© Éditeur officiel du Québec
Updated to 1 April 2014
This document has official status.


chapter S-4.2

An 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.

9.1. (Replaced).

2006, c. 11, s. 3; 2010, c. 38, s. 9.

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 paragraph 28 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, 19.0.3, 19.2 and 27.1, in the second paragraph of section 78.1, in the fourth paragraph of section 107.1, in the fifth paragraph of section 108, in the second paragraph of section 185.1, in section 204.1, in the fourth paragraph of section 349.3 and in sections 520.3.0.1 and 520.3.1;

 (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;

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

 (10) in the cases and for the purposes set out in sections 8 and 9 of the Act to protect persons with regard to activities involving firearms (chapter P-38.0001);

 (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 required for the purposes of the Youth Criminal Justice Act (S.C. 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 Institut national d'excellence en santé et en services sociaux (chapter I-13.03); or

 (13) for the purposes of the Act respecting the sharing of certain health information (chapter P-9.0001).

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; 2006, c. 28, s. 20; 2006, c. 43, s. 1; 2007, c. 30, s. 19; 2009, c. 45, s. 20; 2010, c. 15, s. 82; 2011, c. 15, s. 1; 2012, c. 23, s. 160.

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, expiration date of the health insurance card, telephone 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 the 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; 2012, c. 23, s. 161.

19.0.3. An institution that transfers a user to another institution must send the other institution a summary of the information necessary to take the user in charge within 72 hours after the transfer.

2006, c. 28, s. 21.

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.

If the user is under 14 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.

2005, c. 32, s. 6; 2009, c. 45, s. 21.

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.

The board of directors must send the procedure to the Minister, who shall ensure that it is established and applied in accordance with sections 29 to 59.

1991, c. 42, s. 29; 1998, c. 39, s. 1; 2001, c. 43, s. 41; 2005, c. 32, s. 8.

30. A local service quality and complaints commissioner must be appointed by the board of directors of every institution. 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 and complaints commissioner reports to the board of directors.

After having obtained the opinion of the local service quality and complaints commissioner, the board of directors may, whenever necessary, appoint one or more assistant local service quality and complaints commissioners.

An assistant local service quality and complaints commissioner shall exercise the functions delegated by and act under the authority of the local service quality and complaints 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 and complaints commissioner.

1991, c. 42, s. 30; 2001, c. 43, s. 41; 2005, c. 32, s. 9.

31. The board of directors must take steps to preserve at all times the independence of the local service quality and complaints commissioner and the assistant local service quality and complaints 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 exercise exclusively the functions provided for in section 33.

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.

A local service quality and complaints commissioner may also exercise the functions of a regional service quality and complaints commissioner provided for in this Act, subject to the terms and conditions determined by agreement between the institution and the agency concerned.

1991, c. 42, s. 31; 1998, c. 39, s. 2; 2001, c. 43, s. 41; 2005, c. 32, s. 10.

32. In the exercise of his or her functions, the local service quality and complaints 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 and complaints commissioner may not be otherwise delegated.

1991, c. 42, s. 32; 1998, c. 39, s. 3; 2001, c. 43, s. 41; 2005, c. 32, s. 224.

33. The local service quality and complaints 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 and complaints 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 and complaints commissioner within the institution, distributing information to increase understanding of the rights and obligations of users and the code of ethics referred to in section 233, promoting the complaint examination process and publishing the procedure referred to in section 29;

 (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 commissioner's examination, 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 or the object of an intervention, for a more thorough investigation, 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 board of directors, 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 referred to in 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 board of directors, to the department or service manager concerned within the institution and to the highest authority concerned;

 (7) taking action on his or her own initiative when apprised of the facts and when there are reasonable grounds to believe that the rights of a user or group of users are not being enforced; submitting a report to the board of directors and to the department or the 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 concerned, recommending any action to improve user satisfaction and foster the enforcement of user rights;

 (8) giving advice on any matter within the purview of the local service quality and complaints commissioner submitted by the board of directors, any council or committee created by the board under section 181 or 181.0.1 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 and complaints commissioner together with a statement of any action recommended by the local commissioner to improve user satisfaction and foster 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 and complaints 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) (subparagraph repealed).

1991, c. 42, s. 33; 1998, c. 39, s. 4; 2001, c. 43, s. 41; 2005, c. 32, s. 11.

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 or 108.1, for the provision of those services, except in the case of a complaint concerning a physician, dentist or pharmacist, or a resident, who practises with such an organization, partnership or person.

If an institution carries on research activities, the procedure must also enable any person, whether or not a user, who participates in research to make 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 make 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 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, unless the commissioner's conclusions were sent to the user within 72 hours after the complaint was received;

 (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; 2005, c. 32, s. 12; 2013, c. 17, s. 6.

34.1. (Replaced).

2001, c. 43, s. 41.

35. The local service quality and complaints 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 and complaints 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; 2005, c. 32, s. 224.

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 and complaints commissioner for examining a complaint or intervening, and provide 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 and complaints 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 and complaints 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; 2005, c. 32, s. 224.

38. (Repealed).

1991, c. 42, s. 38; 1992, c. 21, s. 3; 1998, c. 39, s. 173; 2001, c. 43, s. 41; 2005, c. 32, s. 14.

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 and complaints 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; 2005, c. 32, s. 224.

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, who may or may not practise in a centre operated by the institution, on the recommendation of the council of physicians, dentists and pharmacists. The director of professional services may be designated to act in that capacity.

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.

The medical examiner is answerable to the board of directors for the application of the complaint examination procedure in cases involving a physician, dentist or pharmacist, or a resident.

1991, c. 42, s. 42; 1998, c. 39, s. 10; 2001, c. 43, s. 41; 2005, c. 32, s. 15; 2009, c. 45, s. 22.

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 and complaints 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 and complaints commissioner in accordance with the provisions of Division I unless the local service quality and complaints 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; 2005, c. 32, s. 224.

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 and complaints commissioner.

1991, c. 42, s. 46; 1998, c. 39, s. 13; 2001, c. 43, s. 41; 2005, c. 32, s. 224.

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 and complaints commissioner.

1991, c. 42, s. 47; 1998, c. 39, s. 14; 2001, c. 43, s. 41; 2005, c. 32, s. 224.

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 and complaints commissioner of the decision to so refer the complaint.

1991, c. 42, s. 48; 1998, c. 39, s. 173; 2001, c. 43, s. 41; 2005, c. 32, s. 224.

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 and complaints 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; 2005, c. 32, s. 224.

51. A review committee is established for each local authority.

The review committee is composed of three members appointed by the board of directors of the local authority.

The chair of the review committee is appointed from among the members of the board of directors of the local authority who are not employed by or do not practise a profession with the authority. The other two members are appointed from among the physicians, dentists and pharmacists who practise in a centre operated by one of the institutions in the territory of a local health and social services network within the meaning of section 99.2 whose activities and services are coordinated by the local authority. The appointments are made on the recommendation of the councils of physicians, dentists and pharmacists of the local authority and of the other institutions in the territory, or, where no such council has been established for an institution, after consulting with the physicians, dentists and pharmacists concerned.

The board of directors of the local authority fixes the term of appointment of the members of the review committee and determines its operating rules.

However, a public institution other than a local authority may establish its own review committee. This section and sections 52 to 59 apply in such a case, with the necessary modifications, and only physicians, dentists and pharmacists who practise in a centre operated by the institution may be appointed by the board of directors as members of that review committee.

1991, c. 42, s. 51; 1998, c. 39, s. 173; 2001, c. 43, s. 41; 2005, c. 32, s. 16; 2011, c. 15, s. 2.

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 of an institution in the territory of the local health and social services network. 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, to the medical examiner and to the local service quality and complaints commissioner of the institution concerned.

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

 (1) confirm the conclusions of the medical examiner of the institution concerned;

 (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 and complaints commissioner;

 (3) where the complaint concerns a physician, dentist or pharmacist who is a member of the council of physicians, dentists and pharmacists established for an institution, 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; 2005, c. 32, s. 17.

53. A user who disagrees with the conclusions transmitted by the medical examiner of an institution in the territory of the local health and social services network, or deemed to have been transmitted by that medical examiner under section 49, may apply verbally or in writing for a review of the complaint by the review committee of the local authority.

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 and complaints commissioner of the institution concerned 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 of the local authority and include the conclusions and reasons transmitted by the medical examiner of the institution concerned, 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 professional concerned and to the medical examiner and the local commissioner of the institution concerned.

1991, c. 42, s. 53; 1998, c. 39, s. 16; 2001, c. 43, s. 41; 2005, c. 32, s. 18.

53.0.1. Section 53 applies, with the necessary modifications, to a professional concerned by a complaint who wishes to apply for a review.

2005, c. 32, s. 19.

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 concerned shall forward a copy of the entire complaint record to the chair of the review committee of the local authority.

1991, c. 42, s. 54; 1998, c. 39, s. 18; 2001, c. 43, s. 41; 2005, c. 32, s. 20.

55. The review committee must allow the user, the professional and the medical examiner concerned 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; 2005, c. 32, s. 21.

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 of the local authority is final.

1991, c. 42, s. 56; 1998, c. 39, s. 19; 2001, c. 43, s. 41; 2005, c. 32, s. 22.

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 of the local authority, sending a copy to the council of physicians, dentists and pharmacists of each institution in the territory of the local health and social services network, 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 an institution in the territory of the local health and social services network.

A copy of the report shall also be sent to the local service quality and complaints commissioner of each institution in the territory 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; 2005, c. 32, s. 23.

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 of the local authority, the council shall also communicate its conclusions to that 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 and complaints commissioner.

1991, c. 42, s. 58; 1998, c. 39, s. 21; 2001, c. 43, s. 41; 2005, c. 32, s. 24.

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 and complaints commissioner in writing.

1991, c. 42, s. 59; 1998, c. 39, s. 22; 2001, c. 43, s. 41; 2005, c. 32, s. 224.

DIVISION III 
EXAMINATION OF COMPLAINTS BY AGENCY
2001, c. 43, s. 41; 2005, c. 32, s. 227.

60. A complaint may be addressed directly to the agency

 (1) by any person who uses the services of a community organization within the meaning of section 334 or is lodged in a private nursing home or by a community organization referred to in section 454, by a resource offering lodging referred to in section 346.0.21 or in a private seniors' residence referred to in section 346.0.1, regarding the services the person received or ought to have received from the organization, nursing home, resource or residence;

 (2) (paragraph repealed);

 (3) by any natural person regarding a function or an activity of the agency 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, private nursing homes or community organizations referred to in section 454, resources offering lodging referred to in section 346.0.21 or private seniors' residences referred to in section 346.0.1;

 (4) by any natural person regarding any clientele assistance provided by the agency 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 agency for the provision of services, and who cannot otherwise apply to an institution under Division I. This does not apply, however, in the case of a complaint concerning a physician, dentist or pharmacist, or a resident, who practises with such an organization, partnership or person.

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; 2009, c. 46, s. 1; 2011, c. 27, s. 38.

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 agency must make a by-law establishing a complaint examination procedure for the purposes of this division.

The board of directors must send the procedure to the Minister, who shall ensure that it is established and applied in accordance with sections 60 to 72.

1991, c. 42, s. 62; 1998, c. 39, s. 25; 2001, c. 43, s. 41; 2005, c. 32, s. 26.

62.1. (Replaced).

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

63. A regional service quality and complaints commissioner shall be appointed by the board of directors.

The regional commissioner comes under the authority of the board of directors. The regional commissioner alone is answerable to the board of directors for the application of the complaint examination procedure. A member of the personnel of the agency may act under the authority of the regional commissioner if it is permitted by the agency's organization plan.

1991, c. 42, s. 63; 2001, c. 43, s. 41; 2005, c. 32, s. 27.

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

To that end, the board of directors must ensure that the regional commissioner exercises exclusively the functions provided for in section 66.

1991, c. 42, s. 64; 1999, c. 40, s. 269; 2001, c. 43, s. 41; 2005, c. 32, s. 28.

