POLICY ON THE USE OF FORMS FOR THE ASSESSMENT OF THE AUTONOMY OF BENEFICIARIES IN HOSPITALS AND RECEPTION CENTRES
ISSUE A complaint was filed with the Commission d'accès à l'information concerning the disclosure of nominative information about the beneficiaries in institutions in the health and social services network. Upon investigation, the complaint proved founded. Two hospitals were violating section 53 of the Act respecting Access to documents held by public bodies and the Protection of personal information. The section reads as follows: 53. Nominative information is confidential, except in the following cases: (1) where its disclosure is authorized by the person concerned by the information; in the case of a minor, the authorization may also be given by the person having parental authority; (2) where it relates to information obtained in the performance of an adjudicative function by a public body performing quasi-judicial functions; the information remains confidential, however, if the body obtained it when holding a sitting in camera or if the information is contemplated by an order not to disclose, publish or distribute. The two hospitals were posting a form in patients' rooms that assessed their autonomy. The form could be read by anyone with access to the patient's room and could inform the visitor about the beneficiary's capacity to wash himself, dress, eat, hear, understand and so on. The hospitals involved had not obtained the consent of the beneficiaries to post this personal information. Since the Commission's investigation, the situation has been corrected and the confidentiality of.the forms is protected. These assessment instruments are of great use to health and social services institutions in providing beneficiaries with adequate services. The forms are therefore widely used and are generally properly kept, i.e. in the patient's file. The confidentiality of the data is thereby protected. However, the number of hospitals and
reception centres that allow the posting of these forms is sufficient to warrant the intervention of the Commission d'accès à l'information. POLICY OF THE COMMISSION D'ACCÈS À L'INFORMATION The form most often used is entitled "Système de Mesure de l'Autonomie Fonctionnelle", or SMAF for short. It was developed by the community health department of Hôtel-Dieu in Lévis. In some cases, a form prepared in house is used, but it assesses essentially the same functions as the SMAF. Health and social services institutions that post the form claim that, by doing so, they can give beneficiaries better service. The care dispensing staff is not as stable as it used to be; many employees are on call or are part of mobile teams. Hence, they know little or nothing about the patients to be cared for. The posted form enables them to become quickly aware of the condition of the beneficiary and to provide him with the best services. However, this procedure violates the Act respecting Access to documents held by public bodies and the Protection of personal information. It seems clear from the experience of institutions that keep the form in the beneficiary's file that it is possible to care for beneficiaries properly while complying with the Act respecting Access. In addition to being an administrative tribunal, the Commission d'accès à l'information is a body that oversees the application of the Act respecting Access to documents held by public bodies and the Protection of personal information. It feels that it is its duty, following the investigations carried out, to inform all hospitals and reception centres of its policy on the use of autonomy assessment forms. Much nominative information that must remain confidential unless the written consent of the persons concerned is obtained appears on the various assessment forms. This information must also be kept in a secure manner by health and social services institutions. The Commission d'accès à l'information therefore asks reception centres and hospitals not to.post, in its beneficiaries' rooms, nominative information that makes it possible to identify these people, unless their approval has been obtained. It goes without saying that none of this nominative information should be posted elsewhere in the hospital or reception centre, such as at the nurses' station or at the entrance to the department. This notice has been approved by the Association des centres d'accueil, the Association des hôpitaux du Québec, the Association des centres hospitaliers et des centres d'accueil privés du Québec and the Comité provincial des malades. The Commission d'accès à l'information hopes that all these bodies will collaborate in protecting the confidentiality of the information held on the beneficiaries in their institutions.