whose activities relate to the field of health and social services.

For the purposes of this section, the words “immovable surplus to requirements” mean an immovable which the institution, the regional board concerned and the Minister foresee will not be used for the purposes of any institution for whatever purpose for the five ensuing years.

1992, c. 21, s. 31; 1994, c. 23, s. 3; 1996, c. 36, s. 51; 1998, c. 39, s. 82.

263. No public institution or private institution under agreement may, without having obtained prior authorization from the regional board,

(1)  lease an immovable;

(2)  grant a lease on, lend or otherwise permit a third person to use any of its immovables for a period exceeding one year;

(3)  carry out construction, enlargement, development, conversion, demolition, reconstruction or major repair work on its immovables where the estimated total cost of the project is less than the amounts determined by regulation under paragraph 3 of section 505, except development, repair, improvement or maintenance work the cost of which is less than the amounts determined by the same regulation and which requires no borrowing for its financing.

1991, c. 42, s. 263.

263.1. Sections 260 and 263 do not apply to asset maintenance work, whatever the estimated cost of the work and the source of its financing.

“Asset maintenance work” means all the work required to ensure the security of persons and property, stop the deterioration of immovables and ensure their conservation.

2005, c. 32, s. 121.

264. A contract made by an institution without the prior authorization of the Conseil du trésor, the Minister or the regional board is absolutely null in all cases where such authorization is required by this Act.

Furthermore, every contract must, on pain of nullity, be made in accordance with the standards, terms and procedure prescribed by regulation of the Minister.

An action for nullity of a contract made by an institution contrary to this section may be instituted by the Minister, the regional board or any interested person.

No contract made by an institution before 20 June 1998, the object of which is to transfer one of the rights mentioned in the second paragraph of section 260, may be invalidated on the ground that such a transfer is an act for which the institution did not obtain the authorization required under the Act, an Act replaced by this Act or any previous Act applicable to the institution.

1991, c. 42, s. 264; 1998, c. 39, s. 83.

265. No public institution may

(1)  acquire shares in another legal person or operate a commercial enterprise, except with the advice of the regional board concerned and to the extent provided in an agreement entered into with the Minister, the terms of which shall be made public by the institution;

(2)  grant loans to third persons out of the sums of money administered by it;

(3)  guarantee, endorse or otherwise grant security for payment of the obligation of a third person;

(4)  dispose gratuitously of property, except in the case of property of small value or, with the prior authorization of the regional board, where the property is disposed of in the interest of the institution or its mission, in favour of another institution or for humanitarian purposes;

(5)  neglect to exercise or renounce a right belonging to it, except for value;

(6)  grant any subsidy to a third person, except in the case of amounts that may be paid, or goods and services that may be provided, to users or other persons as material or financial assistance under this Act or any other legislative or regulatory provision.

An action for nullity of a decision, by-law, resolution or contract made or adopted by an institution contrary to the first paragraph may be instituted by the Minister, the regional board or any other interested person.

Organization by an institution of activities which are subsidiary to the health services or social services it provides shall not constitute a commercial enterprise.

The prohibition under subparagraph 2 of the first paragraph does not apply where an institution lends money to another institution, if both institutions are administered by the same board of directors.

1991, c. 42, s. 265; 1996, c. 36, s. 51; 1998, c. 39, s. 84.

266. A public institution may acquire, by expropriation, any immovable required for its purposes.

1991, c. 42, s. 266; 1998, c. 39, s. 85; 1999, c. 34, s. 55.

267. Every institution which does not belong to an association recognized by the Minister for the negotiation and conclusion of a contract of civil liability insurance in favour of its members and the management of the deductible must enter into such a contract in respect of acts for which it may be held liable.

1991, c. 42, s. 267.

§ 2 . — Gifts, legacies and subsidies

1.  — Acceptance

268. Any institution may receive gifts, legacies, subsidies or other voluntary contributions from any person or any public or private body wishing to assist in the carrying out of the mission of a centre operated by an institution.

However, no institution may, without the prior authorization of the regional board, accept gifts, legacies, subsidies or other contributions that are paid on the condition that a project having the same particularities as a project mentioned in subparagraph 1 or 2 of the second paragraph of section 272 be carried out, except from the Gouvernement du Québec or from departments and agencies whose operating expenses are borne by the consolidated revenue fund. In that case, the Government, the department or the agency concerned must notify the regional board thereof.

Where the project whose carrying out is a required condition has the same particularities as a project mentioned in subparagraph 2 of the second paragraph of section 272, the regional board shall grant the prior authorization only if the institution shows that the extra cost can be borne without requiring a budgetary adjustment or a special subsidy from the regional board or the Minister.

1991, c. 42, s. 268; 1998, c. 39, s. 86.

269. Every amount received as a gift, legacy, subsidy or other form of contribution, except an amount granted by the Gouvernement du Québec or a department or agency referred to in section 268, shall be entered directly in the institution’s own property and is subject to the rules governing the use of such property prescribed by section 269.1.

However, the amount of a contribution made for special purposes shall be paid into a special fund created by the institution. It shall be deposited or invested in accordance with the provisions of the Civil Code respecting investments presumed sound, until it is used for the special purposes for which the contribution was made.

Where sums have been granted for the specific purpose of furnishing the institution with capital that must be preserved and of which only the income may be used, the amount thereof shall be paid into an endowment fund created by the institution and administered in the manner set out in the second paragraph.

A separate statement for each fund created under this section shall appear in the financial statements of the institution.

1991, c. 42, s. 269; 1998, c. 39, s. 87; 1999, c. 40, s. 269.

269.1. A public institution’s own property may not be used for other purposes than those relating to the carrying out of the mission of a centre it operates.

However, if an intended use involves the carrying out a project having the same particularities as a project mentioned in subparagraph 1 or 2 of the second paragraph of section 272, the public institution must submit its project to the regional board for evaluation and acceptance in accordance with that section.

Notwithstanding subparagraph 4 of the first paragraph of section 265, all or part of the property of a public institution may be transferred to another public institution where both institutions are administered by the same board of directors.

1998, c. 39, s. 88.

270. A public institution that receives a sum of money or a direct or indirect benefit from a foundation or legal person that solicits funds or gifts from the public for purposes related to health and social services must mention it in a schedule appended to its annual financial report indicating the object for which the sum of money or benefit was granted.

1991, c. 42, s. 270; 1996, c. 36, s. 51.

2.  — Foundations

271. Any institution may, with the prior authorization of the regional board, transfer the administration of all or part of any fund referred to in section 269 to a foundation of the institution within the meaning of section 132.2, provided that the foundation is established in accordance with the statutes of Québec and that nothing in its constituting act prevents it from administering such a fund.

The funds whose administration is so transferred to a foundation of the institution are deemed received in trust; the foundation or legal person is, in respect of such funds, subject to the same obligations and vested with the same powers as a trust company constituted in Québec.

In cases of dissolution of the foundation of the institution, the funds which have not yet been used for the special purposes stipulated, together with the accrued income and interest derived from the investment of the funds, shall be returned to the institution and administered in the manner prescribed in section 269.

1991, c. 42, s. 271; 1996, c. 36, s. 51; 1998, c. 39, s. 89; 1999, c. 40, s. 269.

272. A public institution may accept financial or material assistance from any foundation or legal person that solicits funds or gifts from the public in the field of health care or social services for any of the following purposes:

(1)  the purchase, construction, renovation, improvement, enlargement or development of immovable property used or to be used by the institution;

(2)  the purchase, installation, improvement or replacement of furnishings, equipment or machinery of the institution;

(3)  the research activities of the institution;

(4)  the improvement of the quality of life of the users of the institution;

(5)  the training and development of the human resources of the institution for specific needs.

Before accepting such assistance, the institution must submit its project to the regional board for assessment and approval in the following cases:

(1)  where the assistance is intended to finance a project for which the prior authorization of the Conseil du trésor, the Minister or the regional board is required under this Act;

(2)  where the immediate or foreseeable effect of the project is to increase the amount of the annual operating or capitalization expenditures of the institution;

(3)  where, regardless of the amount of assistance, the utilization sought lies outside the scope of the activities of the institution as defined in the regional services organization plans prepared by the regional board;

(4)  (subparagraph repealed).

The application must be accompagnied with such documents and contain such information as are determined by the regional board.

After having assessed the relevance and the financial viability of the project, and after having ascertained that the foundation or legal person has the financial potential to honour its commitments, the regional board shall notify the institution of the eligibility of the project or of the requirements for its approval.

However, the regional board may accept a project referred to in subparagraph 2 of the second paragraph only if the institution shows that the extra cost can be borne without a budgetary adjustment or a special subsidy from the regional board or the Minister.

1991, c. 42, s. 272; 1996, c. 36, s. 51; 1998, c. 39, s. 90.

273. The regional board may, at any time, verify the accuracy of information given to it by an institution concerning any project submitted under section 272, or demand information on the use made of assistance obtained under that section, as the case may be.

Where an institution has obtained the right to receive assistance through false representation or has used any part of the assistance for purposes other than those for which it should have been used, the regional board may, of its own initiative or at the request of the Minister, declare the institution forfeited of the benefit of the assistance granted and take any step to require the institution and the foundation or legal person providing the assistance to remedy the situation.

1991, c. 42, s. 273; 1996, c. 36, s. 51.

274. No executive director of a public institution may, under pain of forfeiture of office, and no senior management officer or middle management officer of a public institution may, under pain of sanctions which may include dismissal, accept any sum of money or any direct or indirect benefit from a foundation or legal person that solicits funds or gifts from the public for purposes related to health or social services.

The second, third and fifth paragraphs of section 197 apply, with the necessary modifications, to the executive director.

1991, c. 42, s. 274; 1996, c. 36, s. 51.

275. A gift made to the owner, a director or an employee of an institution who is neither the spouse nor a close relative of the donor is null if it was made while the donor was receiving care or services from the institution.

A gift made to a member of a family-type resource while the donor was residing there is also null.

1991, c. 42, s. 275.

276. A legacy made to the owner, director or employee of an institution who is neither the spouse nor a close relative of the testator is null if it was made while the testator was receiving care or services from the institution.

A legacy made to a member of a family-type resource while the testator was residing there is also null.

1991, c. 42, s. 276.

