AN ACT RESPECTING HEALTH SERVICES AND SOCIAL

SERVICES
(R.S.Q., c. S-4.2) (excerpts)
. 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;
() fostering the recovery of users! health and welfare;
(") fostering the protection of public health;
(#) fostering the ad$ustment or rehabilitation of users as well as their social
integration or reintegration;
(%) reducing the impact of problems which threaten the stability, fulfilment
or autonomy of users;
(&) attaining comparable standards of health and welfare in the various
strata of the population and in the various regions.
!. The record of a user is confidential and no person may have access to it
e'cept with the consent of the user or the person (ualified to give consent on
his behalf. )nformation 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 e'ercise of the functions of
office;
(2) at the re(uest of the local service (uality and complaints commissioner
under section %, of a medical e'aminer under the third paragraph of section
"&, of a review committee referred to in section #1 or one of its members
under the second paragraph of section ##, of a regional service (uality and
complaints commissioner under section %*, of a council of physicians,
dentists and pharmacists or of an e'pert from outside the institution that the
council calls on under the second paragraph of section 21";
() at the re(uest of a person designated by an agency to carry out an
inspection under the second paragraph of section "1.2 or at the re(uest of
an agency or of a person designated by an agency to conduct an in(uiry
under the second paragraph of section "1";
(") to the +inister under section " for the e'ercise of the +inister!s
functions under section "1;
(#) to a person authori,ed to ma-e an inspection under the second paragraph
of section ".* or section ".*.1;
(%) to a person designated by the /overnment under the second paragraph
of section #00 to investigate a matter referred to in the first paragraph of that
section;
(&) in the cases and for the purposes set out in sections 1*.0.1, 1*.0.2,
1*.0., 1*.2 and 2&.1, in the second paragraph of section &..1, in the fourth
paragraph of section 10&.1, in the fifth paragraph of section 10., in the
second paragraph of section 1.#.1, in section 20".1, in the fourth paragraph
of section "*. and in sections #20..0.1 and #20..1;
(.) at the re(uest of a revisory committee referred to in section "1 of the
1ealth )nsurance Act (chapter A22*) under section &&, or of a person or
committee referred to in section 1*2 of the 3rofessional 4ode (chapter 42
2%), if necessary to carry out their duties;
(*) for the purposes of the 3ublic 1ealth Act (chapter 522.2);
(10) in the cases and for the purposes set out in sections . and * of the Act
to protect persons with regard to activities involving firearms (chapter 32
..0001);
(11) to a person or body if the information is held by an institution operating
a child and youth protection centre or a rehabilitation centre and is re(uired
for the purposes of the 6outh 4riminal 7ustice Act (5.4. 2002, c. 1), for the
rehabilitation or social reintegration of the user or for the protection of the
public;
(12) for the purposes of the Act respecting the )nstitut national d!e'cellence
en sant8 et en services sociau' (chapter )21.0); or
(1) for the purposes of the Act respecting the sharing of certain health
information (chapter 32*.0001).
!.".. )nformation 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 in$ury to the user, another person or an identifiable
group of persons.
The information may in such case be communicated to any person e'posed
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 authori,ed by the director
of professional services or, failing such a director, by the e'ecutive director
of the institution.
The persons so authori,ed may only communicate such information as is
necessary to achieve the purposes for which the information is
communicated.
The e'ecutive director of the institution must, by a directive, determine the
terms and conditions according to which the information may be
communicated. 9very person authori,ed to communicate the information is
re(uired to comply with the directive.
!.. 4onsent to a re(uest 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. :therwise, it is without effect.
The consent is valid only for the time re(uired for the attainment of the
purposes for which it was granted or, in the case of a research pro$ect
approved by an ethics committee, for the period determined, where that is
the case, by the ethics committee.
!.2. The director of professional services of an institution or, if there is no
such director, the e'ecutive director may authori,e a professional to e'amine
the record of a user for study, teaching or research purposes.
;efore granting such authori,ation, the director must, however, ascertain
that the criteria determined under section 12# of the Act respecting Access to
documents held by public bodies and the 3rotection of personal information
(chapter A22.1) are satisfied. )f the director is of the opinion that the
professional!s pro$ect is not in compliance with generally accepted standards
of ethics or scientific integrity, the director must refuse to grant the
authori,ation.
The authori,ation must be granted for a limited period and may be sub$ect to
conditions. )t may be revo-ed at any time if the director has reason to
believe that the authori,ed professional is violating the confidentiality of the
information obtained or is not complying with the conditions imposed or
with generally accepted standards of ethics and scientific integrity.
2#. The heirs, legatees by particular title and legal representatives of a
deceased user are entitled to be given communication of information
contained in his record to the e'tent that such communication is necessary
for the e'ercise of their rights in such capacity. The same applies to the
person entitled to the payment of a benefit under an insurance policy on the
life of the user or under a pension plan of the user.