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

1991, c. 42, s. 65; 2000, c. 8, s. 242; 2001, c. 43, s. 41; 2005, c. 32, s. 29.

65.1. (Replaced).

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

66. The regional service quality and complaints 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 and complaints 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 and complaints commissioner within the agency, promoting the complaint examination process, and publishing the procedure referred to in section 62 for the people of 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 agency 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 commissioner's examination, bringing these questions to the attention of the department concerned or the human resources manager within the agency 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 or the object of an intervention, for a more thorough investigation, 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 board of directors, to the department or service manager concerned within the agency 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 board of directors, to the department or manager concerned within the agency and to the highest authority concerned;

 (7) taking action on his or her own initiative when apprised of the facts and when there are reasonable grounds to believe that the rights of a person or group of persons are not being enforced; submitting a report to the board of directors and to the department or service manager within the agency or, depending on the case, the highest authority of the organization, resource or partnership or the person holding the position of highest authority that is responsible for the services concerned, recommending any action to improve user satisfaction and foster the enforcement of user rights;

 (8) giving advice on any matter within the purview of the regional service quality and complaints commissioner submitted by the board of directors, any council or committee created under section 407 or 412.1 or any department or service or other council or committee of the agency;

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

 (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 and complaints commissioner and all other reports referred to in section 76.10, and presenting the report to the board of directors for approval; and

 (12) (subparagraph repealed).

1991, c. 42, s. 66; 2001, c. 43, s. 41; 2005, c. 32, s. 30.

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 and complaints 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, unless the commissioner's conclusions were sent to the complainant within 72 hours after the complaint was received;

 (4) provide that, where a complaint is received regarding the services provided by a resource, organization, partnership or person other than the agency, 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; 2005, c. 32, s. 31.

68. The regional service quality and complaints 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 and complaints 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; 2005, c. 32, s. 224.

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 agency, must supply all information and, subject to the second paragraph of section 190 and section 218, all documents required by the regional service quality and complaints commissioner for examining a complaint or intervening, 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 and complaints 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 agency 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 and complaints 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; 2005, c. 32, s. 227; 2005, c. 32, s. 224.

71. (Repealed).

1991, c. 42, s. 71; 2001, c. 43, s. 41; 2005, c. 32, s. 33.

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

72. If the regional service quality and complaints 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; 2005, c. 32, s. 224.

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 and complaints 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 and complaints commissioner, a person acting under the authority of a regional service quality and complaints 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; 2005, c. 32, s. 224.

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. Answers given or statements made during the examination of a complaint or during an intervention, including any information or document supplied in good faith by the person in response to a request of a local service quality and complaints commissioner or a regional service quality and complaints 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 and complaints 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; 2005, c. 32, s. 34.

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 and complaints commissioner or a regional service quality and complaints 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 and complaints 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; 2005, c. 32, s. 224.

76.4. Notwithstanding any inconsistent legislative provision, a local service quality and complaints commissioner or a regional service quality and complaints 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 and complaints 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; 2005, c. 32, s. 224.

76.5. Nothing contained in a user's complaint record or in an intervention 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; 2005, c. 32, s. 35.

DIVISION V 
ASSISTANCE BY COMMUNITY ORGANIZATION
2001, c. 43, s. 41.

76.6. The Minister, after consulting with the agency, 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 agency or to the Health Services Ombudsman or whose complaint was referred to the council of physicians, dentists and pharmacists of the institution and is governed by section 58.

Where a complaint is made by a user regarding the services of an institution or agency 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 agency 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; 2005, c. 32, s. 36.

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 agency or with the Health Services Ombudsman, and provide support to the user throughout the proceeding, including when the complaint is referred to the council of physicians, dentists and pharmacists of an institution. 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 user's satisfaction and the enforcement of the user's rights.

2001, c. 43, s. 41; 2005, c. 32, s. 37.

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.

However, the conclusions, including reasons, and any recommendations made by a medical examiner under section 47, or the opinion prepared by a review committee under section 52, must be placed in the file of the professional concerned by the complaint.

2001, c. 43, s. 41; 2005, c. 32, s. 38.

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

2001, c. 43, s. 41; 2005, c. 32, s. 39.

DIVISION VII 
REPORTS
2001, c. 43, s. 41.

76.10. Once a year and whenever so required by the agency, the board of directors of an institution must report to the agency on the application of the complaint examination procedure, on user satisfaction and on the enforcement of user rights.

2001, c. 43, s. 41; 2005, c. 32, s. 40.

76.11. The report shall incorporate the activities summary of the local service quality and complaints 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 and complaints commissioner and indicate any action taken to improve user satisfaction and foster 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; 2005, c. 32, s. 41.

76.12. Once a year, the board of directors of an agency 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 and complaints commissioner referred to in subparagraph 9 of the second paragraph of section 66, describe the reasons for the complaints received by the agency 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 and complaints commissioners and by the regional service quality and complaints commissioner and of the most significant actions taken by the institutions and by the agency to improve clientele satisfaction and foster 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 the rights of persons who apply to the regional service quality and complaints 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; 2005, c. 32, s. 42.

76.13. Whenever so required by the Minister, the board of directors of an institution or agency must report to the Minister on 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.

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

2001, c. 43, s. 41; 2005, c. 32, s. 43.

76.14. The Minister shall table the reports of the agencies referred to in section 76.12 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; 2005, c. 32, s. 44.

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.

78.1. The Government may claim from the operator of a specialized medical centre described in section 333.3 the cost of a preoperative, postoperative, rehabilitation or home care support service that must, under section 333.6, be received in the centre or from a private resource, if the service is provided by a public institution or a private institution under agreement prior to or following surgery or specialized medical treatment provided in that specialized medical centre.

At the Minister's request and after informing the user, an institution must communicate to the Minister any information contained in a user's record that is necessary for the purposes of proceedings under the first paragraph.

2006, c. 43, s. 2.

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 Youth Criminal Justice Act (Statutes of Canada, 2002, chapter 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; 2009, c. 45, s. 23.

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 or psychosocial or family difficulties, or because of an alcohol, gambling or drug addiction or any other 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 with an impairment and, mainly on referral, persons with an 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; 2011, c. 27, s. 2.

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 or persons with a pervasive developmental disorder;

 (2) rehabilitation centres for physically impaired persons;

 (3) rehabilitation centres for persons with an addiction;

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

 (5) rehabilitation centres for mothers with adjustment problems.

1991, c. 42, s. 86; 2005, c. 32, s. 45; 2011, c. 27, s. 3.

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;

 (4) rehabilitation centres for persons with language impairment.

1991, c. 42, s. 87; 2009, c. 45, s. 24.

87.1. Only an institution that operates both a child and youth protection centre and a rehabilitation centre for young persons with adjustment problems or a rehabilitation centre for mothers with adjustment problems, to the exclusion of all other missions, may use youth centre in its name.

2011, c. 27, s. 4.

88. The Minister may, after consulting the Minister of Higher Education, Research, Science and Technology, 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 Québec Research Fund–Health established by the Act respecting the Ministère de l'Enseignement supérieur, de la Recherche, de la Science et de la Technologie (chapter M-15.1.0.1).

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; 2006, c. 8, s. 31; 2011, c. 16, s. 244; 2013, c. 28, s. 186.

89. The Minister, after consulting the Minister of Higher Education, Research, Science and Technology, 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 Québec Research Fund–Health.

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; 2006, c. 8, s. 31; 2011, c. 16, s. 244; 2013, c. 28, s. 187.

90. The Minister may, after consulting the Minister of Higher Education, Research, Science and Technology, 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 Québec Research Fund–Health 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; 2006, c. 8, s. 31; 2011, c. 16, s. 244; 2013, c. 28, s. 187.

91. The Minister may, after consulting the Minister of Higher Education, Research, Science and Technology, 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 the first paragraph of section 110.

In the case of a hospital centre, the Minister may establish criteria allowing that centre to be designated as a regional or supraregional affiliated university centre.

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; 2006, c. 8, s. 31; 2006, c. 43, s. 3; 2009, c. 45, s. 25; 2013, c. 28, s. 187.

92. (Repealed).

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

93. The agency 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; 2005, c. 32, s. 47.

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 or a specialized medical centre described in section 333.1 is not an institution.

A private health consulting room or office is a consulting room or office, situated elsewhere than in a consulting room or office 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 directly or indirectly providing their patients with lodging.

1991, c. 42, s. 95; 2006, c. 43, s. 4.

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,

 (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. It must report on the application of this section in a separate section of the annual management report.

2005, c. 32, s. 48; 2011, c. 15, s. 3.

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 paragraph 27 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 paragraph 27 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.

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.

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 agency.

1991, c. 42, s. 105; 1998, c. 39, s. 37; 2005, c. 32, s. 51.

105.1. Every institution, other than a local authority, must make a significant contribution to defining the clinical and organizational project initiated by a local authority, and must clearly indicate to the agency concerned the services it will provide at the local, regional or supraregional level.

Within the time limits set by the agency, such an institution must also enter into the necessary agreements with the local authority to allow that authority to coordinate the services required in the territory of the local health and social services network.

If the agreements are not entered into within the time limits set by the agency, the agency determines the contribution expected of each institution.

2005, c. 32, s. 52.

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 agency or to the Minister on request.

1991, c. 42, s. 106; 2005, c. 32, s. 227.

107. Every institution must, at the request of the Minister or the agency, 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.

The accreditation is valid for not more than four years. The institution must see that its accreditation is maintained at all times.

If an accreditation body refuses to accredit an institution, the institution must, within 12 months after the refusal, submit a new application for accreditation and inform the agency of the fact.

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.

The institution must make the body's report public within 60 days after receiving it and send it to the agency and the different professional orders concerned whose members practise a profession in a centre operated by the institution.

2002, c. 71, s. 6; 2005, c. 32, s. 54; 2011, c. 15, s. 4.

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.

However, prior authorization from the Minister is required to enter into an agreement with the operator of a specialized medical centre described in subparagraph 2 of the first paragraph of section 333.3 or with a non-participating professional within the meaning of the Health Insurance Act (chapter A-29), or if the service covered by the agreement is an insured service that is considered non-insured under that Act.

Despite the first paragraph, an institution operating a hospital centre may not significantly modify the organization of the specialized medical services it provides in its facilities by entrusting them to a third party unless it enters into an agreement under section 349.3.

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 fourth 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 agency.

An agreement under this section must be transmitted to the agency.

1991, c. 42, s. 108; 1998, c. 39, s. 38; 2001, c. 43, s. 42; 2005, c. 32, s. 55; 2006, c. 43, s. 5; 2009, c. 45, s. 26.

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 second, sixth, seventh and eighth 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; 2006, c. 43, s. 6.

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 board of directors 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; 2008, c. 11, s. 212.

108.3. An institution may enter into an agreement with a community organization that has received a financial allowance under the second paragraph of section 454, to ensure that all or some of the health services or social services required by the organization's clientele are provided.

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. After consulting the agency and obtaining the authorization of the Minister, an institution may 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.

An institution may also enter into a service contract or agreement for the purpose of participating in university training or research programs. Such a contract or agreement must be submitted to the agency and the Minister.

An institution may enter into a contract of association with any other educational institution recognized by the Minister of Education, Recreation and Sports or the Minister of Higher Education, Research, Science and Technology 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 agency.

The terms and conditions of the contracts and agreements referred to in this section must be consistent with the principles and general rules established by the Minister in cooperation with the Minister of Education, Recreation and Sports or the Minister of Higher Education, Research, Science and Technology, as applicable.

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; 2005, c. 32, s. 58; 2013, c. 28, s. 188.

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 agency,

 (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; 2005, c. 32, s. 227.

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 agency before granting his authorization.

1991, c. 42, s. 113; 2005, c. 32, s. 227.

114. A public institution may

 (1) operate a day care centre in accordance with the Educational Childcare Act (chapter S-4.1.1) or a stop over centre under section 153 of that Act;

 (2) if it has been designated by the Minister of Families, Seniors and the Status of Women under section 121 of that Act to be the Minister's regional representative, act in that capacity and exercise the related functions;

 (3) exercise any power that Minister authorizes it to exercise under that Act;

 (4) make an agreement with that Minister under section 10 of the Act respecting the Ministère de la Famille, des Aînés et de la Condition féminine (chapter M-17.2).