277. The restrictions provided for in sections 275 and 276 also apply, with the necessary modifications, to a physician, a dentist or a pharmacist practising in a centre operated by an institution, a person undergoing training at such a centre, a person who, under a service contract, provides services on behalf of the institution to the users of the institution and to any third person assisting the provider of services in the performance of his obligation under the contract.

1991, c. 42, s. 277.

§ 3 . — Rules relating to financial resources

1.  — Provisions applicable to all institutions

278. Every institution must transmit an annual report of its activities, including activities related to risk and quality management, to the regional board and to the Minister within three months after the end of its fiscal year. The report must be filed in the form determined by the Minister and must contain any information required by him and by the regional board.

1991, c. 42, s. 278; 2002, c. 71, s. 12.

279. Every institution must, at the request of the regional board, furnish to it, in the form and within the time prescribed by it, such statements, statistical data, reports and other information on the activities of the institution as it requires or as it considers necessary for the performance of its functions. The Minister may request a copy thereof from the regional board. No document may be furnished that would permit a user of the institution to be identified.

This section applies to a private institution not under agreement only if it is accredited for the purposes of subsidies in accordance with the provisions of Chapter III of Title II of Part III and to the extent that the information is necessary for the application of such provisions.

1991, c. 42, s. 279.

280. The information contained in a report or document prescribed by this subdivision is public, subject to the protection of any personal information it contains.

Notwithstanding section 9 of the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A-2.1), no person may have access to a report or document prescribed by this subdivision before the date of expiry of the time for transmitting the report or document or, if transmitted after that date, before the date of transmission.

1991, c. 42, s. 280; 2005, c. 32, s. 123.

281. Sums of money paid by the Government in respect of an immovable owned by an institution and standing in lieu, in its regard, of taxes, compensations and tariffs payable to a municipality by a person as the owner, lessee or occupant of an immovable shall be part of the operating expenses of the institution concerned. This section applies to sums of money paid in that respect by the Government from 21 December 1979.

1991, c. 42, s. 281.

2.  — Provisions applicable to public institutions

282. The fiscal year of a public institution ends on 31 March.

1991, c. 42, s. 282.

283. The institution shall, each year, establish rules and procedures for the allocation of its financial resources to the various items or entries according to the requirements of its own organization plan.

The rules must permit, subject to the applicable budgetary rules, the budgetary transfers that are required during the fiscal year for the proper operation of the institution and the adequate provision of the services it is called upon to provide.

1991, c. 42, s. 283; 1992, c. 21, s. 32.

284. Every executive director of an institution shall submit to the board of directors the operating budget estimates for the following fiscal year for the institution or for each of the institutions under the administration of the board, before the date fixed by it. The estimates shall be drawn up within the budgetary parameters set forth by the regional board, which must be consistent with those transmitted by the Minister.

The estimates for the operating budget shall show the amount required by the institution for the operations relating to the provision of the services which it is called upon to provide and which are essential for the carrying out of the mission of any centre it operates. The budget estimates of expenditures and revenues must be balanced.

1991, c. 42, s. 284.

285. Before 1 April each year, the regional board shall inform every board of directors of the institutions referred to in sections 119 to 125 and in sections 126.1 and 126.2 of the total of the amounts it is allocating to the operating budget of each institution under the administration of these boards.

Within 30 days from the transmission of the information, the board of directors shall apportion, among the institutions under its administration, the total amount indicated by the regional board, see to it that the operating budget of every institution under its administration is revised, if necessary, adopt the operating budget of every institution and inform the regional board thereof.

Where a budget balancing plan is required to enable an institution under the administration of the board of directors to comply with its operating budget, the board of directors shall see to it that such a plan is prepared, adopted and transmitted to the regional board, within 60 days, along with the operating budget of the institution.

1991, c. 42, s. 285; 1996, c. 36, s. 28.

286. Before 1 April each year, the regional board shall inform every institution not referred to in section 285 of the total amount it shall allocate to its operating budget for the following fiscal year.

Within the following 30 days, the board of directors shall see to it that the operating budget of the institution is revised, if necessary, adopt the operating budget of the institution and inform the regional board thereof.

Where a budget balancing plan is required to enable the institution to comply with its operating budget, the board of directors shall see to it that such a plan is prepared, adopted and transmitted to the regional board, within 60 days, along with the operating budget of the institution.

1991, c. 42, s. 286.

287. If, on 1 April in any year, the total amount allocated to the operating budget of an institution has not been communicated to the institution by the board of directors under the second paragraph of section 285 or by the regional board under the first paragraph of section 286, as the case may be, one-quarter of the budget for the preceding fiscal year shall be renewed at the beginning of each quarter of the fiscal year and shall remain in force until it is replaced by the total amount allocated to the budget for the fiscal year concerned.

1991, c. 42, s. 287.

288. Each institution shall transmit to the regional board, on the dates and in the form it determines,

(1)  periodic reports on budget use and on the operation of the institution;

(2)  an annual statistical report on the resources and services of the institution for the last fiscal year.

The reports must contain any information required by the regional board or the Minister.

The regional board shall furnish a copy of these reports to the Minister at his request.

1991, c. 42, s. 288.

289. The books and accounts of each institution shall be audited every year by an auditor.

1991, c. 42, s. 289.

290. The board of directors shall appoint an auditor for the current fiscal year of the institution before 30 September each year.

The institution must issue a call for tenders, at least once every four years and whenever it intends to retain the services of a new auditing firm, to ensure that the services it receives are as cost-effective as possible.

A new institution constituted as a legal person under this Act, including an institution resulting from an amalgamation or conversion carried out pursuant to this Act, must apply the tendering procedure mentioned in the second paragraph before engaging the services of an auditing firm.

1991, c. 42, s. 290; 1998, c. 39, s. 91.

291. If the auditor leaves office before the end of his term, the board of directors of the institution shall fill the vacancy at its next sitting.

1991, c. 42, s. 291.

292. In the performance of his duties, the auditor shall have access to all the books, registers, accounts and other accounting records and vouchers of the institution. Every person having custody of such documents must facilitate his examination of them.

The auditor may also require from the members of the board of directors of the institution or from the officers, employees or other representatives of the institution the information, explanations and other documents necessary for the carrying out of his mandate.

1991, c. 42, s. 292.

293. The auditor shall, for the fiscal year for which he has been appointed, audit the financial statements of the institution and perform the other duties included in his mandate, in particular those determined by regulation under paragraph 8 of section 505 and, if the case arises, those determined by the institution, the regional board or the Minister.

1991, c. 42, s. 293.

294. The auditor shall submit his audit report to the board of directors of the institution.

1991, c. 42, s. 294.

295. The institution shall, on or before 30 June each year, submit to the regional board its annual financial report for the last fiscal year. The report shall be prepared on the forms prescribed by the Minister and shall include the financial statements of the institution, the audit report referred to in section 294 and any other information required by the regional board or by the Minister.

The regional board shall transmit a copy of the annual financial report of the institution to the Minister, at his request.

1991, c. 42, s. 295.

296. Notwithstanding any legislative provision inconsistent herewith, an institution may, with the prior authorization of the regional board and subject to the terms and conditions it determines, borrow money by any method recognized by law to pay current operating expenditures or capital expenditures made for the organization of complementary activities in accordance with section 115 or as part of an investment project which is self-financed by savings to be made in the current operating expenditures.

The institution may also, with the prior authorization of the Minister and subject to the terms and conditions he determines, borrow money by any method recognized by law to finance capital expenditures or the debt service of the institution.

The Minister shall determine in what cases and circumstances and on what conditions the regional board may allow borrowings to be made under the first paragraph, and the maximum amount of such borrowings.

1991, c. 42, s. 296.

297. At the request of the regional board or of the Minister, the institution shall, either directly or through the financial institutions with which it does business, furnish the board or the Minister with any information on its financial position.

1991, c. 42, s. 297.

3.  — Provisions applicable to private institutions under agreement

298. The fiscal year of a private institution under agreement ends on 31 March.

1991, c. 42, s. 298.

299. Before 1 April each year, the regional board shall transmit to each private institution under agreement in its region its operating budget for the ensuing fiscal year. The budget shall be established on the basis of the financing agreement entered into between the institution and the regional board, according to the terms and conditions, if any, set out therein.

If, on 1 April in a year, the operating budget of an institution has not been transmitted to it, one quarter of the budget for the preceding fiscal year shall be renewed at the beginning of each quarter of the fiscal year and shall remain in force until it is replaced by the budget for the fiscal year concerned.

1991, c. 42, s. 299; 1992, c. 21, s. 33; 1998, c. 39, s. 92.

300. Every private institution under agreement is subject to sections 288 to 295 as regards reports to be submitted and audits to be made.

The periodic reports referred to in subparagraph 1 of the first paragraph of section 288 must, however, contain only the information necessary for the application of the relevant provisions of the financing agreement entered into with the regional board.

1991, c. 42, s. 300; 1998, c. 39, s. 93.

DIVISION V INTERMEDIATE AND FAMILY-TYPE RESOURCES

§ 1 . — Intermediate resources

301. A public institution identified by the regional board may call upon the services of an intermediate resource for the purpose of carrying out the mission of a centre operated by the institution.

1991, c. 42, s. 301.

302. Every resource attached to a public institution through which the institution provides a user registered for the institution’s services with a living environment suited to the user’s needs, together with the support or assistance services required by the user’s condition, in order to maintain the user in or integrate the user into the community, is an intermediate resource.

The immovable or dwelling premises in which the services of an intermediate resource are provided is not deemed to be a facility maintained by the public institution to which the resource is attached, except for the purposes of the Youth Protection Act (chapter P-34.1), in which case it is considered to be a place where foster care is provided by an institution operating a rehabilitation centre.

1991, c. 42, s. 302; 1998, c. 39, s. 94.

302.1. Notwithstanding any provision inconsistent herewith, an intermediate resource is deemed not to be in the employ of or an employee of the public institution that calls upon the services of the resource and any agreement or convention entered into between them to determine the rules and the terms and conditions that apply to their relationship as regards the activities and services expected from the intermediate resource is deemed not to constitute a contract of employment.

2003, c. 12, s. 1.

303. In order to foster an adequate framework and the regional implementation of intermediate resources, and to ensure sufficient flexibility for the emergence of new resources within the framework of regional service organization plans, the Minister shall propose to regional boards a classification of the services offered by intermediate resources based on the degree of support or assistance required by users.