The spouse, ascendants or direct descendants of a deceased user are entitled
to be given communication of information relating to the cause of death of
the user, unless the deceased user entered in writing in his record his refusal
to grant such right of access.
The holder of parental authority is entitled to be given communication of the
information contained in the record of a user under 1" years of age even if
the user is deceased. 1owever, that right of access does not e'tend to
information of a psychosocial nature.
<otwithstanding the second paragraph, persons related by blood to a
deceased user may be given communication of information contained in his
record to the e'tent that such communication is necessary to verify the
e'istence of a genetic or hereditary disease.
24. At the re(uest of a user, an institution must send a copy or summary of,
or an e'tract from, the user!s record as soon as possible to another institution
or to a professional.
1owever, where the re(uest of the user is made for study, teaching or
research purposes, the institution may re(uire consent in writing as provided
for in section 1*.1.
2$.#. An institution may use the name and address of a user to invite that
user to ma-e a gift to the institution or to a foundation of the institution
within the meaning of section 12.2, unless the user ob$ects. 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 re(uest the institution to no longer use that
information for such a purpose.
=or the purposes of this section, an institution must respect the rules of
ethics adopted in accordance with the second paragraph of section 2.
)f the user is under 1" years of age, the institution may use the name and
address of the user!s father or mother for the same purpose. The other
provisions of this section then apply in respect of that person as though the
person were a user.
2%. 5ections 1& to 2&. apply notwithstanding the Act respecting Access to
documents held by public bodies and the 3rotection of personal information
(chapter A22.1).
#4. The complaint e'amination procedure must enable a user to address a
verbal or written complaint to the local service (uality commissioner
regarding the health services or social services the user received, ought to
have received, is receiving or re(uires from the institution, an intermediary
or family2type resource or any other organi,ation, partnership or person to
which or whom the institution has recourse, in particular by an agreement
under section 10. or 10..1, for the provision of those services, e'cept in the
case of a complaint concerning a physician, dentist or pharmacist, or a
resident, who practises with such an organi,ation, partnership or person.
)f an institution carries on research activities, the procedure must also enable
any person, whether or not a user, who participates in research to ma-e a
complaint concerning the research. This division applies to such a
complaint, and >user?, with the necessary modifications, includes any person
who participates in research.
The procedure must also allow the heirs or the legal representatives of a
deceased user to ma-e a complaint regarding the services the user received
or ought to have received or regarding any research referred to in the second
paragraph in which the user participated.
The complaint e'amination 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 re(uire
assistance for the formulation of a complaint or for any further step related
to the complaint, in particular by the community organi,ation in the region
to which a user assistance and support mandate has been given pursuant to
section &%.%;
() ensure that the user receives a written notice of the date on which the
verbal or written complaint is received by the local commissioner, unless the
commissioner!s conclusions were sent to the user within &2 hours after the
complaint was received;
(") establish a procedure for the e'amination of complaints regarding a
physician, dentist or pharmacist, or a resident, in accordance with @ivision
)), e'cept the procedure to be followed by the board of directors in ta-ing
disciplinary measures in accordance with a regulation under paragraph 2 of
section #0%;
(#) provide for the prompt referral of any complaint concerning or involving
a physician, dentist or pharmacist, or a resident, to the medical e'aminer
designated under section "2;
(%) provide that, where a complaint is received regarding the services
provided by a resource, organi,ation, 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 pre$udice 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;
(&) specify what communications must be made in writing in the case of a
written complaint;
(.) allow the user and the highest authority of the organi,ation, resource or
partnership or the person holding the position of highest authority
responsible for the services that are the sub$ect of a complaint referred to in
the first paragraph to present their observations; and
(*) provide that the local commissioner, after e'amining the complaint, is to
communicate his or her conclusions, including reasons, to the user within
the time prescribed in subparagraph % of the second paragraph of section ,
together with the procedure for applying to the 1ealth 5ervices :mbudsman.
"$. 9very institution must, at the re(uest of the +inister or the agency,
ta-e 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 e'pectations and
satisfaction with respect to the (uality of the services offered by the
institution.
A local authority may do the same to ascertain the level of user satisfaction
with the organi,ation of services and the results obtained.
A user may at any time re(uest the institution or local authority to no longer
use the information concerning the user for such a purpose.
=or the purposes of this section, an institution must respect the rules of
ethics adopted in accordance with the second paragraph of section 2.
2##. 9very institution must adopt a code of ethics which shall set out the
rights of the users and the practices and conduct e'pected, 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 2&. and 10&.
The institution must give a copy of the code of ethics to every user who is an
in2patient or who ma-es a re(uest therefor.
2##.. 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 e'ecutive director of the institution
or to a person designated by the e'ecutive director. 5uch incidents or
accidents shall be reported in the form provided for such purposes, which
shall be filed in the user!s record.
The e'ecutive director of the institution or the person designated by the
e'ecutive director shall report, in non2nominative form, all reported
incidents or accidents to the agency at agreed intervals or whenever the
agency so re(uires