1991, c. 42, s. 114; 1996, c. 16, s. 67; 1997, c. 58, s. 135; 2005, c. 47, s. 144; 2006, c. 25, s. 15.

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 considering the recommendations of the Institut national d'excellence en santé et en services sociaux. 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 they are published on the Board's website or on any later date specified in the accompanying notice from the Minister. The publication imparts authentic value to the list or updating and the notice from the Minister.

Any corrections made by the Régie de l'assurance maladie du Québec under section 60.2 of the Act respecting prescription drug insurance (chapter A-29.01) apply, under the same conditions and in the same manner, to the list drawn up in accordance with the first paragraph.

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.

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 third or fourth 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; 2005, c. 40, s. 42; 2007, c. 21, s. 37; 2010, c. 15, s. 83.

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 Québec Research Fund–Health 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; 2011, c. 16, s. 244.

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 Institut national d'excellence en santé et en services sociaux.

1991, c. 42, s. 118; 1994, c. 40, s. 457; 2002, c. 27, s. 41; 2010, c. 15, s. 84.

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 is established to administer a local authority or an institution that operates a residential and long-term care centre.

1991, c. 42, s. 119; 1992, c. 21, s. 70; 2005, c. 32, s. 59.

120. A board of directors is established to administer an institution that operates a rehabilitation centre for mentally impaired persons or persons with a pervasive developmental disorder.

1991, c. 42, s. 120; 2005, c. 32, s. 59.

121. A board of directors is established to administer an institution that operates a rehabilitation centre for physically impaired persons.

1991, c. 42, s. 121; 1996, c. 36, s. 1; 2005, c. 32, s. 59.

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 is established to administer an institution that operates a rehabilitation centre for persons with an addiction.

1991, c. 42, s. 124; 2005, c. 32, s. 60; 2011, c. 27, s. 5.

125. A board of directors shall be established to administer all the institutions having their head offices in the territory of an agency 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 agency established for the Montréal region, the Minister shall determine otherwise than on the basis of the territory of the agency, 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; 2005, c. 32, s. 61.

126. A board of directors shall be established to administer an institution which operates a hospital centre.

1991, c. 42, s. 126; 1992, c. 21, s. 70; 2001, c. 24, s. 5; 2005, c. 32, s. 62; 2011, c. 15, s. 5.

126.1. (Repealed).

1996, c. 36, s. 2; 2001, c. 24, s. 6; 2005, c. 32, s. 63.

126.2. (Repealed).

1996, c. 36, s. 2; 2001, c. 24, s. 7; 2005, c. 32, s. 63.

126.2.1. (Repealed).

2001, c. 24, s. 8; 2005, c. 32, s. 63.

126.3. (Repealed).

1996, c. 36, s. 2; 2001, c. 24, s. 9; 2005, c. 32, s. 63.

126.4. (Repealed).

1996, c. 36, s. 2; 1998, c. 39, s. 41; 2001, c. 24, s. 10; 2005, c. 32, s. 63.

126.5. (Repealed).

1996, c. 36, s. 2; 1998, c. 39, s. 42; 2001, c. 24, s. 11; 2005, c. 32, s. 63.

127. (Repealed).

1991, c. 42, s. 127; 1998, c. 39, s. 43; 2005, c. 32, s. 64; 2011, c. 15, s. 6.

128. If an agency is of the opinion that the circumstances warrant it, it may, after consulting the institutions concerned, propose to the Minister that two or more institutions that have their head offices in the area of jurisdiction of the agency be administered by the same board of directors. However, the agency must take into account the ethnocultural or linguistic characteristics of the institutions concerned, particularly the institutions recognized under section 29.1 of the Charter of the French language (chapter C-11).

A decision by the Minister to accept the agency's proposal must be approved by the Government. The decision must specify the day and month the elections, designations, appointments and co-optations must be completed to be in compliance with section 129. Sections 135, 137, 138 and 147 apply.

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.

The invitation to the public is made jointly by the boards of directors of the institutions concerned.

Despite the first paragraph of section 149, the term of office of the members of the first board of directors established under this section ends on the date set for the next election, designation, appointment or co-optation of members to the new board, depending on whether the members were elected, designated, appointed or co-opted.

On the 30th day following the day on which the co-optations are completed, the institutions concerned by a decision made by the Minister under this section cease to be administered by their respective boards of directors and begin to be administered by the first board of directors established under this section.

1991, c. 42, s. 128; 1994, c. 23, s. 2; 1996, c. 36, s. 3; 2005, c. 32, s. 65; 2011, c. 15, s. 7.

128.1. (Repealed).

2005, c. 32, s. 66; 2011, c. 15, s. 8.

§ 2. —  Composition of the board

1. Mode of appointment of members

129. The board of directors of each institution referred to in sections 119 to 126 is composed of the following persons, who become members of the board as and when they are elected, designated, appointed or co-opted:

 (1) the executive director of the institution;

 (2) two independent persons elected by the public in an election held under section 135;

 (3) two persons designated by and from among the members of the institution's users' committee or committees;

 (4) one person designated by the boards of directors of the institution's foundations, if applicable;

 (5) two persons designated by the universities with which the institution is affiliated if the institution operates a centre designated as a university hospital centre, a university institute or an affiliated university centre;

 (6) four or, if applicable, five persons from within the institution, including

(a)  one person designated by and from among the members of the council of physicians, dentists and pharmacists of the institution, if applicable;

(b)  one person designated by and from among the members of the council of nurses of the institution, if applicable;

(c)  one person or, if subparagraph a or b cannot be applied owing to the absence of one of those councils, two persons or, if both subparagraphs a and b cannot be applied owing to the absence of both of those councils, three persons designated by and from among the members of the multidisciplinary council of the institution; the designated persons must have different position titles and, if applicable, be members of different professional orders;

(d)  one person designated by and from among the members of the council of midwives of the institution, if applicable; and

(e)  one person designated by and from among the personnel of the institution who is not a member of any of the councils mentioned in subparagraphs a to d;

 (7) two independent persons appointed by the agency concerned on the basis of the expertise and experience profiles adopted by the board; and

 (8) six independent persons co-opted, on the basis of the expertise and experience profiles adopted by the board, by the members of the board of directors identified in paragraphs 2 to 7 once they have been elected, designated or appointed. At least one of those persons must be chosen from a list provided by the community organizations identified by the agency concerned that serve the people in the region.

A person referred to in subparagraph 3, 4 or 5 of the first paragraph may not be employed by or practise a profession in the institution. Nor may a person referred to in subparagraph 4 of the first paragraph be employed by or practise a profession in the foundations that designate the person.

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; 2005, c. 32, s. 67; 2009, c. 45, s. 27; 2011, c. 15, s. 9.

129.1. (Repealed).

2001, c. 24, s. 13; 2005, c. 32, s. 68.

130. The board of directors must be made up of an equal number of men and women. If the difference between their numbers is no greater than two, there is a presumption of parity.

For the purposes of the first paragraph, the executive director and the two elected members are not counted.

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; 2005, c. 32, s. 69; 2011, c. 15, s. 9.

131. For the purposes of section 129, a person qualifies as independent if the person has no direct or indirect relation or interest, in particular of a financial, commercial, professional or philanthropic nature, likely to interfere with the quality of the person's decisions as regards the interests of the institution.

A person is deemed not to be independent if that person

 (1) is in the employ of the institution or has been in such employ in the three years before being elected, designated, appointed or co-opted to office, or practises or has practised a profession in the institution;

 (2) has an immediate family member who is the executive director, an assistant executive director or a senior management officer of the institution;

 (3) provides goods or services for valuable consideration to the institution;

 (4) is employed by the Ministère de la Santé et des Services sociaux, by an agency or by the Régie de l'assurance maladie du Québec, receives remuneration from the Régie or is a member of the board of directors of an agency or of the Régie; or

 (5) is a user lodged in the institution.

For the purposes of this section, immediate family member means a person's spouse or child, the spouse's child, the person's mother or father, the spouse of the person's mother or father, or the spouse of the person's child or of the person's spouse's child.

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; 2005, c. 32, s. 69; 2011, c. 15, s. 9.

131.1. (Repealed).

1996, c. 36, s. 7; 1998, c. 39, s. 47; 2001, c. 24, s. 16; 2005, c. 32, s. 70.

132. (Repealed).

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; 2005, c. 32, s. 70.

132.1. (Repealed).

1996, c. 36, s. 9; 1998, c. 39, s. 49; 2001, c. 24, s. 18; 2005, c. 32, s. 70.

132.2. For the purposes of subparagraph 4 of the first paragraph of section 129, 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; 2005, c. 32, s. 71; 2011, c. 15, s. 10.

132.3. A member of the board of directors of an institution elected, appointed or co-opted as an independent director must disclose in writing to the board any situation likely to affect the member's status.

2001, c. 24, s. 20; 2005, c. 32, s. 72; 2011, c. 15, s. 11.

133. No act or document of an institution or decision of the board of directors is invalid because the board is not made up of an equal number of men and women or because there are fewer independent directors than prescribed by this Act.

1991, c. 42, s. 133; 1992, c. 21, s. 70; 1996, c. 36, s. 10; 2001, c. 24, s. 21; 2005, c. 32, s. 73; 2011, c. 15, s. 11.

133.0.1. For the purposes of subparagraph c of subparagraph 6 of the first paragraph of section 129, 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; 2005, c. 32, s. 74; 2011, c. 15, s. 12.

133.1. (Repealed).

2001, c. 24, s. 22; 2005, c. 32, s. 75; 2011, c. 15, s. 13.

133.2. New members must be designated as soon as

 (1) the first foundation of an institution within the meaning of subparagraph 4 of the first paragraph of section 129 is created;

 (2) a centre is designated by the Minister as a university hospital centre, a university institute or an affiliated university centre within the meaning of subparagraph 5 of the first paragraph of section 129;

 (3) a council of physicians, dentists and pharmacists or a council of nurses within the meaning of subparagraphs a and b of subparagraph 6 of the first paragraph of section 129 is established for an institution, allowing the addition of a member designated by and from among the members of the new council; or

 (4) a council of midwives within the meaning of subparagraph d of subparagraph 6 of the first paragraph of section 129 is established for an institution, allowing the addition of a member designated by and from among the members of the new council.

These persons are designated in accordance with the procedure provided for in section 137.

Despite the first paragraph of section 149, the term of office of a person designated under this section ends on the date set for the next designations.

When a member is designated in accordance with subparagraph 3 of the first paragraph, one member from the multidisciplinary council, designated under subparagraph c of subparagraph 6 of the first paragraph of section 129 must withdraw voluntarily or following a drawing of lots.

1996, c. 36, s. 11; 1998, c. 39, s. 51; 2001, c. 24, s. 23; 2005, c. 32, s. 76; 2011, c. 15, s. 14.

133.3. (Repealed).

2005, c. 32, s. 77; 2011, c. 15, s. 15.

133.4. (Repealed).

2005, c. 32, s. 77; 2011, c. 15, s. 15.

134. (Repealed).

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

135. Every four years, on the day of the month of October or November that the Minister determines, every institution shall invite the public to elect the persons referred to in subparagraph 2 of the first paragraph of section 129.

In addition to the restrictions set out in section 150, 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 the local authority serving the territory in which the person's principal residence is situated;

 (2) any other election held in the region to elect members to the board of directors of an institution referred to in sections 119 to 126;

 (3) (subparagraph replaced);

 (4) (subparagraph replaced);

 (5) (subparagraph replaced);

 (6) (subparagraph replaced).

The mechanisms whereby candidates may address the population before an election, as well as the election procedure to be followed and the standards relating to advertising, financing, the powers and duties of election officers and campaign literature, shall be determined by a by-law of the Minister, made after consulting the chief electoral officer. The by-law comes into force on the date of its publication in the Gazette officielle du Québec.

A person who works in an institution or who practises a profession in a centre operated by an institution may not vote in an election held for that institution. Nor may a minor vote in the election.