The Minister shall determine, with the approval of the Conseil du trésor, the rates or scale of rates of compensation applicable to each type of service listed in the classification established pursuant to the first paragraph.

The Minister shall also identify the policy to be followed by regional boards in determining the rules and procedures governing access to the services provided by intermediate resources, including the general criteria for admission to such resources.

1991, c. 42, s. 303; 1998, c. 39, s. 95; 2003, c. 12, s. 2.

303.1. The Minister may, with the approval of the Government, enter into an agreement with one or more bodies representing intermediate resources to determine the general conditions for the carrying on of the activities of all intermediate resources and the normative framework applicable to the living conditions of users placed under the care of intermediate resources, and to establish various measures, terms and conditions relating to the compensation for the services provided by intermediate resources.

Such an agreement shall bind the regional boards, the institutions and all intermediate resources, whether or not they are members of a body that entered into the agreement.

2003, c. 12, s. 3.

303.2. A body is considered to represent intermediate resources if the membership of that body includes, on a Québec-wide scale, any resource that reflects the specific character of the body and either a minimum of 20% of the total number of such resources throughout Québec or the number of resources required to meet the needs of at least 30% of the total number of users of such resources throughout Québec.

The same applies to a group of bodies representing intermediate resources that intervene only on a local or regional scale, provided that all of these bodies combined ensure the same representation as that required under the first paragraph.

A representative body must provide the Minister, on request, with up-to-date documents establishing its constitution, and the name and address of each of its members.

A group must provide up-to-date documents establishing its constitution, the names and addresses of the bodies it represents and the name and address of each member of each of those bodies.

When a representative body is a group of bodies, the group alone is authorized to represent each of the member bodies.

For the purposes of section 303.1, an intermediate resource may not be a member of more than one representative body other than a group.

2003, c. 12, s. 3.

304. The regional board shall, in addition to establishing the rules and procedures of access to the services provided by intermediate resources in its region,

(1)  specify the criteria for recognizing intermediate resources, recognize them and keep a register of recognized resources classified according to the types of clientele;

(2)  identify the public institutions in its region which may call upon the services of intermediate resources and which must ensure professional follow-up;

(3)  (paragraph repealed);

(4)  ensure that mechanisms for concerted action between institutions and their intermediate resources are established and put into operation.

1991, c. 42, s. 304; 1998, c. 39, s. 96; 2003, c. 12, s. 4.

305. Public institutions identified by the regional board shall themselves recruit and assess intermediate resources with a view to their recognition by the regional board.

1991, c. 42, s. 305.

306. With the authorization of the regional board, several institutions may call upon the services of the same intermediate resource. The regional board shall, however, see to it that the institutions concerned agree on the professional follow-up and on the payments made to the resource.

1991, c. 42, s. 306.

307. Every person responsible for an intermediate resource may apply to the regional board for review of a decision made by the public institution to which the resource is attached to settle any misunderstanding concerning them.

The regional board must, when examining the application, give the institution and the person responsible for the resource the opportunity to present their views.

After examining the application, the regional board shall transmit its decision to the institution and to the person responsible for the intermediate resource.

1991, c. 42, s. 307.

308. A municipal permit or certificate shall not be refused and proceedings under a by-law shall not be instituted for the sole reason that a building or dwelling premises are to be occupied in whole or in part by an intermediate resource.

This section takes precedence over any general or special Act and over any municipal by-law adopted under any such Act.

1991, c. 42, s. 308.

309. The person responsible for, or the employees of, an intermediate resource, as the case may be, are subject to the following provisions of this Act, with the necessary modifications:

(1)  the right, recognized by section 16, of a person or of his successors to pursue a remedy against that resource;

(2)  the practices and conduct expected of employees in respect of users as set out in the code of ethics of the institution in accordance with section 233;

(3)  the restrictions imposed by sections 275, 276 and 277 as regards gifts or legacies made by a user while he was receiving services from an intermediate resource.

1991, c. 42, s. 309; 1999, c. 40, s. 269.

§ 2 . — Family-type resources

310. A public institution identified by the regional board may call upon the services of a family-type resource for the placement of adults or elderly persons.

Subject to the third paragraph, only an institution operating a child and youth protection centre may recruit and call upon the services of such a resource for the placement of children. It shall see to it that professional follow-up is provided to the child by the institution best suited to assist him.

An institution which operates a rehabilitation centre for mentally or physically impaired persons may, for its clientele, recruit and call upon the services of family-type resources for children provided, however, that the placement in such resources is made in accordance with the provisions of section 357 and of the regulation made under paragraph 10 of section 505.

1991, c. 42, s. 310.

311. Family-type resources comprise foster families and foster homes.

1991, c. 42, s. 311.

312. One or two persons receiving in their home a maximum of nine children in difficulty entrusted to them by a public institution in order to respond to their needs and afford them living conditions fostering a parent-child relationship in a family-like environment may be recognized as a foster family.

One or two persons receiving in their home a maximum of nine adults or elderly persons entrusted to them by a public institution in order to respond to their needs and afford them living conditions as close to a natural environment as possible may be recognized as a foster home.

1991, c. 42, s. 312.

313. Activities and services provided by a family-type resource are deemed not to be a commercial enterprise or a means to make profit.

1991, c. 42, s. 313.

314. The provisions of sections 302.1 to 308 apply, with the necessary modifications, to family-type resources.

1991, c. 42, s. 314; 1998, c. 39, s. 97; 2003, c. 12, s. 5.

CHAPTER IV RULES APPLICABLE TO THE CONSTITUTING INSTRUMENT OF INSTITUTIONS

DIVISION I GENERAL PROVISIONS

315. “Constituting instrument of an institution” means the special Act constituting the institution, the letters patent, supplementary letters patent, the articles of constitution or continuance and any other document or charter granted for its constitution.

In case of discrepancy between this Act and the constituting instrument of an institution including any relevant provision of the Act under which the constituting document was granted, this Act shall prevail.

1991, c. 42, s. 315; 1999, c. 40, s. 269.

316. No constituting instrument of an institution may be granted, amended, revoked or abandoned without the written authorization of the Minister.

However, the Minister may, with the same effects, give the authorization referred to in the first paragraph in cases where the constituting instrument of an institution has been granted, amended, revoked or abandoned without that authorization.

1991, c. 42, s. 316.

DIVISION II CONSTITUTION OF A PUBLIC INSTITUTION

1999, c. 40, s. 269.

317. From 1 October 1992, no public institution may be constituted otherwise than under this Act.

1991, c. 42, s. 317; 1999, c. 40, s. 269.

318. Where the amalgamation or conversion of institutions or, as the case may be, the expansion of the sphere of activity of a centre entails the creation of a public institution, the public institution shall be constituted by letters patent issued by the enterprise registrar, at the request of the Minister.

Notice of the issuance of letters patent shall be published in the Gazette officielle du Québec.

1991, c. 42, s. 318; 1999, c. 40, s. 269; 2002, c. 45, s. 556.

319. The letters patent shall indicate the name of the institution, the location of its head office and the mission of each centre operated by the institution. They shall also indicate, in the case of a hospital centre or a rehabilitation centre, its class and, in the case of a rehabilitation centre for physically impaired persons, its type.

In the cases referred to in section 319.1, the letters patent shall indicate the names of not less than five and not more than the number of persons who must be elected or appointed under sections 129 to 132.1 and 133, as the case may be; such persons shall be members of the board of directors until the elections or appointments provided for in the said sections have taken place. The executive director of the institution shall, once appointed, be a member of the board of directors.

The letters patent may also contain any other provision consistent with this Act.

1991, c. 42, s. 319; 1992, c. 21, s. 34; 1992, c. 21, s. 70; 1996, c. 36, s. 29; 2001, c. 24, s. 46.

319.1. The second paragraph of section 319 shall apply

(1)  to an institution resulting from the amalgamation of all the institutions referred to in section 125;

(2)  to an institution referred to in section 129 or 129.1 if, in the territory in which the head office of the institution is situated, no board of directors has been established to administer other institutions of the same type that have their head offices in that territory;

(3)  to an institution referred to in section 129 or 129.1 if the regional board, after taking into account the criteria set out in section 128, has recommended to the Minister that the institution be excluded from the group of similar institutions in the territory and that a board of directors be established to administer only that institution;

(4)  to an institution referred to in section 131, 132 or 133.

However, the provisions of subparagraphs 2 and 4 of the first paragraph do not apply where the new institution results from the amalgamation or conversion of institutions that, pursuant to section 126.1 or 126.2, were already administered by a board of directors established to administer at least one other institution that remains in existence.

1996, c. 36, s. 30; 2001, c. 24, s. 47.

320. From the date of issuance of the letters patent, the institution is a legal person.

1991, c. 42, s. 320; 1996, c. 36, s. 51; 1999, c. 40, s. 269.

321. When the letters patent contain a misnomer, a misdescription or a clerical error, the enterprise registrar may, if there is no contestation, direct the letters patent to be corrected or cancelled, and corrected letters patent to be issued.

1991, c. 42, s. 321; 2002, c. 45, s. 556.

322. To amend the constituting instrument of a public institution, other than an institution to which paragraph 1 of section 98 refers, the enterprise registrar shall issue supplementary letters patent at the request of the Minister.

A notice of issuance of supplementary letters patent shall be published in the Gazette officielle du Québec.

1991, c. 42, s. 322; 2002, c. 45, s. 556.

322.1. Despite any inconsistent legislative provision, the enterprise registrar may, upon an application by a public institution within the meaning of paragraph 1 of section 98 that has been constituted by a special Act, and with the written authorization of the Minister, issue supplementary letters patent to amend the constituting instrument of that institution.

The enterprise registrar shall publish the supplementary letters patent in the Gazette officielle du Québec, with a notice indicating the date on which they come into effect. The Québec Official Publisher must include in the annual compilation of the statutes of Québec printed after the issuance of the supplementary letters patent a table indicating both the date of effect of the supplementary letters patent and the legislative provisions they amend.

The application referred to in the first paragraph must be signed by the executive director and by the chair of the board of directors of the institution. It must be supported by a by-law passed by the board of directors and, if the institution is a legal person within the meaning of section 139, the by-law must also be approved by at least two thirds of the members of the legal person who cast a vote at a meeting called for that purpose.

