POLICY MATTERS
Particular set of circumstances necessary
for delegation of controlled acts
T
he College reminds physicians that they must
comply with the CPSO’s Delegation of Controlled Acts policy when delegating acts to others, in order to ensure quality patient care is provided.
Under Ontario law, certain acts, referred to as “controlled acts,” may only be performed by authorized
health-care professionals. However, under a particular
set of circumstances, these acts may be delegated to
others. Delegation is a mechanism that allows a physician who is authorized to perform a controlled act to
confer that authority to another person who is not
independently authorized to perform the act. Acts can
be delegated to those who are regulated (i.e., nurses) or
unregulated (i.e., physician assistants).
It is recognized that delegation can result in more
timely delivery of health care, and can promote optimal
use of health-care resources and personnel.
Delegation must never be done for convenience or
financial reasons.
“The ability to delegate controlled acts is meant to
improve patient access to necessary care while ensuring
safety and clear accountability. The only justification for
delegation is because it is in the patient’s best interests,”
said Dr. Marc Gabel, College President.
Physicians who are unsure of expectations should turn
to the Delegation of Controlled Acts policy for guidance. For example, its requirements will not be met
where:
• ere are not sufficient medical directives or orders in
Th
place to authorize the range of care and the circumstances under which care is provided by the delegate;
• e delegating physician has not appropriately evaluTh
ated the patient safety implications of delegating the
care;
• ppropriate quality assurance measures and superviA
sion are not in place;
• e physician delegates acts that are outside the scope
Th
of his or her own practice;
• e patient does not provide informed consent to the
Th
act being provided by a delegate and/or is left with the
impression that the delegate is a physician.
Physicians who delegate care should also be mindful
of other relevant College policies, including those that
pertain to record-keeping, consent, confidentiality, and
prescribing.1 For example, they should keep appropriate
records documenting the care provided and the directives/orders related to the delegation that has taken place.
Delegation that is improperly carried out may also raise
concerns in relation to billing practices, and physicians
should pay close attention to OHIP restrictions, for
example with respect to services for which they must be
present. Physicians who delegate the provision of care
may also wish to speak to the CMPA to inquire about
liability-related issues.
1. Medical Records policy; Consent to Medical Treatment policy; Confidentiality of Personal Health Information policy; and Prescribing Drugs policy.
DIALOGUE • Issue 2, 2014
23