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; 2005, c. 32, s. 78; 2011, c. 15, s. 16.

136. (Repealed).

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

137. The Minister shall, by regulation, determine the procedure for designating the persons referred to in subparagraphs 3 to 6 of the first paragraph of section 129. The regulation comes into force on the date of its publication in the Gazette officielle du Québec.

The designations take place on the date set by the Minister.

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; 2005, c. 32, s. 79; 2011, c. 15, s. 17.

138. Once the elections, designations and appointments have taken place, the members elected, designated or appointed, except the executive director, shall carry out the co-optations under subparagraph 8 of the first paragraph of section 129 within the next 30 days, even if some positions still remain vacant.

The co-optations must bring to the board of directors persons whose expertise and qualifications are considered useful for the administration of the institutions concerned and ensure better representation of the different parts of the territory and better sociocultural, ethnocultural, linguistic and demographic representation of the population served by the institutions.

In the case of an institution operating a child and youth protection centre or a rehabilitation centre for young persons with adjustment problems or for mothers with adjustment problems, the co-optations must also bring to the board of directors at least one person under 35 years of age if no such person is as yet on the board.

1991, c. 42, s. 138; 1996, c. 36, s. 16; 1998, c. 39, s. 56; 2001, c. 24, s. 27; 2005, c. 32, s. 80; 2011, c. 15, s. 18.

139. For the purposes of sections 170, 180, 181.1, 262.1, 322.1 and 327, legal person means an institution within the meaning of paragraph 1 of section 98 that owns all or part of the immovables used for the institution's activities, if, on 1 September 2002, that institution met one of the following conditions:

 (1) it had been issued an express designation by the Minister stating that it was a legal person within the meaning of this section; or

 (2) it was deemed to be a legal person designated by the Minister under section 601.1.

1991, c. 42, s. 139; 1992, c. 21, s. 15; 1996, c. 36, s. 17; 2001, c. 24, s. 28; 2005, c. 32, s. 81; 2011, c. 15, s. 19.

140. (Repealed).

1991, c. 42, s. 140; 1996, c. 36, s. 51; 2005, c. 32, s. 82.

141. (Repealed).

1991, c. 42, s. 141; 2005, c. 32, s. 82.

142. (Repealed).

1991, c. 42, s. 142; 2005, c. 32, s. 82.

143. (Repealed).

1991, c. 42, s. 143; 2005, c. 32, s. 82.

144. (Repealed).

1991, c. 42, s. 144; 2005, c. 32, s. 82.

145. (Repealed).

1991, c. 42, s. 145; 2005, c. 32, s. 82.

146. (Repealed).

1991, c. 42, s. 146; 2005, c. 32, s. 82.

147. If a position cannot be filled by the application of section 135, 137 or 138, the agency shall appoint a person to the position within 120 days.

1991, c. 42, s. 147; 1998, c. 39, s. 57; 2005, c. 32, s. 83.

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 the board of directors other than the executive director is four years. However, the actual term of office may vary, depending on the date set for the next election, designation, appointment or co-optation of members to the new board.

A member may not serve more than two consecutive terms.

However, if a member serves a term of office of less than two years, the term is not taken into account for the purposes of the second paragraph.

On the expiry of their term, board members shall remain in office until replaced or until elected, designated, appointed or co-opted again.

1991, c. 42, s. 149; 2001, c. 24, s. 29; 2011, c. 15, s. 20.

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 agency 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; 2005, c. 32, s. 227.

151. (Repealed).

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; 2005, c. 32, s. 84; 2011, c. 15, s. 21.

152. A person ceases to be a member of a board of directors upon ceasing to qualify for election, designation, appointment or co-optation.

1991, c. 42, s. 152; 1996, c. 36, s. 19; 1998, c. 39, s. 59; 2001, c. 24, s. 31; 2011, c. 15, s. 22.

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 agency 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 agency, the institution or the Minister.

1991, c. 42, s. 155; 2005, c. 32, s. 227.

156. A vacancy on the board of directors is filled for the unexpired portion of the term.

In the case of an elected, designated or co-opted member, the vacancy is filled by resolution of the board of directors provided the person who is the subject of the resolution has the same qualifications to be a member of the board of directors as the person being replaced.

A vacancy that is not filled by the board of directors within 120 days may be filled by the agency.

An unexplained absence from the number of regular and consecutive board meetings stipulated in the rules of internal management, in the cases and circumstances set out in those rules, constitutes a vacancy.

1991, c. 42, s. 156; 1996, c. 36, s. 20; 2001, c. 24, s. 32; 2005, c. 32, s. 85; 2011, c. 15, s. 23.

§ 3. —  Operation

1. Chairman, vice-chairman and secretary

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

1991, c. 42, s. 157; 2011, c. 15, s. 24.

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.

158.1. The chairman of the board of directors and the executive director shall report to the agency on the results obtained measured against the objectives set out in the strategic plan and the management and accountability agreement.

2011, c. 15, s. 25.

159. The vice-chairman of the board of directors may not 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; 2011, c. 15, s. 26.

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. If all the members of the board of directors consent, they may participate in a public meeting of the board by means of equipment enabling all participants to communicate directly with one another. In such a case, however, a place must be provided for the public to attend the meeting and participate in the question period.

1998, c. 39, s. 60; 2011, c. 15, s. 27.

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 and if all consent, participate in a special meeting of the board by means of equipment enabling all participants to communicate directly with one another.

The minutes of such a meeting must mention the equipment used to enable all participants to communicate directly with one another. The decisions made at the meeting must be tabled at the following public meeting.

1991, c. 42, s. 164; 1998, c. 39, s. 62; 2011, c. 15, s. 28.

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 section 125 or 128, 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; 2005, c. 32, s. 87.

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 under section 125 or 128 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; 2005, c. 32, s. 88.

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 of an institution shall manage the affairs and exercise all the powers of the institution, except the powers assigned to the members of a legal person referred to in 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; 2005, c. 32, s. 225; 2011, c. 15, s. 29.

171. The board of directors of an institution shall establish strategic orientations in accordance with province-wide and regional orientations. It must also establish priorities and ensure compliance with them.

Strategic orientations 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 agency under section 378.

1991, c. 42, s. 171; 2005, c. 32, s. 89; 2011, c. 15, s. 30.

172. The board of directors of an institution must also

 (1) adopt the strategic plan and the annual management report;

 (2) approve the management and accountability agreement;

 (3) approve the financial statements;

 (4) ensure the pertinence, quality, safety and effectiveness of the services provided;

 (5) ensure respect for users' rights and promptness in processing users' complaints;

 (6) ensure the economical and efficient use of human, material and financial resources;

 (7) ensure the participation and development of human resources and see that they are motivated, that they are valued, and that their skills are maintained;

 (8) ensure that performance is monitored and results are reported; and

 (9) ensure that the teaching and research mission is complied with if the institution operates a centre designated as a university hospital centre, a university institute or an affiliated university centre.

1991, c. 42, s. 172; 2002, c. 71, s. 7; 2011, c. 15, s. 31.

172.1. The board of directors shall exercise its responsibilities in keeping with province-wide and regional orientations while fostering networking with local, regional and provincial partners.

2011, c. 15, s. 31.

173. The board of directors must,

 (1) appoint the executive director and senior management officers;

 (2) appoint the local service quality and complaints 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; 2005, c. 32, s. 224.

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, on user satisfaction and on the enforcement of user rights 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; 2005, c. 32, s. 90.

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 referred to in 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; 2005, c. 32, s. 225.

181. The board of directors shall establish a governance and ethics committee and an audit committee. Each committee must be composed in the majority of independent members and chaired by an independent member.

The board may also establish other committees to advise it in the pursuit of its mission. It shall determine the composition, functions, duties and powers of the committees, 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; 2011, c. 15, s. 32.

181.0.0.1. The functions of the governance and ethics committee include drawing up

 (1) governance rules for the conduct of the institution's affairs;

 (2) a code of ethics and professional conduct, in accordance with section 3.0.4 of the Act respecting the Ministère du Conseil exécutif (chapter M-30), applicable to members of the board of directors;

 (3) expertise and experience profiles to be used in appointing or co-opting independent board members, making sure to identify the diverse expertise required and the desired representation of the milieu based on its characteristics;

 (4) criteria for evaluating the performance of the board; and

 (5) initiation and ongoing training programs for board members.

The committee shall carry out the evaluation referred to in subparagraph 4 of the first paragraph in accordance with the criteria approved by the board.

2011, c. 15, s. 33.

181.0.0.2. The audit committee must include at least one member with accounting or financial expertise.

Moreover, the members of the committee may not be employed by or practise a profession in the institution.

2011, c. 15, s. 33.

181.0.0.3. The functions of the audit committee include

 (1) making sure a plan for the optimal utilization of the institution's resources is put in place, and following up on that plan;

 (2) making sure that a risk management process for the conduct of the institution's affairs is put in place and followed;

 (3) reviewing any activity likely to be detrimental to the institution's financial health that is brought to its attention;

 (4) examining the financial statements with the auditor appointed by the board of directors;

 (5) recommending the approval of the financial statements by the board of directors; and

 (6) seeing that internal control mechanisms are put in place and making sure that they are appropriate and effective.

2011, c. 15, s. 33.

181.0.1. With a view to improving the quality of services offered and in a manner respectful of individual and group rights, the board of directors must create a watchdog committee to be responsible mainly for insuring the follow-up, with the board, of the recommendations made by the local service quality and complaints commissioner or the Health and Social Services Ombudsman regarding complaints or interventions made under this Act or the Act respecting the Health and Social Services Ombudsman (chapter P-31.1).

The committee is also to be responsible for coordinating all the activities of the other authorities established within the institution to exercise responsibilities relating to any of the elements mentioned in subparagraph 1 of the second paragraph of section 181.0.3, and for ensuring that their recommendations are followed up.

2005, c. 32, s. 91.

181.0.2. The watchdog committee is composed of five members, including the executive director and the local service quality and complaints commissioner. The other three members are chosen by the board of directors from among board members who do not work for the institution or do not practise their profession in any of the centres operated by the institution, and include one of the persons designated under subparagraph 3 of the first paragraph of section 129.

2005, c. 32, s. 91; 2011, c. 15, s. 34.

181.0.3. The watchdog committee shall ensure that the board of directors fulfils its service quality responsibilities effectively, especially those set out in paragraphs 3 and 4 of section 172.

To that end, the committee must, in particular,

 (1) receive and analyze the reports and recommendations sent to the board of directors on the pertinence, quality, safety or effectiveness of the services provided, the enforcement of user rights or the handling of user complaints;

 (2) establish systemic links between those reports and recommendations and draw from them the conclusions necessary to make recommendations under subparagraph 3;

 (3) make recommendations to the board of directors on the action to be taken following those reports or recommendations in order to improve the quality of user services;

 (4) ensure the follow-up, with the board of directors, of the board's implementation of the recommendations made under subparagraph 3;

 (5) promote joint action and cooperation among the stakeholders concerned by subparagraph 1;

 (6) ensure that the local service quality and complaints commissioner has the necessary human, material and financial resources required to carry out the responsibilities of office effectively and efficiently; and

 (7) exercise any other function that the board of directors considers useful in fulfilling the mandate entrusted to the committee under the first paragraph.

2005, c. 32, s. 91; 2011, c. 15, s. 35.

§ 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 referred to in 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; 2005, c. 32, s. 225.

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 179, 180, 262.1, 322.1, 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; 2005, c. 32, s. 92; 2011, c. 15, s. 36.

DIVISION II 
ADMINISTRATION OF PRIVATE INSTITUTIONS

182. The functions, duties and responsibilities entrusted to a board of directors under sections 29 to 34, 39, 42, 43, 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; 2009, c. 45, s. 28.

182.0.1. Sections 181.0.1 and 181.0.3 apply to a private institution.

However, in that case, the watchdog committee is composed of at least four members, including the executive director and the local service quality and complaints commissioner. The other members are chosen by the board of directors of the private institution or, in the case of an unincorporated institution, by the permit holder.