2005, c. 32, s. 129.

DIVISION III AMALGAMATION AND CONVERSION

323. The following institutions may amalgamate to form a public institution constituted under this Act:

(1)  two public institutions;

(2)  a public institution and a private institution referred to in paragraph 3 of section 99 or in section 551;

(3)  two or more private institutions referred to in paragraph 2 of this section.

1991, c. 42, s. 323; 1999, c. 40, s. 269.

324. The following institutions may be converted into a public institution constituted under this Act:

(1)  a public institution referred to in paragraph 1 of section 98;

(2)  a private institution referred to in paragraph 3 of section 99 or in section 551.

1991, c. 42, s. 324; 1999, c. 40, s. 269.

325. No institution may be amalgamated or converted except with its consent and on the conditions agreed upon, after consultation with the regional board, between the institution and the Minister.

1991, c. 42, s. 325.

326. The amalgamation or conversion shall be requested by a resolution adopted for that purpose by the board of directors.

The resolution shall indicate

(1)  the name of the new institution;

(2)  the place in Québec where the head office of the institution will be situated;

(3)  the mission of each centre operated by the institution and, where applicable, the class to which a rehabilitation centre or hospital centre will belong and the type to which a rehabilitation centre for physically impaired persons will belong;

(4)  any other condition, term or measure concerning the administration and operation of the institution which is consistent with this Act.

1991, c. 42, s. 326; 1992, c. 21, s. 70; 1999, c. 40, s. 269.

327. Where the amalgamation or conversion involves a legal person designated by the Minister under section 139 or referred to in paragraph 3 of section 99 or in section 551, the conversion or amalgamation resolution must be approved by at least two-thirds of the votes cast by the members of the legal person at a meeting called for that purpose.

1991, c. 42, s. 327; 1996, c. 36, s. 51.

328. Notwithstanding sections 325 to 327, the Government may, on a proposal by the Minister, amalgamate two or more public institutions which do not own their immovable assets or whose immovable assets have been acquired out of funds derived for the greater part from government subsidies. The Minister shall propose such an amalgamation where, after consulting the regional board, he is of the opinion that the public interest warrants it.

The Minister shall publish in the Gazette officielle du Québec a notice of his intention to propose to the Government, 45 days after the publication of the notice, the amalgamation of the institutions and the issue of letters patent to that effect by the enterprise registrar.

After publication of the notice, the Minister shall give the institutions concerned the opportunity to present their views.

1991, c. 42, s. 328; 2002, c. 45, s. 556.

329. The new institution resulting from the amalgamation or conversion, under the name given to it by the letters patent, has all the rights, acquires all the property and assumes all the obligations of the amalgamated institutions or of the converted institution, and proceedings to which the latter are parties may be continued without continuance of suit.

1991, c. 42, s. 329.

DIVISION IV INTEGRATION

330. A public institution may, within the scope of its objects, agree with another public institution to integrate the whole of its property, rights and obligations with those of that institution.

The integration agreement shall indicate the date on which the integrating institution shall take charge of the activities of the integrated institution, and make any necessary provision for the carrying out of the integration and for the management of the activities of the integrated institution.

The agreement must provide for the cancellation or amendment, as the case may be, of the constituting instrument of the integrated institution.

With the authorization of the regional board, each institution shall adopt the integration agreement by resolution of its board of directors. Section 327 applies, with the necessary modifications, to the resolution.

1991, c. 42, s. 330.

331. The integration agreement must be submitted to the Minister for approval. The Minister shall transmit a copy thereof, duly signed, together with a certified copy of each of the resolutions made for its adoption and execution, to the enterprise registrar.

The enterprise registrar, in accordance with the provisions of the integration agreement, shall cancel the constituting instrument of the integrated institution or, as the case may be, issue supplementary letters patent to amend it. Where the integrated institution is a legal person within the meaning of paragraph 1 of section 98, the second paragraph of section 548 and section 549, apply, with the necessary modifications, to the supplementary letters patent issued to the institution.

1991, c. 42, s. 331; 1996, c. 36, s. 51; 2002, c. 45, s. 556.

332. From the date of integration, the integrating institution acquires the rights and property of the integrated institution and assumes the obligations thereof. Proceedings to which the integrated institution is a party may be continued without continuance of suit.

1991, c. 42, s. 332.

DIVISION V DISSOLUTION

333. The enterprise registrar may, at the request of a public institution referred to in paragraph 2, 3 or 4 of section 98 and with the authorization of the Minister, cancel the letters patent of the institution. The cancellation takes effect 60 days after publication of notice thereof in the Gazette officielle du Québec.

The institution is thereupon dissolved and its property devolves, after the payment of its debts and the performance of its obligations, to the Government or to a public institution designated by the Government.

1991, c. 42, s. 333; 2002, c. 45, s. 556.

TITLE II COMMUNITY ORGANIZATIONS

334. In this Act, “community organization” means a legal person constituted under an Act of Québec for non-profit purposes whose affairs are administered by a board of directors composed in the majority of users of the services offered by the organization or of members of the community served by the organization and engages in activities related to the field of health and social services.

1991, c. 42, s. 334; 1999, c. 40, s. 269.

335. Every community organization which receives a subsidy under this Title shall be free to define its orientations, policies and approaches.

1991, c. 42, s. 335.

336. A regional board may, according to the eligibility and allotment criteria it determines in accordance with the applicable budgetary rules, subsidize a community organization in one or other of the following cases:

(1)  where it offers prevention, assistance and support services to persons in the region, including temporary lodging services included in the regional service organization plan of the regional board;

(2)  where it engages, at the regional level, in activities to promote, raise awareness of and defend the rights and interests of the users of its services or the users of health or social services in the region.

A regional board may also subsidize a community organization committed, at the regional level, to promoting health and social development where so provided for in the regional service organization plans.

1991, c. 42, s. 336.

337. The Minister may, in accordance with the applicable budgetary rules, subsidize

(1)  community organizations committed to the defence of the rights or promotion of the interests of the users of services of community organizations or the interests of users of health or social services throughout Québec;

(2)  community organizations committed to the promotion of social development, improvement of living conditions, prevention, or promotion of health throughout Québec;

(3)  community organizations which engage in activities which respond to new needs, take new approaches or which are directed at specific groups of persons not provided for in the regional service organization plan of the regional board;

(4)  provincial groups of community organizations.

1991, c. 42, s. 337.

338. Every community organization or provincial group which receives a subsidy in cases covered by section 336 or 337 must, not later than 30 June each year, hold a public information meeting to which the users of its services and the users of health or social services whom it has served are invited. It must present them with a report of its activities and a financial statement.

It must also, not later than the said date, transmit the report of its activities and its financial statement to the authority from which it received a subsidy in cases covered by section 336 or 337.

1991, c. 42, s. 338.

PART III COORDINATION, CONTROL AND REGULATION OF HEALTH SERVICES AND SOCIAL SERVICES

TITLE I REGIONAL INSTITUTIONS

CHAPTER I REGIONAL HEALTH AND SOCIAL SERVICES BOARDS

DIVISION I STATUS AND OBJECTS

339. The Government shall establish, for each region it delimits, a regional health and social services board.

1991, c. 42, s. 339.

340. The main object of a regional board is to plan, organize, implement and evaluate, in the region, the orientations determined and policies established by the Minister.

The other objects of a regional board are

(1)  ensuring public participation in the management of the public network of health services and social services and ensuring that users’ rights are protected;

(1.1)  ensuring the safe provision of health services and social services to users;

(2)  formulating priorities in matters of health and welfare according to the needs of the population of the region and within the scope of the objectives fixed by the Minister;

(3)  establishing service organization plans in its territory and evaluating the effectiveness of services. Any part of the service organization plans dealing with medical services requires the advice of the regional medical commission established under section 367 which shall be obtained in the manner provided for in subparagraph 1 of the first paragraph of section 369 and the advice of the regional department of general medicine established pursuant to section 417.1;

(4)  allocating the budgets intended for the institutions and granting subsidies to community organizations and accredited private resources;

(5)  ensuring the coordination of the special medical activities of physicians who are under agreement pursuant to section 360 or section 361.1 and the activities of the institutions, community organizations, intermediate resources and nursing homes accredited for the purposes of subsidies under section 454 and promoting their cooperation with the other agents of community development;

(6)  implementing measures for the protection of public health and for the social protection of individuals, families and groups;

(7)  ensuring economical and efficient management of the human, material and financial resources at its disposal;

(7.1)  exercising the responsibilities conferred on it by the Act respecting pre-hospital emergency services (chapter S‐6.2);

(8)  carrying out any mandate entrusted to it by the Minister.

1991, c. 42, s. 340; 1992, c. 21, s. 35; 1996, c. 36, s. 31; 1998, c. 39, s. 98; 2001, c. 24, s. 48; 2002, c. 69, s. 154; 2002, c. 71, s. 13; 2002, c. 66, s. 6.

341. The name of a regional board must include the expression “regional board” and indicate the region for which it is established.

1991, c. 42, s. 341.

342. A regional board is a legal person.

1991, c. 42, s. 342; 1996, c. 36, s. 51; 1999, c. 40, s. 269.

342.1. Each regional board may adopt the by-laws needed to conduct its affairs and exercise its responsibilities. It must adopt by-laws for each matter determined in a regulation made under paragraph 6 of section 505, where the matter falls within the competence of the regional board.

A copy of the by-laws adopted by a regional board must be forwarded to the Minister at the Minister’s request.

1998, c. 39, s. 99.

DIVISION II SPECIAL FUNCTIONS

§ 1 . — Functions in respect of the population and the rights of users

343. The regional board shall see that mechanisms for public participation provided for in this Act, such as users’ committees, are implemented.

The regional board shall supervise the election and appointment of the members of the board of directors of public institutions where such election or appointment is provided for by this Act.

1991, c. 42, s. 343; 1996, c. 36, s. 32.

343.1. A people’s forum whose activities are coordinated by the president and executive director of the regional board is hereby established for each region of Québec where the Government institutes a regional board.

The forum shall be composed of 15 to 20 members designated by the board of directors of the regional board. The term of office of those members is three years.

To take into account the regional particularities, the regional board shall enter into an agreement with the regional conference of elected officers referred to in section 97 of the Act respecting the Ministère du Développement économique et régional et de la Recherche (chapter M-30.01) on

(1)  the specific composition of the people’s forum ;

(2)  the modes of consultation of the various socio-economic organizations of the region to draw up a list of names from which the members of the forum will be designated.

2001, c. 24, s. 50; 2003, c. 29, s. 155.

343.2. The people’s forum is responsible to the board of directors of the regional board

(1)  for setting up different modes of consultation of the population on issues regarding health and well-being ;

(2)  for making recommendations on the means to put in place so as to improve satisfaction of the population as regards available health and social services and to better respond to the needs in terms of service organization.

2001, c. 24, s. 50.

343.3. The people’s forum shall establish its own operating rules and submit them for approval to the board of directors of the regional board.

2001, c. 24, s. 50.

343.4. The people’s forum shall meet with the board of directors of the regional board at least twice a year, and the meetings shall be open to the public.

2001, c. 24, s. 50.

343.5. The board shall place at the disposal of the people’s forum the resources the board considers necessary for the exercise of the forum’s responsibilities.

2001, c. 24, s. 50.

343.6. The regional board must report on the activities of the people’s forum at the time of the presentation of its annual report of activities to the population of its territory, according to the procedure determined pursuant to the second paragraph of section 384.

2001, c. 24, s. 50.

344. The regional board must, in addition to the functions entrusted to it by sections 60 to 72, inform the users in its territory of the health and social services available to them and of their rights, recourses and obligations in that respect.

1991, c. 42, s. 344; 1998, c. 39, s. 100; 2001, c. 43, s. 52.

345. (Repealed).

1991, c. 42, s. 345; 2001, c. 43, s. 53.

§ 2 . — Functions relating to priorities in matters of health and welfare

346. The regional board shall see to it that health and welfare priorities are respected and that health and welfare objectives are achieved. To that end, it shall

(1)  ensure that the information on the health of the population in the region is up to date and accessible;

(2)  identify the needs of the population for the preparation of regional service organization plans;

(3)  inform the Minister of the needs of the population for the preparation and update of the health and welfare policy and health and social services policies;

(4)  assess, at intervals determined by the Minister, the effectiveness of the health and social services, the extent to which the objectives pursued have been achieved and the extent to which users are satisfied with the services;

(5)  prepare and implement, in accordance with the directives of the Minister, assessments of the programs of services in which the institutions participate;

(6)  carry out any specific mandate entrusted to it by the Minister.

In exercising the functions enumerated in the first paragraph, the regional board must refrain from reporting any information or document that would allow the user of an institution or a person using the services of a community organization to be identified.

1991, c. 42, s. 346; 1996, c. 36, s. 33; 1998, c. 39, s. 101.

346.0.1. Each regional board must, for the purpose of identifying the resources as regards housing for elderly persons in its territory, establish and maintain a register of residences for the elderly.

A residence for the elderly is a congregate residential facility where rooms or apartments intended for elderly persons are offered for rent along with a varied range of services relating, in particular, to security, housekeeping assistance and assistance with social activities, except a facility operated by an institution and a building or residential facility where the services of an intermediate resource or a family-type resource are offered.

The information collected by a regional board to establish and maintain the register is as follows : the name and address of the owner or person in charge of the residence, the address and physical description of the residence, certain information concerning the building and the municipal permits held, certain characteristics of the residence, the services offered and the facilities available as well as the age groups of the clientele. Such information is public information.

2002, c. 36, s. 1.

346.0.2. The person in charge of a residence for the elderly must on receiving its first resident and, subsequently, on 1 April each year, file with the regional board a declaration containing the information required under the last paragraph of section 346.0.1.

2002, c. 36, s. 1.

§ 3 . — Functions relating to the organization of services

346.1. The regional board must, after consulting the people’s forum, submit a three-year strategic service organization plan to the Minister for approval. The plan must indicate the financial implications of the measures it contains and take into account the financial resources at the disposal of the regional board.

2001, c. 24, s. 51.

347. A regional board must, in accordance with its three-year strategic service organization plan and in collaboration with the institutions and community organizations in its region and, where applicable, with persons involved in sectors of activity having an impact on health and social services, develop and implement service organization plans.

The plans must be consistent with the orientations determined and policies established by the Minister.

In addition, the plans shall identify the services required to respond to the needs of the population in the region, taking into account

(1)  (subparagraph repealed);

(2)  the health and social resources in the region, particularly those of community organizations;

(3)  the mission of the centres operated by the institutions of the region;

(4)  the financial resources identified for such purposes;

(5)  the social, cultural and linguistic characteristics of the population of the region and, where applicable, of the institutions of the region coming under section 348;

(6)  the organization of teaching and research taking place in the institutions of the region.

The plans must identify the institutions operating a local community service centre which are authorized to offer midwifery services and which may enter into a service contract to that effect with a midwife pursuant to section 259.2.

The plans must specify the contribution expected from each institution and each community organization in the region in order to achieve the objectives formulated in the policy.

The Minister may, subject to the rights of third persons, cancel a decision made by a regional board pursuant to a service organization plan that is inconsistent with the Minister’s orientations and policies.

The part of the plans dealing with the highly specialized services determined by the Minister that are provided by the institutions in the region, and the part dealing with the services for which an institution has been granted a supraregional vocation by the Minister pursuant to paragraph 1 of section 112, must be submitted to the Minister for approval.

1991, c. 42, s. 347; 1996, c. 36, s. 34; 1998, c. 39, s. 102; 1999, c. 24, s. 36; 2001, c. 24, s. 52.

348. Each regional board, in collaboration with institutions, must develop a program of access to health services and social services in the English language for the English-speaking population of its area in the centres operated by the institutions of its region that it indicates or, as the case may be, develop jointly, with other regional boards, such a program in centres operated by the institutions of another region.

Such an access program must take into account the human, financial and material resources of institutions and include any institution in the region designated under section 508.

The program must be approved by the Government and revised at least every three years.

1991, c. 42, s. 348.

349. Each regional board must, in concert with the bodies representing the cultural communities and the institutions of its region, facilitate accessibility to health and social services in a manner which is respectful of the characteristics of those cultural communities.

1991, c. 42, s. 349.

§ 4 . — Functions relating to the allocation of financial resources

350. Each regional board shall allocate the financial resources put at its disposal for the implementation of the regional service organization plans developed for its region. The allocation must be carried out in accordance with a plan approved beforehand by the Minister as provided for in the third paragraph of section 463.

Each regional board shall be responsible, to the extent and on the conditions prescribed by the Minister in accordance with the applicable budgetary rules, for allocating operating budgets to the public institutions and private institutions under agreement of its region and for granting subsidies to community organizations in its region in accordance with section 336 and to the accredited private resources referred to in Chapter III of Title II of this Part.

The regional board shall also assume the management of funds relating to any special mandate entrusted to it by the Minister under subparagraph 6 of the first paragraph of section 346.

The regional board shall, in addition, be entrusted, on the conditions determined by the Minister, with the administration and financing of capital expenditure by a public institution in its region with respect to work authorized by the regional board in accordance with section 263, expenses incurred by such an institution for equipment, and capital expenditure incurred by a private institution under agreement in its region that occupies an immovable belonging to a public institution or to the Corporation d’hébergement du Québec.

1991, c. 42, s. 350; 1992, c. 21, s. 36; 1998, c. 39, s. 103; 2001, c. 24, s. 53.

351. Each regional board must, in accordance with the rules determined by the Minister, ensure control over the budgets allocated and subsidies granted under section 350.

1991, c. 42, s. 351.

§ 5 . — Functions relating to the coordination of health services and social services

352. Each regional board shall take the necessary measures to coordinate the work of institutions and community organizations and the special medical activities of physicians who are under agreement pursuant to section 360 so as to promote joint action and cooperation among them for the purpose of ensuring rational utilization and equitable distribution of resources and to take the complementarity of institutions, community organizations and private facilities into account, eliminate duplication of services and allow the setting up of joint services.

1991, c. 42, s. 352.

353. The regional board shall cooperate with other bodies and agencies of the region, particularly municipalities, regional branches of government departments and of government agencies, institutions in the education and higher education sector and socio-economic organizations, in activities conducive to improving the health and welfare of the population.

1991, c. 42, s. 353.

353.1. The Minister may give a regional board instituted for a region the mandate to take the necessary measures to coordinate its services with the services of the regional boards instituted for neighbouring regions.

2001, c. 24, s. 54.

354. In addition to the rules governing access to the services offered by intermediate resources and family-type resources it establishes under sections 303, 304 and 314, the regional board shall also determine, within the framework of its regional service organization plans and in accordance with the orientations identified for that purpose by the Minister, the general rules governing access to the various services offered by the institutions of its region.

The regional board shall, in addition, foster the implementation, by the institutions concerned, of mechanisms of access to services considered necessary by the institutions to ensure a prompt and adequate response to the users’ needs.

1991, c. 42, s. 354.

355. The regional board shall determine the procedure for setting up mechanisms to coordinate access to the services provided by residential and long-term care centres, rehabilitation centres of the class specified by the board, intermediate resources attached to institutions and family-type resources of its region.

The regional board must also ensure that the mechanisms of access to services take the socio-cultural and linguistic characteristics of the users into account.

1991, c. 42, s. 355; 1998, c. 39, s. 104.

356. Every institution concerned with a mechanism of access to services established pursuant to section 355 must submit its criteria of access to services to the regional board for approval, in particular with respect to the admission and discharge of users and the policies for their transfer. However, the Minister may require that an institution, by reason of its special vocation, submit its criteria and policies directly to him for approval. The Minister shall in that case obtain the opinion of the board.

1991, c. 42, s. 356.

357. Each regional board shall, to ensure rational utilization of child placement services, see to it that every institution operating a child and youth protection centre and every other institution exercising responsibilities in matters of child placement coordinate their actions and comply with the measures determined for that purpose by regulation made under paragraph 10 of section 505.

1991, c. 42, s. 357.

358. Each regional board shall ensure that the institutions of the region carry out their functions of reception, assessment and referral of users, and that intermediate resources and family-type resources are developed in harmony with the capacity of the population concerned to accept them.

1991, c. 42, s. 358.