2005, c. 32, s. 93.

DIVISION II.0.1 
ORGANIZATION OF SERVICES
2011, c. 15, s. 37.

182.0.2. In accordance with province-wide and regional orientations and recognized standards of accessibility, integration, quality, effectiveness and efficiency, and taking into account available resources, the institution is responsible for preparing a multi-year strategic plan containing the following elements:

 (1) a description of the mission of the institution;

 (2) a statement of the social and health needs of the clientele served or the local population, based on an understanding of the health and well-being of that clientele or population;

 (3) a description of the context in which the institution acts and the main challenges it faces;

 (4) the directions and objectives to be pursued with respect to, among other things, the accessibility, continuity, quality and safety of care and services with a view to improving the health and well-being of the population;

 (5) the results targeted over the period covered by the plan; and

 (6) the performance indicators to be used in measuring results.

The strategic plan must also take into account the priorities established in the clinical and organizational projects with which the institution is associated.

2011, c. 15, s. 37.

182.0.3. The strategic plan is sent to the agency.

2011, c. 15, s. 37.

182.0.4. The agency and the institution meet to discuss the adjustments to the strategic plan, where applicable, and to agree on how to follow up on the plan. The adjustments are then submitted to the board of directors of the institution.

2011, c. 15, s. 37.

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 agency.

In the case of an institution that operates a centre designated as a university hospital centre, university institute or affiliated university centre, however, the Minister must be a party to the agreement.

2001, c. 24, s. 35; 2005, c. 32, s. 94; 2011, c. 15, s. 38.

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.

2001, c. 24, s. 35; 2005, c. 32, s. 227; 2011, c. 15, s. 39.

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 agency 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; 2005, c. 32, s. 227.

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 agency may suspend or cancel the management and accountability agreement. The agency shall notify the Minister immediately of the suspension or cancellation.

2001, c. 24, s. 35; 2005, c. 32, s. 227.

§ 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 set out in the strategic plan and in the management and accountability agreement entered into with the agency;

 (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 agency.

2001, c. 24, s. 35; 2005, c. 32, s. 227; 2011, c. 15, s. 40.

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.

182.9. The institution must publish its annual management report on its website.

2011, c. 15, s. 41.

182.10. An institution must set up a website to inform the public of the services it offers.

2011, c. 15, s. 41.

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 agency 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; 2005, c. 32, s. 227.

183.1. The organization plan of an institution must also provide for the creation of a risk 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; 2005, c. 32, s. 226.

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 manager or a risk 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 manager or a member of a risk 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 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; 2005, c. 32, s. 226.

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 management committee are confidential.

No person may have access to the minutes of a risk 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; 2005, c. 32, s. 226.

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 and, in the case of a centre designated as a university hospital centre or a university institute, the distribution of clinical, research and teaching tasks among the physicians. These elements must be determined taking into account the permit of the institution operating the hospital centre, the financial resources at its disposal, 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 agency 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 agency, 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 agency decides on its revision.

1991, c. 42, s. 184; 1992, c. 21, s. 70; 1998, c. 39, s. 67; 2005, c. 32, s. 96.

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.

185.1. The organization plan of a hospital centre must also provide for a central mechanism for managing access to the specialized and superspecialized services of the centre's clinical departments. The mechanism must include specific rules to be followed to enter a user on the access list for the specialized or superspecialized services of a department, the manner in which the estimated date when services will be received is to be determined and communicated to the user and, should the services not be provided on that date, the alternative arrangements to be offered to the user, such as setting a new date to be agreed to by the user, seeing another physician in the department concerned or having recourse to another institution. The mechanism is implemented after consultation with the heads of the clinical departments concerned and the institution's council of physicians, dentists and pharmacists.

To ensure uniform management of access lists under the first paragraph, the Minister may determine the information to be collected and used by the institutions for the day-to-day management of their access lists. If the Minister so requires, this information must be communicated to the provider chosen under section 520.3.0.1, in the manner and within the time specified by the Minister, so that the provider may retain and manage the information for each institution.

The organization plan must also identify the person responsible for the central access management mechanism. Under the authority of the director of professional services, that person shall see to it that each clinical department head concerned ensures the proper operation of the mechanism in the department. In addition, that person shall offer, to users unable to receive the services on the date communicated to them, the alternative arrangements specified in the mechanism. Finally, that person shall make any adjustments required by the Minister's directives under section 431.2.

The executive director shall report to the board of directors at least once every three months on the effectiveness of the central access management mechanism, in particular as regards waiting times calculated from the time users are entered on the access list referred to in the first paragraph to the time they receive the specialized or superspecialized services they require.

2006, c. 43, s. 7.

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, 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 or where a local authority operates a hospital centre.

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 agency for approval in accordance with section 378. Once approved by the agency, 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 agency decides on its revision.

1991, c. 42, s. 186; 1992, c. 21, s. 20; 1998, c. 39, s. 69; 2005, c. 32, s. 97.

187. The organization plan of every institution must also provide for any element required under this Act or a regulation made under paragraphs 11 and 13 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;

 (3.1) ensuring that the rules and procedures of the central access management mechanism provided for in section 185.1 are observed in 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; 2006, c. 43, s. 8.

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 board of directors 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; 2008, c. 11, s. 212.

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

192.1. The board of directors of a public institution must draw up an expertise and experience profile for the appointment of the executive director.

2011, c. 15, s. 42.

193. The executive director of a public institution is appointed by the board of directors on the recommendation of a selection committee.

The selection committee is established by the board of directors and is composed of five members, including one person designated by the Minister and one person designated by the agency.

The recommendation of the selection committee to the board of directors must receive the consent of the majority of the committee members.

If the recommendation of the selection committee does not receive either the consent of the person designated by the Minister or the consent of the person designated by the agency, the board of directors must establish a new selection committee.

1991, c. 42, s. 193; 1992, c. 21, s. 21; 1998, c. 39, s. 70; 2001, c. 24, s. 36; 2005, c. 32, s. 227; 2011, c. 15, s. 42.

193.0.1. If the board of directors administers more than one institution, the executive director is the executive director of each of those institutions.

If the executive director is absent or unable to act, the board of directors may designate a person to exercise the functions and powers of the executive director.

2011, c. 15, s. 42.

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 agency 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 agency 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; 2005, c. 32, s. 227.

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 agency 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; 2005, c. 32, s. 227.

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 agency 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 agency for the period of disqualification determined in the judgment. That period shall not exceed three years.

1991, c. 42, s. 200; 2005, c. 32, s. 227.

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. When informed of the imminent or recent death of a potential organ or tissue donor, the director of professional services of an institution operating a general and specialized hospital shall diligently

 (1) verify, with one of the organizations that coordinate organ or tissue donations and are designated by the Minister under section 2.0.11 of the Act respecting the Régie de l'assurance maladie du Québec (chapter R-5), whether the potential donor's consent for the post-mortem removal of organs or tissues is recorded in the consent registries established by the Ordre professionnel des notaires du Québec and the Régie de l'assurance maladie du Québec, in order to determine the donor's last wishes expressed in this regard in accordance with the Civil Code; and

 (2) send to such an organization, if the consent has been given, any necessary medical information concerning the potential donor and the organs or tissues that may be removed.

The director of professional services is informed of the imminent or recent death of a potential organ or tissue donor in accordance with the procedure established by the institution.

1993, c. 14, s. 1; 2010, c. 38, s. 3.

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 paragraph 13 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 paragraph 13 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. A users' committee is established for each institution, and each institution must, in the case of a public institution or of a private institution which is a party to an agreement allocate to it 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, allocate to it the amount paid for that purpose by the Minister.

However, an institution operating a residential and long-term care centre that has facilities in more than one region of Québec may choose to set up one users' committee for each region or a single users' committee for two or more regions, the committee members being elected by the users of the region or regions concerned.

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; 2009, c. 45, s. 29; 2011, c. 15, s. 43.

209.0.1. Despite the third paragraph of section 209, an institution may choose not to set up an in-patients' committee for a facility that provides lodging to fewer than 10 users or that expects to provide lodging to most of its users for a period of less than six months.

In such a case, after consulting its users' committee, the institution must either entrust the exercise of the functions set out in section 212.1 to the users' committee, or group the facility together with one or more other facilities maintained by the institution in order to establish a single in-patients' committee for all those facilities.

Sections 209 to 212.1 then apply, with the necessary modifications.

Each year, the institution must assess the effectiveness of the measure chosen under the second paragraph and, if need be, modify it in accordance with this section.

2009, c. 45, s. 30.

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;

 (6) to assess the effectiveness of any measure implemented under section 209.0.1.

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 agency.

1991, c. 42, s. 212; 1998, c. 39, s. 74; 2001, c. 43, s. 47; 2005, c. 32, s. 104; 2009, c. 45, s. 31.

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 established under section 125 or 128 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; 2005, c. 32, s. 106.

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 under section 125 or 128 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; 2005, c. 32, s. 108.

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.

1999, c. 24, s. 32; 2001, c. 24, s. 41; 2005, c. 32, s. 111.

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 under section 125 or 128 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; 2005, c. 32, s. 112.

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 incidents 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 agency at agreed intervals or whenever the agency 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 organization plan and of the medical and dental staffing plan of the institution as approved by the agency.

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; 2005, c. 32, s. 115.

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 and, in addition, before accepting or refusing an application, take into account the distribution of the clinical, research and teaching tasks among the physicians, having regard to the specific requirements of the institution.

1991, c. 42, s. 238; 1992, c. 21, s. 70; 1998, c. 39, s. 77; 2005, c. 32, s. 116.

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 agency; the agency 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; 2005, c. 32, s. 227.

240.1. Where the agency has reason to believe that privileges have been granted to a physician by an institution in contravention of section 240, the agency shall conduct an inquiry in accordance with section 414; the agency shall communicate the results of its inquiry to the Minister, the institution and the physician concerned.

2001, c. 24, s. 44; 2005, c. 32, s. 227.

240.2. Where the results of the inquiry show that the institution contravened section 240, the agency 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 agency may bring a proceeding to annul pursuant to section 239.

2001, c. 24, s. 44; 2005, c. 32, s. 227.

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. In addition, where an institution operates a hospital centre designated as a university hospital centre or a university institute, the board's resolution must specify, if applicable, the breakdown of the clinical, research and teaching tasks assigned to that physician or dentist.

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; 2005, c. 32, s. 117.

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 agency, that the agency 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; 2005, c. 32, s. 227.

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 agency of all applications for appointment or renewal of appointment that have been accepted by the board of directors.

1991, c. 42, s. 245; 2005, c. 32, s. 227.

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 agency 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; 2005, c. 32, s. 227.

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. During that period, the physician may not practise in a specialized medical centre described in subparagraph 2 of the first paragraph of section 333.3.

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; 2006, c. 43, s. 9.

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 paragraph 22 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 paragraph 22 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 agency 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; 2005, c. 32, s. 118.

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 agency 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; 2005, c. 32, s. 119.

259.11. An institution that operates a local community service centre designated by the agency 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; 2005, c. 32, s. 120.

DIVISION IV 
MATERIAL AND FINANCIAL RESOURCES

§ 1. —  Rules relating to material resources

260. No public institution may, without having obtained the advice of the agency 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;

 (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; 2005, c. 32, s. 227.

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 agency, the sum and the revenues may also be used to finance a specific operating expenditure of the institution.

1991, c. 42, s. 262; 2005, c. 32, s. 227.

262.1. Any institution which is a legal person referred to in 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 agency 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; 2005, c. 32, s. 227; 2005, c. 32, s. 225.

263. No public institution or private institution under agreement may, without having obtained prior authorization from the agency,

 (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; 2005, c. 32, s. 227.

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.

263.2. No public institution or private institution under agreement may, without having obtained prior authorization from the Minister, lease its facilities to a non-participating professional within the meaning of the Health Insurance Act (chapter A-29) or otherwise allow such a professional to use its facilities to provide medical services.

2006, c. 43, s. 10.

264. A contract made by an institution without the prior authorization of the Conseil du trésor, the Minister or the agency 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 or, as applicable, in accordance with the Act respecting contracting by public bodies (chapter C-65.1).