359. For the purpose of distributing emergency cases and ensuring a prompt and adequate response to the needs of the users, the regional board and the regional department of general medicine shall, after consultation with the regional medical commission,

(1)  approve admission criteria for and policies governing the transfer of users to centres operated by public institutions and private institutions under agreement;

(1.1)  designate the institutions that are to dispense emergency services;

(2)  ensure that adequate operating standards of emergency services are adopted by the institutions designated under paragraph 1.1 or, if not, fix such standards;

(3)  ensure that the institutions designated under paragraph 1.1 adopt and apply standards for the use and allocation of beds which are consistent with an adequate distribution of emergency cases or, if not, fix such standards;

(4)  develop and implement a regional information system to monitor, on a daily basis, the situation in the centres operated by the institutions designated under paragraph 1.1 as regards the number and nature of registrations and admissions of users and their transfer and transport by ambulance.

1991, c. 42, s. 359; 1992, c. 21, s. 37; 1998, c. 39, s. 105.

360. Every general practitioner wishing to participate in an agreement under the fifth paragraph of section 19 of the Health Insurance Act (chapter A-29) must undertake to devote part of his or her practice to specific medical activities listed in section 361.

1991, c. 42, s. 360; 1992, c. 21, s. 70; 2002, c. 66, s. 7.

361. For the purposes of section 360, the regional board shall establish, on the basis of such recommendations as may be made by the regional department of general medicine, a list of specific medical activities based on its service organization plans. The list shall also specify the conditions of exercise of each activity offered, in accordance with the conditions of the agreement referred to in section 360.

In the case of a general practitioner applying to participate in an agreement referred to in section 360, the list of specific medical activities includes the following activities:

(1)  as a priority, the provision of medical services in the emergency departments of institutions designated under paragraph 1.1. of section 359;

(2)  the provision of care to users admitted for short-term care by an institution operating a hospital centre;

(3)   the provision of medical services involving on-call duty in any residential and long-term care centre or rehabilitation centre operated by an institution or in connection with a home care support program of a local community service centre operated by an institution;

(4)  the provision of obstetrical medical services in a centre operated by an institution;

(5)  the provision of primary care services to vulnerable patients, whether in their homes, in a private health facility or in any centre operated by an institution; and

(6)  participation in any other priority activity determined by the regional board and approved by the Minister, to the extent and under the conditions prescribed by the Minister.

1991, c. 42, s. 361; 1992, c. 21, s. 38; 1998, c. 39, s. 106; 2002, c. 66, s. 8.

361.1. Every medical specialist in a specialty covered by an agreement under the fifth paragraph of section 19 of the Health Insurance Act (chapter A-29) having no privileges in any institution operating a hospital centre who wishes to participate in such an agreement must devote part of his or her practice to specific medical activities referred to in the second paragraph.

For the purposes of the first paragraph, the regional board shall establish a list of specific medical activities based on its service organization plans. The list shall also specify the conditions of exercise of each activity offered, in accordance with the conditions of the agreement referred to in the first paragraph.

2002, c. 66, s. 9.

361.2. An agreement referred to in section 360 or 361.1 may provide for adjustments as regards the nature of activities and the level of participation of physicians according to the number of years of practice.

2002, c. 66, s. 9.

362. A physician shall submit his application to the regional board which shall transmit to him a list of specific medical activities from which he must choose.

1991, c. 42, s. 362.

363. The regional board shall authorize physicians to participate in the agreement referred to in section 360 if they undertake in writing to exercise one of the specific medical activities described in section 361.

The regional board, before authorizing a physician to participate in the agreement referred to in section 360, must take into account the number of physicians authorized in its medical staffing plan.

1991, c. 42, s. 363.

364. For as long as a physician respects the undertaking made by him in accordance with section 363, and until he is discharged in accordance with the terms of an agreement referred to in section 360, he shall remain subject to that agreement.

1991, c. 42, s. 364.

364.1. The regional board may, in accordance with the procedure set out in the agreement, periodically review the undertaking made by a physician pursuant to section 363.

However, in the event of a serious shortage of and in order to ensure the availability of the medical services referred to in subparagraph 1 of the second paragraph of section 361, a regional board may, in accordance with the terms of the agreement, after consulting the regional department of general medicine and upon 60 days’ notice, review the undertaking made by a physician who only exercises activities referred to in subparagraph 5 or 6 of the second paragraph of that section.

2002, c. 66, s. 10.

365. Where, in the opinion of the regional board, a physician ceases to respect the undertaking made by him in accordance with section 363, the board shall terminate his participation in the agreement and inform the physician, the regional department of general medicine and the Régie de l’assurance maladie du Québec. The regional board must give the physician an opportunity to present observations.

1991, c. 42, s. 365; 1997, c. 43, s. 730; 1998, c. 39, s. 107; 1999, c. 89, s. 53.

366. A physician who is not satisfied with a decision refusing or terminating his participation may submit that decision to the arbitration procedure provided for in the agreement referred to in section 360.

1991, c. 42, s. 366.

366.1. The provisions of sections 362 to 366 apply, with the necessary modifications, to medical specialists to whom section 361.1 applies.

2002, c. 66, s. 11.

367. A regional medical commission is hereby instituted for each region of Québec where the Government institutes a regional board.

The commission is composed of:

(1)  three general practitioners designated by the general practitioners of the region from among their number;

(2)  three specialists designated by the specialists of the region from among their number;

(3)  one person designated by the Dean of each Faculty of Medicine of the region, if any;

(4)  the Director of Public Health.

The president and executive director of the regional board or the physician he designates for that purpose shall also be a member of the commission.

To ensure better representation of the fields of medical practice in the centres operated by the institutions of the region, the regional board shall designate not more than four physicians from the region who are members of the commission from the time of their designation. However, the regional board, in making such designations, must ensure that general practitioners and specialists are represented in equal numbers on the commission.

On the recommendation of the regional medical commission, the regional board may designate not more than four resource persons as observers. In regions where there is a Faculty of Medicine, the number of resource persons shall be not more than six of whom one must be a medical resident. Such persons shall participate in the discussions of the commission but shall be without voting rights.

The chairman of the regional medical commission shall be designated by the members designated under subparagraphs 1 and 2 of the second paragraph from among their number.

1991, c. 42, s. 367; 2001, c. 24, s. 55.

368. The procedure of designation of the members of the regional medical commission and of its chairman, their terms of office and the rules of internal management of the commission shall be determined by by-law of the regional board.

1991, c. 42, s. 368; 2001, c. 24, s. 56.

369. The regional medical commission is responsible to the board of directors of the regional board

(1)  for advising it on the organization and distribution of medical services in the territory and on the medical staffing plan referred to in section 377, on the basis of the regional service organization plans referred to in section 347;

(1.1)  for advising it on the quality of the medical services organization in the territory, and on the accessibility and coordination of services;

(2)  for advising it on the remuneration methods and the organization of the practice of physicians which are best suited to respond to the needs of the region;

(3)  (subparagraph repealed);

(4)  for carrying out any other mandate entrusted to it by the board of directors and submitting periodic reports thereon.

For the purposes of this section, the regional medical commission and the regional board may require the Régie de l’assurance maladie du Québec to send them the practice profiles and information referred to in the third paragraph of section 66.1 of the Health Insurance Act (chapter A-29).

1991, c. 42, s. 369; 1998, c. 39, s. 108; 1999, c. 89, s. 53.

370. The regional medical commission may establish the committees necessary for the pursuit of its objects.

1991, c. 42, s. 370.

370.1. A regional nursing commission is hereby instituted for each region of Québec where the Government institutes a regional board.

The commission is composed of

(1)  four persons designated by and from among the members of the executive committees of the council of nurses of the institutions of the region, including one person working for an institution referred to in section 119 or the first paragraph of section 126 and one person working for an institution referred to in section 120, 121, 124 or 125 or the second or third paragraph of section 126 ;

(2)  two persons designated by the directors of nursing care of the institutions of the region from among their number and referred to in section 206 ;

(3)  one person designated by the representatives of general and vocational colleges from among their number ;

(4)  one person designated by the dean or director of the university nursing program, where applicable ;

(5)  one person designated by and from among the members of the committees of nursing assistants of the councils of nurses of the institutions of the region ;

(6)  one person designated by the members referred to in subparagraphs 1 to 5, recognized for leading-edge expertise as a nurse or nurse practitioner.

The president and executive director of the regional board or the nurse designated by the president and executive director for that purpose shall also be a member of the regional nursing commission.

On the recommendation of the regional nursing commission, the regional board may designate four resource persons as observers. Such persons shall participate in the discussions of the commission but shall be without voting rights.

The chair of the regional nursing commission shall be designated by the members referred to in the second paragraph from among their number.

2001, c. 24, s. 57.

370.2. The procedure of designation of the members of the regional nursing commission and of its chair, their terms of office and the rules of internal management of the commission shall be determined by by-law of the regional board.

2001, c. 24, s. 57.

370.3. The regional nursing commission is responsible to the board of directors of the regional board

(1)  for advising it on the organization, distribution and integration of nursing care in the territory and on the nursing care staffing plan, on the basis of the regional service organization plans referred to in section 347 ;

(2)  for advising it on certain matters relating to the accessibility and coordination of services in the region which involve nursing care ;

(3)  for advising it on innovative approaches in nursing care and their incidence on the health and well-being of the population ;

(4)  for carrying out any other mandate entrusted to it by the board of directors and submitting periodic reports thereon.

2001, c. 24, s. 57.

370.4. The regional nursing commission may establish the committees necessary for the pursuit of its objects.

2001, c. 24, s. 57.

370.5. A regional multidisciplinary commission is hereby instituted for each region of Québec where the Government institutes a regional board.

The commission is composed of

(1)  three professionals in the social sector, including one manager and two persons designated by and from among the members of the multidisciplinary councils of the institutions of the region ;

(2)  three professionals in the rehabilitation sector and in the health sectors, other than medicine and nursing care, including one manager and two persons designated by and from among the members of the executive committees of the multidisciplinary councils of the institutions of the region ;

(3)  three persons in the technical sectors designated by and from among the members of the executive committees of the multidisciplinary councils of the institutions of the region ;

(4)  one person designated by and from among the representatives of general and vocational colleges ;

(5)  one person designated by and from among the representatives of university-level schools and faculties in the health sectors ;

(6)  one person designated by and from among the representatives of university-level schools and faculties in the social sectors.