An action for nullity of a contract made by an institution contrary to this section may be instituted by the Minister, the agency 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; 2005, c. 32, s. 227; 2006, c. 29, s. 42.

265. No public institution may

 (1) acquire shares in another legal person or operate a commercial enterprise, except with the advice of the agency 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 agency, 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 agency 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; 2005, c. 32, s. 227.

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 agency, 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 agency 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 agency 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 agency or the Minister.

1991, c. 42, s. 268; 1998, c. 39, s. 86; 2005, c. 32, s. 227.

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 agency 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; 2005, c. 32, s. 227.

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 agency, 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; 2005, c. 32, s. 227.

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 agency 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 agency 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) (subparagraph repealed);

 (4) (subparagraph repealed).

The application must be accompanied with such documents and contain such information as are determined by the agency.

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 agency shall notify the institution of the eligibility of the project or of the requirements for its approval.

However, the agency 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 agency or the Minister.

1991, c. 42, s. 272; 1996, c. 36, s. 51; 1998, c. 39, s. 90; 2005, c. 32, s. 122.

273. The agency 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 agency 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; 2005, c. 32, s. 227.

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 agency 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 agency.

1991, c. 42, s. 278; 2002, c. 71, s. 12; 2005, c. 32, s. 227; 2011, c. 15, s. 44.

279. Every institution must, at the request of the agency, 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 agency. 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; 2005, c. 32, s. 227.

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 agency, 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; 2005, c. 32, s. 227.

285. Before 1 April each year, the agency shall inform every board of directors of the institutions referred to in sections 125 and 128 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 agency, 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 agency 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 agency, within 60 days, along with the operating budget of the institution.

1991, c. 42, s. 285; 1996, c. 36, s. 28; 2005, c. 32, s. 124.

286. Before 1 April each year, the agency 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 agency 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 agency, within 60 days, along with the operating budget of the institution.

1991, c. 42, s. 286; 2005, c. 32, s. 227.

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 agency 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; 2005, c. 32, s. 227.

288. Each institution shall transmit to the agency, 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 agency or the Minister.

The agency shall furnish a copy of these reports to the Minister at his request.

1991, c. 42, s. 288; 2005, c. 32, s. 227.

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 agency or the Minister.

1991, c. 42, s. 293; 2005, c. 32, s. 227.

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 agency 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 agency or by the Minister.

The institution shall publish its annual financial report on its website within 30 days after the report is adopted by the board of directors, subject to the protection of the personal information it contains.

1991, c. 42, s. 295; 2005, c. 32, s. 227; 2011, c. 15, s. 45.

296. Notwithstanding any legislative provision inconsistent herewith, an institution may, with the prior authorization of the agency 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 agency may allow borrowings to be made under the first paragraph, and the maximum amount of such borrowings.

1991, c. 42, s. 296; 2005, c. 32, s. 227.

297. At the request of the agency 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; 2005, c. 32, s. 227.

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 agency 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 agency, 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; 2005, c. 32, s. 227.

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 agency.

1991, c. 42, s. 300; 1998, c. 39, s. 93; 2005, c. 32, s. 227.

DIVISION V 
INTERMEDIATE AND FAMILY-TYPE RESOURCES

§ 1. —  Intermediate resources

301. A public institution identified by the agency 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. An intermediate resource is a resource that is operated by a natural person as a self-employed worker or by a legal person or a partnership and is recognized by an agency for the purpose of participating in the maintenance of users otherwise registered for a public institution's services in the community or in their integration into the community by providing them with a living environment suited to their needs, together with the support or assistance services required by their condition.

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; 2009, c. 24, s. 112.

302.1. (Repealed).

2003, c. 12, s. 1; 2009, c. 24, s. 113.

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, the Minister shall propose to agencies a classification of the services offered by intermediate resources based on the degree of support or assistance required by users.

The Minister shall also identify the policy to be followed by agencies in determining the rules and procedures governing access to the services provided by intermediate resources, including the general criteria for admission to such resources.

The remuneration for each type of service listed in the classification established under the first paragraph is determined

 (1) in accordance with the Act respecting the representation of family-type resources and certain intermediate resources and the negotiation process for their group agreements (chapter R-24.0.2) in the case of intermediate resources represented by an association recognized under that Act;

 (2) by the Minister, with the authorization of the Conseil du trésor and on the conditions it determines, in the case of intermediate resources to whom that Act applies but who are not represented by an association recognized under that Act; or

 (3) in accordance with section 303.1, in the case of intermediate resources to whom that Act does not apply.

1991, c. 42, s. 303; 1998, c. 39, s. 95; 2003, c. 12, s. 2; 2005, c. 32, s. 125; 2009, c. 24, s. 114.

303.1. The Minister may, with the authorization of the Conseil du trésor and on the conditions it determines, enter into an agreement with one or more bodies representing intermediate resources, other than those to whom the Act respecting the representation of family-type resources and certain intermediate resources and the negotiation process for their group agreements (chapter R-24.0.2) applies, on the following subjects:

 (1) minimum and specific conditions for the delivery of services by those intermediate resources;

 (2) the modes and scale of remuneration for those services, taking into account the classification established by the Minister under section 303 as well as various measures, terms and conditions applicable to the payment of the remuneration;

 (3) the funding, implementation and maintenance of programs and services that meet the needs of all resources the body represents, particularly with regard to training and professional development;

 (4) the setting up of a joint committee either to ensure the administrative follow-up of the agreement, the provision of adequate training and professional development to maintain existing resources and renew them, or for any other purpose deemed useful or necessary by the parties.

Such an agreement is binding on the agencies, the institutions and all intermediate resources covered by the agreement, whether or not they are members of the body that entered into the agreement.

If no agreement is entered into under this section, the mode and scale of remuneration for the services, as well as the various measures, terms and conditions applicable to the payment of the remuneration are determined by the Minister, with the authorization of the Conseil du trésor and subject to the conditions it determines.

2003, c. 12, s. 3; 2005, c. 32, s. 227; 2009, c. 24, s. 115.

303.2. A body is considered representative of the intermediate resources referred to in section 303.1 if the membership of that body includes, on a Québec-wide scale, both resources for children or resources for adults 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 such intermediate resources who intervene only on a local or regional scale, provided that the bodies as a group 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 evidencing its establishment, and the name and address of each of its members.

A group must provide up-to-date documents evidencing 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; 2009, c. 24, s. 115.

304. The agency 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 the professional follow-up of the users referred to the resources;

 (3) (paragraph repealed);

 (4) ensure that mechanisms for concerted action between institutions and their intermediate resources are established and put into operation, in particular with regard to group agreements entered into under the Act respecting the representation of family-type resources and certain intermediate resources and the negotiation process for their group agreements (chapter R-24.0.2) or under section 303.1.

1991, c. 42, s. 304; 1998, c. 39, s. 96; 2003, c. 12, s. 4; 2005, c. 32, s. 227; 2009, c. 24, s. 116.

305. Public institutions identified by the agency shall themselves recruit and assess intermediate resources with a view to their recognition by the agency.

1991, c. 42, s. 305; 2005, c. 32, s. 227.

305.1. An intermediate resource whose recognition is suspended or revoked by an agency may contest that decision before the Administrative Tribunal of Québec within 60 days after being notified of the decision.

2009, c. 24, s. 117.

305.2. An agency whose decision is contested is a party to the proceeding within the meaning of section 101 of the Act respecting administrative justice (chapter J-3) and must, among other things, send the documents and information referred to in the first paragraph of section 114 of that Act to the secretary of the Tribunal within 30 days after receiving a copy of the motion.

2009, c. 24, s. 117.

305.3. The intermediate resource may, during the proceeding, be assisted or represented by the resource association recognized for the representation unit to which the resource belongs or by the representative body of which the resource is a member.

2009, c. 24, s. 117.

306. With the authorization of the agency, several institutions may call upon the services of the same intermediate resource. The agency shall, however, see to it that the institutions concerned agree on the professional follow-up of the users and on the payments made to the resource.

1991, c. 42, s. 306; 2005, c. 32, s. 227; 2009, c. 24, s. 118.

307. Every person responsible for an intermediate resource referred to in section 303.1 may apply to the agency for review of a decision made by the public institution to which the resource is attached to settle any misunderstanding concerning them.

The agency 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 agency shall transmit its decision to the institution and to the person responsible for the intermediate resource.

1991, c. 42, s. 307; 2005, c. 32, s. 227; 2009, c. 24, s. 119.

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 agency 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 or persons with a pervasive developmental disorder 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; 2005, c. 32, s. 227; 2005, c. 32, s. 126.

311. Family-type resources comprise foster families and foster homes.

1991, c. 42, s. 311.

312. One or two persons receiving in their principal place of residence 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 principal place of residence 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 principal place of residence.

1991, c. 42, s. 312; 2009, c. 24, s. 120.

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 303, 304 to 306 and 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; 2009, c. 24, s. 121.

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.

The letters patent give the names of no fewer than five persons and not more than the maximum number of persons elected, designated, appointed or co-opted under section 129; such persons are members of the board of directors until the elections, designations, appointments or co-optations provided for in that section take place. Once appointed, the executive director of the institution is also 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; 2005, c. 32, s. 127; 2011, c. 15, s. 46.

319.1. (Repealed).

1996, c. 36, s. 30; 2001, c. 24, s. 47; 2005, c. 32, s. 128.

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 agency, between the institution and the Minister.

1991, c. 42, s. 325; 2005, c. 32, s. 227.

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 referred to in 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; 2005, c. 32, s. 225.

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 agency, 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; 2005, c. 32, s. 227.

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 agency, 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; 2005, c. 32, s. 227.

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 I.1 
SPECIALIZED MEDICAL CENTRES
2006, c. 43, s. 11.

333.1. In this Act, “specialized medical centre” means a place, outside a facility maintained by an institution, that is equipped for the provision by one or more physicians of medical services necessary for a hip or knee replacement, a cataract extraction and intraocular lens implantation or any other specialized medical treatment determined by regulation of the Government.

The regulation may specify that a type of surgery or other specialized medical treatment referred to in the first paragraph may be provided only in a centre described in section 333.3 and, in the case of a centre described in subparagraph 1 of the first paragraph of that section, only under an agreement under section 349.3.

The factors the Government must take into account for the purpose of determining a specialized medical treatment include the risks generally associated with the treatment, the necessary personnel and equipment, and, if applicable, the type of anaesthesia normally used for and the length of stay usually required after the treatment.

Before making a regulation under the first paragraph, the Government must consult the Collège des médecins du Québec.

2006, c. 43, s. 11; 2009, c. 29, s. 1.

333.1.1. Specialized medical treatment not provided for in a regulation under the first paragraph of section 333.1 may be provided only in an institution operating a hospital centre if general, spinal or limb block, excluding digital block, anaesthesia is used.

2009, c. 29, s. 2.

333.2. A physician who is a member of the Collège des médecins du Québec is the only natural person who may operate a specialized medical centre. If the operator of the centre is a legal person or a partnership, more than 50% of the voting rights attached to the shares of the legal person or the interests in the partnership must be held

 (1) by physicians who are members of that professional order;

 (2) by a legal person or a partnership all of whose voting rights attached to the shares or interests are held

(a)  by physicians described in subparagraph 1; or

(b)  by another legal person or partnership all of whose voting rights attached to the shares or interests are held by such physicians; or

 (3) both by physicians described in subparagraph 1 and by one or more legal persons or partnerships described in subparagraph 2.

The affairs of a legal person or a partnership that operates a specialized medical centre must be administered by a board of directors or internal management board a majority of whose members are physicians practising in the centre; such physicians must at all times form the majority of the quorum of the board of directors or internal management board.

The shareholders of a legal person or the partners in a partnership that operates a specialized medical centre may not enter into an agreement that restricts the power of the directors of the legal person or the partnership.

A producer or distributor of a good or service related to health and social services who is not a physician described in the first paragraph may not hold, directly or indirectly, any shares of the legal person or any interest in the partnership operating a specialized medical centre if such a good or such a service may be required by the centre's clientele before, while or after a medical service is provided.