The president and executive director of the regional board or the person designated by the president and executive director for that purpose shall also be a member of the regional multidisciplinary commission.

On the recommendation of the regional multidisciplinary commission, the regional board may designate not more than four resource persons as observers. Such persons shall participate in the discussions of the commission but shall be without voting rights.

The chair of the regional multidisciplinary commission shall be designated by and from among the members referred to in the second paragraph.

2001, c. 24, s. 57.

370.6. The procedure of designation of the members of the regional multidisciplinary commission and of its chair, their terms of office and the rules of internal management of the commission shall be determined by by-law of the regional board.

2001, c. 24, s. 57.

370.7. The regional multidisciplinary commission is responsible to the board of directors of the regional board

(1)  for advising it on the organization, distribution and integration of services in the territory and on the staffing plan, on the basis of the regional service organization plans referred to in section 347 ;

(2)  for advising it on certain matters relating to the accessibility and coordination of services in the region ;

(3)  for advising it on innovative approaches in services and their incidence on the health and well-being of the population ;

(4)  for carrying out any other mandate entrusted to it by the board of directors of the regional board and submitting periodic reports thereon.

2001, c. 24, s. 57.

370.8. The regional multidisciplinary commission may establish the committees necessary for the pursuit of its objects.

2001, c. 24, s. 57.

§ 6 . — Functions relating to public health

371. Each regional board shall

(1)  establish a public health department;

(2)  ensure the security and confidentiality of the personal or confidential information obtained by a public health department in the exercise of its functions;

In force: 2003-02-26

(3)  entrust the management of the regional public health action plan provided for in the Public Health Act (chapter S‐2.2) to the public health director appointed under section 372;

In force: 2003-02-26

(4)  organize services and allocate resources for the purposes of the regional public health action plan.

1991, c. 42, s. 371; 1992, c. 21, s. 39; 1998, c. 39, s. 109; 2001, c. 60, s. 163.

372. The Minister, on the recommendation of the regional board, shall appoint a public health director.

The Minister may require that a person representing the Minister participate in the process of selection of the public health director.

The public health director must be a physician trained in community health care and shall be appointed for a term of not more than four years. At the expiry of the term, the public health director shall remain in office until replaced or reappointed.

1991, c. 42, s. 372; 2001, c. 24, s. 58.

372.1. The Minister may, if a public health director is unable to act, is guilty of grave misconduct or tolerates a situation which could pose a threat to the health of the population, entrust the functions and powers vested in that public health director to another public health director, Québec’s national public health director appointed under the Act respecting the Ministère de la Santé et des Services sociaux (chapter M-19.2) or a physician the Minister designates, for the time and on the conditions the Minister considers appropriate.

The Minister shall forthwith notify the president and executive director and the board of directors of the regional board of the decision.

2001, c. 24, s. 59.

373. The public health director shall be responsible, in the region, for

(1)  informing the population on its general state of health and of the major health problems, the groups most at risk, the principal risk factors, the interventions he considers the most effective, monitoring the evolution thereof and conducting studies or research required for that purpose;

(2)  identifying situations which could pose a threat to the population’s health and seeing to it that the measures necessary for its protection are taken;

(3)  ensuring expertise in preventive health and health promotion and advising the regional board on prevention services conducive to reducing mortality and avoidable morbidity ;

(4)  identifying situations where intersectorial action is necessary to prevent diseases, trauma or social problems which have an impact on the health of the population, and, where the public health director considers it appropriate, taking the measures considered necessary to foster such action.

The public health director shall assume, in addition, any other function entrusted to him by the Public Health Act (chapter S-2.2).

1991, c. 42, s. 373; 1998, c. 39, s. 110; 2001, c. 24, s. 60; 2002, c. 38, s. 11.

374. The director shall carry out any other mandate entrusted to him by the regional board within the scope of his responsibilities.

1991, c. 42, s. 374.

375. The director must, without delay, inform Québec’s national public health director of any emergency or of any situation posing a threat to the health of the population.

1991, c. 42, s. 375; 2001, c. 24, s. 61.

375.0.1. Québec’s national public health director may request a public health director to report on the decisions or advice made or given in the exercise of the public health director’s functions.

2001, c. 24, s. 61.

375.1. (Repealed).

1992, c. 21, s. 40; 1998, c. 39, s. 111.

§ 7 . — Functions relating to human, material and financial resources management

376. Each regional board shall draw up a regional human resources development plan in keeping with the orientations determined by the Minister and the policies he establishes and in cooperation with the institutions and organizations concerned, and see to its implementation. To that end, the regional board shall

(1)  coordinate personnel development activities within the scope of the regional service organization plans;

(2)  coordinate personnel development activities for the members of the boards of directors of institutions;

(3)  assist community organizations with regard to human resource development activities for their members.

In addition, the regional board shall assist the institutions in preparing their plans of action for personnel development, if they so request, and identify priority needs so as to foster the pooling, by institutions, of services related to personnel development and mobility.

1991, c. 42, s. 376.

377. Each regional board shall prepare a regional medical staffing plan on the basis of the parts of the organization plans of institutions transmitted to it in accordance with sections 184 and 186, the number of physicians required to perform the specific activities referred to in section 361, and the number of general practitioners and medical specialists, listed by speciality, who are remunerated by the Régie de l’assurance maladie du Québec and practise in the region, including those who practise in a private health facility.

In preparing its regional plan, the regional board shall take into account the expansion or reduction objectives identified by the Minister, the medical activities of the physicians practising in the region who receive remuneration from the Régie de l’assurance maladie du Québec, and the number of positions determined by the Minister to be reserved for physicians having practised in other regions.

In preparing its regional plan, the regional board must also take into account the recommendations of the regional medical commission, obtained in the manner set out in subparagraph 1 of the first paragraph of section 369, and the recommendations of the regional department of general medicine, obtained in the manner set out in subparagraph 1 of the first paragraph of section 417.2.

The regional plan, together with the parts of the organization plans of institutions that were used in preparing the regional plan, must be submitted to the Minister for approval with or without amendment.

The regional plan must be reviewed at least every three years and shall continue in force until the Minister decides on its review.

1991, c. 42, s. 377; 1998, c. 39, s. 112; 1999, c. 89, s. 53.

377.1. In order to ensure compliance with the regional medical staffing plan, every physician in the region who is remunerated by the Régie de l’assurance maladie du Québec and practises in a private health facility shall be bound by an agreement entered into under the sixth paragraph of section 19 of the Health Insurance Act (chapter A-29).

1998, c. 39, s. 113; 1999, c. 89, s. 53; 2002, c. 66, s. 13.

378. Once its regional medical staffing plan is approved, the regional board shall approve the parts of the organization plans transmitted to it by institutions in accordance with sections 184 and 186.

However, before approving the parts of the organization plans referred to in the first paragraph that were transmitted to it by institutions which operate a centre designated as a university hospital centre or university institution, the regional board shall consult the university with which each institution is affiliated. Such consultation shall bear on all the parts of the organization plans of the institutions.

The regional board shall, on request, transmit to the Minister each part of an organization plan it has approved.

1991, c. 42, s. 378; 1992, c. 21, s. 70; 1998, c. 39, s. 114.

379. A regional board may, in exceptional circumstances and with the Minister’s authorization, depart from its regional medical staffing plan to enable a physician to be appointed by an institution, upon obtaining his licence to practise, subject to the terms it determines, if, on 1 October 1992, that physician was a student enrolled in a medical training program.

Sections 237 to 252 apply, with the necessary modifications, to such a student.

1991, c. 42, s. 379.

380. Where the Minister so requests, the regional board shall advise him on the methods of remuneration and on the organization of the practice of physicians practising in the region which best correspond to the needs of the region.

1991, c. 42, s. 380.

381. In performing its functions or at the request of the Minister, the regional board may require that the institutions and community organizations of its region furnish to it, in the form and within the time limit it prescribes or which are determined by the Minister, the information prescribed by regulation under paragraph 25 of section 505 concerning clientele, services requested and provided and resources used. No information may be transmitted that would permit a user of an institution or a person using the services of a community organization to be identified.

It shall furnish the Minister with any information he requires on the allocation and use of the financial and material resources of the institutions and community organizations of its region.

1991, c. 42, s. 381.

382. The regional board shall examine the institutions’ requests relating to material resources which must be submitted to it for advice or authorization in accordance with this Act or the regulations. It must reply to them with diligence.

1991, c. 42, s. 382.

383. The regional board shall ensure that the institutions of its region are grouped for the joint procurement of goods and services it determines. It may, if necessary, require institutions to participate in regional joint purchasing groups.

The institutions of a region may, with the authorization of the regional board and on the conditions determined by the Minister, establish a non-profit legal person representing the institutions of the region to manage the procurement of goods and services. They must, however, establish such a legal person where the regional board considers it necessary. If they fail to do so, the regional board may, with the authorization of the Minister, see to the establishment of a joint service legal person for the institutions of the region.

With the authorization of the Minister, the types and manner of grouping institutions for the joint procurement of goods and services may be determined for two or more regions.

The provisions of sections 260 to 265, 278 to 280, 282, 289 to 292, 294 to 297, 436, 485, 486, 489, 499 and 500 apply, with the necessary modifications, to a legal person referred to in this section.

The auditor appointed by a legal person pursuant to section 290 must, for the fiscal year of the appointment, audit the financial report of the legal person and perform the other duties included in the audit mandate determined by the legal person, the regional board or the Minister.

1991, c. 42, s. 383; 1996, c. 36, s. 51; 1998, c. 39, s. 115.

384. The regional board shall determine the procedure according to which, and the intervals at which, a public institution, a private institution under agreement, and an accredited private resource must respond to the questions of the regional board concerning their management.

The regional board shall also determine the procedure according to which it must, once a year, account for its management to the population of its territory, more specifically by presenting an annual report on its activities. The procedure must be submitted to the Minister for approval.

1991, c. 42, s. 384; 1998, c. 39, s. 116.

385. Upon ascertaining that an institution or one or several members of a board of directors is or are in one of the situations described in subparagraphs 3, 4 and 5 of the first paragraph of section 490, the regional board shall inform the Minister thereof.

1991, c. 42, s. 385.

DIVISION II.1 MANAGEMENT AND REPORTING

2001, c. 24, s. 62.