2006, c. 43, s. 11; 2009, c. 29, s. 3.

333.3. A specialized medical centre may be operated only in the form of

 (1) a specialized medical centre where only physicians subject to the application of an agreement under section 19 of the Health Insurance Act (chapter A-29) practise; or

 (2) a specialized medical centre where only non-participating physicians within the meaning of that Act practise.

Depending on the form in which a specialized medical centre operates, its operator must ensure that the requirement of subparagraph 1 or 2 of the first paragraph is met.

2006, c. 43, s. 11.

333.4. Within three years after the permit required under section 437 is issued, the operator of a specialized medical centre must have the services provided in the centre accredited by an accreditation body recognized by the Minister. The accreditation must subsequently be maintained at all times.

2006, c. 43, s. 11.

333.4.1. The operator of a specialized medical centre must ensure that the medical services provided in the centre meet generally recognized standards of quality and safety.

2009, c. 29, s. 4.

333.5. The operator of a specialized medical centre must appoint a medical director. The medical director must be chosen from among the physicians practising in the centre.

The medical director, under the authority of the operator, is responsible for

 (1) organizing the medical services provided in the centre;

 (2) ensuring the quality and safety of those services;

 (3) seeing that standard medical procedures for all surgery or other specialized medical treatment provided in the centre are established and complied with; and

 (4) taking any other measure necessary for the proper operation of the centre.

2006, c. 43, s. 11; 2009, c. 29, s. 5.

333.6. The operator of a specialized medical centre described in subparagraph 2 of the first paragraph of section 333.3 must offer persons who have surgery or receive some other specialized medical treatment referred to in section 333.1 in the centre, either directly or through another private resource with which the operator has entered into an agreement and to which the operator refers those persons, all the preoperative and postoperative services normally associated with the surgery or treatment, excluding any services associated with complications, and all the rehabilitation services and home care support services needed for complete recovery. The operator of the centre must also inform a person who wishes to receive such surgery or specialized medical treatment in the centre that the person must also obtain the preoperative, postoperative, rehabilitation and home care support services either in the centre or from another private resource. In addition, the operator of the centre must inform the person of the total foreseeable cost of the preoperative, postoperative, rehabilitation and home care support services that the person must obtain either in the centre or from another private resource.

The obligations under the first paragraph also apply to the operator of a specialized medical centre described in subparagraph 1 of the first paragraph of section 333.3 with respect to specialized medical treatment described in section 333.1 and provided in the centre that is non-insured or considered non-insured under the Health Insurance Act (chapter A-29).

The cost of medical services obtained from a private resource under the first or second paragraph may not be assumed by the Régie de l'assurance maladie du Québec.

However, if surgery or other specialized medical treatment is provided under an agreement under the second paragraph of section 108 or under an alternative access mechanism implemented under section 431.2, the Minister may allow the obligations under this section not to apply.

2006, c. 43, s. 11; 2009, c. 29, s. 6.

333.7. Only the following medical services may be provided in a specialized medical centre:

 (1) medical services necessary for surgery or any other specialized medical treatment referred to in section 333.1 and entered on the permit issued to the operator of the specialized medical centre under section 441;

 (2) medical services identified in section 333.6 that are associated with such surgery or such specialized medical treatment; and

 (3) medical services corresponding to activities permitted in a private health facility.

The operator of a specialized medical centre must ensure compliance with the first paragraph.

2006, c. 43, s. 11; 2009, c. 29, s. 7.

333.7.1. Not later than 31 March each year, the operator of a specialized medical centre must send the Minister and the agency in the centre's territory a report on the centre's activities for the preceding calendar year. The report must include the name of the medical director, the name of the general practitioners and the specialists, by specialty, who practised in the centre, the number of specialized medical treatments provided in the centre, by type of treatment entered on the permit, and any other information required by the Minister.

The information provided under the first paragraph must not allow the centre's clientele to be identified.

2009, c. 29, s. 8.

333.8. The Minister may request an advisory opinion from the board of directors of a professional order on the quality and safety of the professional services provided in a specialized medical centre by the members of the order.

The Minister may also require an advisory opinion from the board of directors of a professional order on the standards to be followed to improve the quality and safety of the professional services provided in such a centre by the members of the order.

2006, c. 43, s. 11; 2008, c. 11, s. 212.

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. An agency 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;

 (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.

An agency may also subsidize a community organization committed, at the regional level, to promoting health and social development.

1991, c. 42, s. 336; 2005, c. 32, s. 130.

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;

 (4) provincial groups of community organizations.

The Minister may also subsidize a community organization to which the Minister has given a mandate to assist and support users under the first paragraph of section 76.6, for the purposes of that mandate.

1991, c. 42, s. 337; 2005, c. 32, s. 131.

338. Every community organization or provincial group that receives a subsidy in one of the cases described in section 336 or 337 must, within three months after the end of its fiscal year, send its activity report and its financial report to the authority from which it received the subsidy.

1991, c. 42, s. 338; 2011, c. 27, s. 6.

338.1. Despite any inconsistent provision of this Act or the regulations, a community organization may offer termination of pregnancy services on its premises if it obtains authorization from the Minister.

A community organization seeking that authorization must send its application to the agency so the agency may determine whether the needs in its region justify those services.

After approving the application, the agency shall send it to the Minister, who shall grant the authorization if of the opinion that it is in the public interest.

The authorization is valid until it is revoked.

Sections 333.4, 333.5, 333.8, 446.1 to 450 and 489 apply, with the necessary modifications, to such a community organization, as the operator for the purposes of those sections.

2009, c. 29, s. 9.

PART III 
COORDINATION, CONTROL AND REGULATION OF HEALTH SERVICES AND SOCIAL SERVICES

TITLE I 
REGIONAL INSTITUTIONS

CHAPTER I 
HEALTH AND SOCIAL SERVICES AGENCIES
2005, c. 32, s. 227.

DIVISION I 
STATUS AND OBJECTS

339. The Government shall establish, for each region it delimits, a health and social services agency.

1991, c. 42, s. 339; 2005, c. 32, s. 227.

340. The agency is established to carry out the functions necessary for coordinating the establishment of health services and social services in its area of jurisdiction, in particular as regards financing, human resources and specialized services.

To that end, the objects of the agency 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) facilitating the development and management of the local health and social services networks in its region;

 (3) preparing the multi-year strategic plan referred to in section 346.1 and ensuring follow-up;

 (4) allocating the budgets intended for the institutions, granting subsidies to community organizations and granting financial allowances to the private resources referred to in section 454;

 (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 private nursing homes and community organizations referred to in section 454 and promoting their cooperation with the other agents of community development;

 (5.1) ensuring the coordination of the services in its region with those offered in neighbouring regions and, on the Minister's request, coordinating interregional services;

 (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);

 (7.2) assessing the results of implementing its strategic plan and ensuring management accountability on the basis of province-wide and regional targets and recognized standards of accessibility, integration, quality, effectiveness and efficiency;

 (7.3) supporting institutions in the organization of services and becoming involved with institutions to foster service agreements entered into to meet the needs of the general public or, if no agreement is entered into, determining the contribution expected of each institution in accordance with section 105.1;

 (7.4) allowing the use of numerous standard agreement models in order to facilitate the making of agreements under subparagraph 7.3;

 (7.5) ensuring that the mechanisms for referral and for service coordination between institutions are established and functional;

 (7.6) developing information and management tools for the institutions in its region and adapting them to the distinctive characteristics of those institutions;

 (7.7) establishing procedures and mechanisms to inform the general public and involve people in the organization of services, and to ascertain their level of satisfaction with the results obtained; the agency must report on the application of this subparagraph in a separate section of its annual management report;

 (7.8) developing mechanisms for the protection of users and for user rights advocacy; and

 (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; 2005, c. 32, s. 132; 2011, c. 15, s. 47.

340.1. An agency exercises its responsibilities by taking into consideration the proposals made by an integrated university health network under section 436.6.

In addition, an agency must seek the advice of the integrated university health network serving its area of jurisdiction on any question relating to technical facilities, medical staff or services corridors.

A decision made by the agency following the proposals or advice of an integrated university health network must be substantiated and be sent to the network in writing.

2005, c. 32, s. 133.

341. The name of an agency must include the expression “health and social services agency” and indicate the region for which it is established.

1991, c. 42, s. 341; 2005, c. 32, s. 134.

342. An agency is a legal person and a mandatary of the State. The property of an agency forms part of the domain of the State, but the execution of the obligations of an agency may be levied against its property.

An agency binds none but itself when it acts in its own name.

1991, c. 42, s. 342; 1996, c. 36, s. 51; 1999, c. 40, s. 269; 2005, c. 32, s. 135.

342.1. Each agency 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 agency.

A copy of the by-laws adopted by an agency must be forwarded to the Minister at the Minister's request.

1998, c. 39, s. 99; 2005, c. 32, s. 227.

DIVISION II 
SPECIAL FUNCTIONS

§ 1. —  Functions in respect of the population and the rights of users

343. The agency shall see that mechanisms for public participation provided for in this Act, such as users' committees and in-patients committees, are implemented.

The agency shall supervise the election, designation and co-optation of the members of the boards of directors of public institutions where provided for by this Act.

1991, c. 42, s. 343; 1996, c. 36, s. 32; 2005, c. 32, s. 136; 2009, c. 45, s. 32; 2011, c. 15, s. 48.

343.0.1. Every agency must set up a website to inform the public of the services offered in the region.

2011, c. 15, s. 49.

343.1. An agency may establish a people's forum in its area of jurisdiction; the activities of the forum are coordinated by the president and executive director.

The forum shall be composed of 15 to 20 members designated by the board of directors of the agency. The term of office of those members is four years.

To take into account the regional particularities, the agency shall enter into an agreement with the regional conference of elected officers referred to in section 21.5 of the Act respecting the Ministère des Affaires municipales, des Régions et de l'Occupation du territoire (chapter M-22.1) 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; 2005, c. 32, s. 227; 2006, c. 8, s. 26; 2009, c. 26, s. 109; 2011, c. 15, s. 50.

343.2. The people's forum is responsible to the board of directors of the agency

 (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; 2005, c. 32, s. 227.

343.3. The people's forum shall establish its own operating rules and submit them for approval to the board of directors of the agency.

2001, c. 24, s. 50; 2005, c. 32, s. 227.

343.4. The people's forum shall meet with the board of directors of the agency at least twice a year, and the meetings shall be open to the public.

2001, c. 24, s. 50; 2005, c. 32, s. 227.

343.5. The agency shall place at the disposal of the people's forum the resources the agency considers necessary for the exercise of the forum's responsibilities.

2001, c. 24, s. 50; 2005, c. 32, s. 227.

343.6. The agency must report on the activities of the people's forum, in particular the consultation mechanisms used, at the time of the presentation of its annual report of activities to the population of its territory at a public meeting of its board of directors.

2001, c. 24, s. 50; 2005, c. 32, s. 137.

344. The agency 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; 2005, c. 32, s. 227.

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 agency shall see that orientations and priorities in the area of health and welfare are respected. 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 with a view to preparing its multi-year strategic plan;

 (3) inform the Minister of the needs of the population with a view to the preparation and update, by the agency, of the multi-year strategic plan developed under section 431.1 and the 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 agency 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; 2005, c. 32, s. 138.

§ 2.1. —  Functions related to the identification and certification of private seniors' residences and certain resources offering lodging to vulnerable clienteles
2005, c. 32, s. 139; 2009, c. 46, s. 2; 2011, c. 27, s. 38.

346.0.1. Each agency must, for the purpose of identifying the private seniors' residences in its region, establish and maintain a register of those residences.

For the purposes of this Act, a private seniors' residence is all or part of a congregate residential facility occupied or designed to be occupied mainly by persons 65 years of age or over; in addition to leasing rooms or apartments, the operator of the residence offers various services included in at least two of the following categories of services, defined by regulation: meal services, personal assistance services, nursing care services, domestic help services, security services or recreation services. The cost of those services may be included in the rent or paid in another manner.