§ 1 . — Management and accountability agreement

2001, c. 24, s. 62.

385.1. The Minister shall determine, within the scope of a management and accountability agreement entered into with a regional board, the objectives to be achieved by the regional board.

2001, c. 24, s. 62.

385.2. Such a management and accountability agreement must also contain

(1)  a definition of the mission and strategic directions of the regional board ;

(2)  an annual plan describing the objectives for the first year of the agreement, the measures to be taken to achieve them and the available resources, and an undertaking to produce such a plan on an annual basis ;

(3)  the main indicators to be used in measuring the results ;

(4)  an undertaking to produce, at the end of each year, a management report describing the results achieved.

2001, c. 24, s. 62.

385.3. A management and accountability agreement is a public document.

2001, c. 24, s. 62.

385.4. The president and executive director of a regional board having entered into a management and accountability agreement must ensure that the mission and strategic directions of the regional board are complied with, and that the regional board achieves its annual objectives within the management framework applicable to it using the resources allocated to it.

2001, c. 24, s. 62.

385.5. The Minister is empowered to exercise supervision and control over the achievement of the objectives of a regional board with which the Minister has entered into a management and accountability agreement.

The board of directors of the regional board is also empowered to exercise supervision and control.

2001, c. 24, s. 62.

385.6. Where the Minister ascertains that the annual objectives of a regional board have not been achieved or that the regional board has not complied with its management and accountability agreement, the Minister may suspend or cancel the management and accountability agreement.

2001, c. 24, s. 62.

§ 2 . — Reporting

2001, c. 24, s. 62.

385.7. Every regional board must prepare an annual management report.

The report must include

(1)  a presentation of the results obtained, measured against the objectives fixed in the management and accountability agreement ;

(2)  a statement by the president and executive director of the regional board concerning the reliability of the data and of the monitoring mechanisms ;

(3)  any other particular or information determined by the Minister.

The annual management report of a regional board shall be transmitted to the Minister, who shall table it in the National Assembly.

2001, c. 24, s. 62.

385.8. The annual management report shall replace the annual report of activities that is required under section 391 if the annual management report contains the information required to be included in the annual report of activities.

2001, c. 24, s. 62.

385.9. Sections 8 to 29 and 58 to 63 of the Public Administration Act (chapter A-6.01) do not apply to a regional board.

2001, c. 24, s. 62.

DIVISION III OPERATING BUDGET AND REPORTS

386. The fiscal year of the regional board ends on 31 March.

1991, c. 42, s. 386.

387. The president and executive director of the regional board shall submit to the board of directors, before the date determined by the latter, the operating budget of the regional board for the following fiscal year, prepared according to the budgetary parameters transmitted by the Minister.

The estimates of the expenditures and revenues must be balanced.

1991, c. 42, s. 387; 2001, c. 24, s. 63.

388. The Minister shall inform every regional board, before 1 April each year, of the total amount he shall allocate to its operating budget for the following fiscal year.

Within the following 30 days, the board of directors shall see to it that the operating budget of the regional board is revised, if necessary, adopt the operating budget of the regional board and inform the Minister thereof.

Where a budget balancing plan is required to enable the regional board to adhere to its operating budget, the board of directors shall see to it that such a plan is prepared, adopted and transmitted to the Minister, within 60 days, along with the operating budget of the regional board.

In addition, the Minister may, if he considers it expedient, allocate a capital budget to a regional board on the conditions he determines.

1991, c. 42, s. 388.

389. If, on 1 April in a year, a regional board has not been informed by the Minister of the total amount allocated to its operating budget, one-quarter of the budget of the preceding fiscal year shall be renewed at the beginning of each quarter of the fiscal year and shall remain in force until it is replaced by the amount allocated to the budget of the fiscal year concerned.

1991, c. 42, s. 389.

390. A regional board is subject to the provisions of section 115 and the first paragraph of section 269.1, with the necessary modifications, with regard to the complementary activities it organizes and the rules governing the use of its own property.

1991, c. 42, s. 390; 1996, c. 36, s. 35; 1998, c. 39, s. 117.

391. Not later than 30 September each year, a regional board shall submit a report on its activities for the year ending on the preceding 31 March to the Minister.

The report must contain a description of the role of the regional board and a general statement of its operations for the preceding fiscal year, with a description of the objectives set at the beginning of the fiscal year, the results obtained, the new orientations adopted, and any changes affecting the activities, including activities related to risk and quality management, and the human, material and financial resources of the board for that year.

The report must include financial statements, consisting of a balance sheet, a statement of revenue and expenditure and a statement of changes in financial position. The statements must be presented in a way that allows each item for the fiscal year just ended to be compared with the corresponding item for the previous fiscal year. The regional board must mention, in its financial statements and in the notes and tables to which the statements refer, if any, all the relevant information needed for a full disclosure of its financial position.

The report must also mention the activities, including activities related to risk and quality management, of the institutions in the region and the community organizations that receive subsidies from the regional board under section 336 for the year ending on the preceding 31 March.

1991, c. 42, s. 391; 1996, c. 36, s. 36; 1998, c. 39, s. 118; 2002, c. 71, s. 14.

392. The Minister shall table the report of every regional board before the National Assembly within 30 days of its receipt or, if the Assembly is not in session, within 30 days after resumption.

The National Assembly shall refer the report to the Parliamentary Committee on Social Affairs, which shall examine it and, for that purpose, hear each regional board at least once every three years.

1991, c. 42, s. 392.

393. (Repealed).

1991, c. 42, s. 393; 1998, c. 39, s. 119.

394. Each regional board must provide the Minister, at his request and in the manner and within the time he determines, with any statement, statistics, report or other information that he requires with regard to the activities of the regional board or that he considers relevant to the carrying out of this Act. No information may be provided that would permit the user of an institution or a person using the services of a community organization to be identified.

1991, c. 42, s. 394.

395. The regional board is subject to sections 280, 288 and 295, with the necessary modifications, with respect to the reports it must transmit to the Minister.

1991, c. 42, s. 395; 1998, c. 39, s. 120; 2001, c. 24, s. 64.

396. Notwithstanding any inconsistent legislative provision, a regional board may, with the authorization of the Minister and on the conditions he determines, take out any form of loans recognized by law.

At the request of the Minister, a regional board shall, either directly or through the financial institutions with which it does business, provide the Minister with any information on its financial position.

1991, c. 42, s. 396.

DIVISION IV BOARD OF DIRECTORS

§ 1 . — Composition, tenure and qualifications of members

397. The board of directors of a regional board shall consist of 16 or 17 members, appointed by the Government as follows :

(1)  four persons recognized for their management skills, who are representative of the various parts of the territory of the regional board and chosen from a list of names provided by the socio-economic organizations, the regional county municipalities, the municipalities and the members of the people’s forum ; in the case of the regional board instituted for the Montréal Centre region, a fifth person from the university community is added ;

(2)  three persons recognized for their management skills and their experience in the health and social services sector chosen from a list of names provided by the institutions of the region, one person being from the social sector ; in regions where there is a faculty of medicine, one of those persons must be from the research sector ;

(3)  one person chosen from a list of names provided by the organizations representative of the community sector ;

(4)  one person chosen from a list of names provided by the organizations representative of the public education sector ;

(5)  one person chosen from a list of names provided by the organizations representative of the union sector ;

(6)  one member of the regional medical commission chosen from a list of names provided by the commission ;

(7)  one member from the regional nursing commission chosen from a list of names provided by the commission ;

(8)  one member from the regional multidisciplinary commission chosen from a list of names provided by the commission ;

(9)  two persons recognized for their management skills and chosen from a list of names provided by the members of the board of directors of the regional board referred to in paragraphs 1 to 8 ;

(10)  the president and executive director of the regional board, after consultation with the other members of the board of directors.

1991, c. 42, s. 397; 1996, c. 36, s. 37; 1996, c. 59, s. 1; 1998, c. 39, s. 121; 2001, c. 24, s. 65.

397.0.1. All the lists of names referred to in section 397 must tend towards gender parity.

2001, c. 24, s. 66.

397.1. (Repealed).

1992, c. 21, s. 41; 1996, c. 36, s. 38; 1998, c. 39, s. 122.

397.2. The Minister may determine, for each region that the Minister indicates, the composition of each group referred to in paragraphs 1 to 5 of section 397 in order to ensure an equitable representation of institutions, reflecting the mission of the centres they operate, and of socio-economic organizations, community organizations, regional county municipalities, municipalities, educational institutions and union groups.

1996, c. 36, s. 38; 1998, c. 39, s. 123; 2001, c. 24, s. 67.

397.3. In making the appointments referred to in section 397, the Government must take into account the representation of the various parts of the territory of the regional board, the sectors of activity and the sociocultural, linguistic and demographic groups as well as the most equitable representation possible of men and women and of different age groups.

1996, c. 36, s. 38; 2001, c. 24, s. 67.

398. (Repealed).

1991, c. 42, s. 398; 1992, c. 21, s. 42; 1996, c. 36, s. 39; 2001, c. 24, s. 68.

398.0.1. (Repealed).

1998, c. 39, s. 124; 2001, c. 24, s. 68.

398.1. Section 150 applies, with the necessary modifications to the members of the board of directors of a regional board.

In addition, with the exception of the president and executive director of the regional board, the member of the regional nursing commission, the member of the regional multidisciplinary commission and the member of the regional medical commission, no person who is employed by the Ministère de la Santé et des Services sociaux, a regional board, an institution or the Régie de l’assurance maladie du Québec, or who receives remuneration from the latter, and no person having made a service contract under section 259.2, may be a member of the board of directors of a regional board.

A bursary, a subsidy or an amount paid under a research contract is deemed not to be remuneration for the purposes of the second paragraph.

No person employed by a community organization may be appointed as a member of the board of directors of a regional board, except under subparagraph 3 of section 397.

1996, c. 36, s. 40; 1998, c. 39, s. 125; 1999, c. 24, s. 37; 1999, c. 89, s. 53; 2001, c. 24, s. 69.

398.2. A person ceases to be a member of a board of directors when the person no longer qualifies for appointment to the board of directors.

1998, c. 39, s. 126; 2001, c. 24, s. 70.

399. The president and executive director shall be appointed for a term of not more than five years ; the other members shall be appointed for a term of not more than three years.

At the expiry of their terms, the president and executive d