Each agency collects the following information to establish the register and keep it up to date: the name and address of the operator, the number of the certificate of compliance issued to the operator under this subdivision, or the number of the operator's temporary certificate of compliance if the operator does not hold a certificate of compliance, the period of validity of the certificate concerned, the name and address of the person in charge of the residence if that person is not the operator, the address and physical description of the residence, certain information concerning the building, the municipal permits the operator holds and any other permit required to carry on the operator's activities, certain characteristics of the residence, the services offered by the operator of the residence, the facilities available and, if applicable, the category of private seniors' residence to which the residence belongs. In addition, if a residence is administered by a board of directors, the agency shall draw up a list of board members comprising the name, address, occupation and function of each member, as well as the nature of any family relationships between the members themselves or between members and persons working at the residence. This information, with the exception of that concerning any family relationships between the members or between members and persons working at the residence, is public information.

The Government may, by regulation, define the categories of services listed in the second paragraph, specify the information that must be collected and kept up to date by an agency under the third paragraph, prescribe any other information to be collected and kept up to date and determine whether it is public information. It may also provide for categories of private seniors' residences including at least one category of residences offering services for independent elderly persons and one category of residences offering services for semi-independent elderly persons.

For the purposes of the second paragraph,

 (1) services offered indirectly by the operator of a private seniors' residence, in particular through a legal person or a partnership controlled by or that controls the operator or through another resource with which the operator has entered into an agreement for that purpose, are considered to be offered by the operator;

 (2) a facility operated by an institution or a building, a part of a building or a dwelling offering the services of an intermediate resource or a family-type resource, which remains subject to the other provisions applicable to it under this Act, is not a private seniors' residence.

2002, c. 36, s. 1; 2005, c. 32, s. 140; 2009, c. 46, s. 3; 2011, c. 27, s. 38; 2011, c. 27, s. 7.

346.0.2. No person may begin operating a private seniors' residence without having obtained a temporary certificate of compliance from the agency for the region where the residence will be situated.

2002, c. 36, s. 1; 2005, c. 32, s. 227; 2011, c. 27, s. 38; 2011, c. 27, s. 8.

346.0.3. To obtain a temporary certificate of compliance, a person must apply in writing to the agency using the form provided by the agency.

The agency shall issue a temporary certificate of compliance if, in addition to providing the information required under the third and fourth paragraphs of section 346.0.1, the person possesses the qualifications, fulfills the conditions and provides the documents and other information prescribed by government regulation.

However, the agency must refuse to issue a temporary certificate of compliance to an applicant if the applicant or, if applicable, one of the directors or officers of the applicant is charged with or convicted of an indictable or other offence related to the abilities and conduct required to operate a private seniors' residence, unless, in the case of a conviction, a pardon has been obtained.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 8.

346.0.4. From the beginning of the period of validity of the temporary certificate of compliance, the operator of a private seniors' residence is subject to this subdivision and the regulations.

Not later than one year after the beginning of the period referred to in the first paragraph, the operator must obtain from the agency a certificate of compliance attesting that the operator meets the health and social criteria prescribed under paragraph 2 of section 346.0.6.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 8.

346.0.4.1. The agency shall begin the certification process at the very beginning of the period of validity of the temporary certificate of compliance.

For the purpose of carrying out the verifications required by that process, the agency may enter into an agreement with a body recognized by the Minister.

Such an agreement sets out the conditions for the verifications.

2011, c. 27, s. 8.

346.0.4.2. At the end of the one-year period specified in section 346.0.4, an agency must refuse to issue a certificate of compliance if the operator of a private seniors' residence does not meet the health and social criteria prescribed under paragraph 2 of section 346.0.6.

An agency may also refuse to issue a certificate for any of the reasons listed in section 346.0.11.

In exceptional circumstances, an agency may extend the one-year period referred to in the first paragraph, in particular if the failure to meet a health and social criterion is attributable to a cause beyond the operator's control. The agency may attach conditions to the extension.

2011, c. 27, s. 8.

346.0.4.3. Both the certificate of compliance and the temporary certificate of compliance must state the name of the operator of the private seniors' residence, the address of the residence, the category to which the residence belongs and the period of validity of the certificate concerned.

2011, c. 27, s. 8.

346.0.5. The operator of a private seniors' residence who holds a certificate of compliance or a temporary certificate of compliance must publicly display its certificate in the residence at all times.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 8.

346.0.5.1. On 1 April each year, the operator of a private seniors' residence must file a return with the agency of the region concerned containing the information required under the third and fourth paragraphs of section 346.0.1.

2011, c. 27, s. 8.

346.0.5.2. Before directing an elderly person to a private seniors' residence or proposing such a residence, an institution must ensure that the operator of the residence holds a certificate of compliance or a temporary certificate of compliance.

2011, c. 27, s. 8.

346.0.6. In addition to the other regulatory powers conferred on it by this subdivision, the Government may prescribe, by regulation,

 (1) (paragraph repealed);

 (1.1) the qualifications an applicant for a temporary certificate of compliance must possess, the conditions the applicant must fulfill and the information and documents the applicant must provide, in particular to enable the agency to verify compliance with the third paragraph of section 346.0.3;

 (1.2) the information and documents the operator of a private seniors' residence must provide to the agency for the purposes of the certificate renewal process, including the information and documents it must provide to enable the agency to verify compliance with paragraph 4 of section 346.0.11;

 (2) the health and social criteria with which the operator of a private seniors' residence must comply to receive a certificate of compliance, which may vary according to category of private seniors' residence;

 (2.1) the conditions that staff members and volunteers of a private seniors' residence and any other person working in such a residence must fulfill, depending on their duties, in particular conditions relating to training and security, including conditions relating to judicial records, and the information and documents those persons must provide to the operator of the residence to enable the operator to verify whether those conditions have been fulfilled;

 (3) the cases, conditions and circumstances in which this subdivision, one of its provisions or a regulatory provision does not apply to an operator of a private seniors' residence;

 (3.1) the tools and procedures to be used to assess the autonomy of the elderly persons who reside or wish to reside in a private seniors' residence;

 (3.2) the obligation of an operator of a private seniors' residence that has more rooms and apartments than the number determined by regulation to establish a residence life committee, and the functions and composition of that committee;

 (4) the fees payable for issuing or renewing, if applicable, a certificate of compliance or a temporary certificate of compliance;

 (5) any other certification measure;

 (6) any other standard applicable to the operation of a private seniors' residence; and

 (7) the provisions of a regulation under this section whose violation constitutes an offence.

2005, c. 32, s. 141; 2009, c. 46, s. 4; 2011, c. 27, s. 38; 2011, c. 27, s. 9.

346.0.7. The Government must include in the health and social criteria determined under paragraph 2 of section 346.0.6 the minimum number of persons required to be present at all times in a private seniors' residence to ensure proper supervision, taking into account, as applicable, the category of the residence.

However, if an agency considers that, due to the physical layout of a private seniors' residence or the type of clientele residing there, the minimum number of persons determined under paragraph 2 of section 346.0.6 does not ensure proper supervision, it may increase the minimum number of persons required to be present at all times in that residence.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 10.

346.0.8. The agency is authorized to inspect a private seniors' residence in order to ascertain whether this subdivision and the regulations are being complied with, and whether the operator of the residence is avoiding practices or situations that could pose a threat to the health or safety of the persons to whom the operator provides services.

2005, c. 32, s. 141; 2009, c. 46, s. 5; 2011, c. 27, s. 38; 2011, c. 27, s. 11.

346.0.9. The person authorized by the agency to carry out an inspection must, on request, produce identification attesting to that authorization.

In carrying out the inspection, the person has the power

 (1) to enter, at any reasonable time of day, a private seniors' residence whose operator holds a certificate of compliance or a temporary certificate of compliance and any other place, except a room or apartment, where the person has reason to believe that activities for which a certificate or a temporary certificate is required under this Act are carried on; and

 (2) to demand any information or documents relating to the administration of this Act for the purpose of inspecting or copying them.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 12.

346.0.10. Subject to the third paragraph of section 346.0.4.2, a temporary certificate of compliance is valid for up to one year. It may not be renewed.

A certificate of compliance is valid for three years. It may be renewed for the same period.

Six months before the expiry date of a certificate of compliance, an agency must initiate the renewal process for the certificate with the certificate holder.

2005, c. 32, s. 141; 2009, c. 46, s. 6; 2011, c. 27, s. 13.

346.0.11. The agency may revoke a temporary certificate of compliance or revoke or refuse to issue or renew a certificate of compliance if the holder

 (1) no longer fulfills the conditions prescribed for the issue of a temporary certificate of compliance;

 (2) fails to take the corrective measures ordered by the agency within the prescribed period, in particular further to recommendations formulated during the complaint examination process;

 (3) fails to comply with a provision of this subdivision or the regulations, a condition imposed under the third paragraph of section 346.0.4.2 or a decision under the second paragraph of section 346.0.7;

 (4) during the period of validity of the certificate, is charged with or convicted of an indictable or other offence related to the abilities and conduct required to operate a residence of the same category, or has a director or officer who is charged with or convicted of such an offence; or

 (5) engages in practices or tolerates a situation that could pose a threat to the health or safety of the persons to whom the operator provides services.

2005, c. 32, s. 141; 2009, c. 46, s. 7; 2011, c. 27, s. 38; 2011, c. 27, s. 13.

346.0.12. When an agency revokes a temporary certificate of compliance or revokes or refuses to issue or renew a certificate of compliance, it may prescribe the conditions that must be complied with by the operator of the private seniors' residence concerned until the cessation of the activities of the residence. In such a case, it must prescribe a maximum period for terminating the activities of the residence.

Those conditions may include

 (1) despite any inconsistent provision, the obligation to allow any person designated by the agency to enter the residence, including the rooms or apartments, at any time;

 (2) the obligation to inform the agency in advance of the relocation of any resident, providing the resident's name, the name of the person acting on the resident's behalf, if any, and the address of the resident's new residence;

 (3) any other measure prescribed to ensure the welfare of every resident during that period.

The certificate ceases to have effect at the end of the period provided for in the first paragraph.

The costs, fees and expenses incurred by the agency to implement those conditions may be claimed from the operator of the private seniors' residence.

2005, c. 32, s. 141; 2009, c. 46, s. 8; 2011, c. 27, s. 13.

346.0.13. Before refusing to issue a certificate of compliance or a temporary certificate of compliance, or revoking or, if applicable, refusing to renew such a certificate, the agency must first inform the applicant or the certificate holder in writing of its intention, as prescribed by section 5 of the Act respecting administrative justice (chapter J-3), and grant a period of at least 10 days for the applicant or the certificate holder to submit observations.

2005, c. 32, s. 141; 2011, c. 27, s. 14.

346.0.14. Instead of revoking or refusing to renew, if applicable, a certificate of compliance or a temporary certificate of compliance, the agency may order the certificate holder to take the necessary corrective measures within the period the agency determines.

If the certificate holder fails to comply with the order, the agency may then revoke or, if applicable, refuse to renew the certificate.

2005, c. 32, s. 141; 2011, c. 27, s. 15.

346.0.15. The agency must inform the holder of a certificate of compliance or a temporary certificate of compliance in writing of its decision, giving its reasons, within 30 days after the date the decision was made.

2005, c. 32, s. 141; 2011, c. 27, s. 16.

346.0.16. The person whose application for a certificate of compliance or a temporary certificate of compliance has been rejected, or the holder of a certificate whose certificate has been revoked or for which renewal has been refused, if applicable, may contest the agency's decision before the Administrative Tribunal of Québec within 60 days after the date of notification.

2005, c. 32, s. 141; 2011, c. 27, s. 17.

346.0.17. An agency whose decision is contested is subject to the obligations set out in the first paragraph of section 114 of the Act respecting administrative justice (chapter J-3), with the necessary modifications.

2005, c. 32, s. 141.

346.0.17.1. The operator of a private seniors' residence who wishes to cease activities, even with respect to only a part of the residence, must give at least six months' prior notice of that intention to the agency concerned.

The prior notice must state the date on which the operator plans to cease activities and the contact information of the residents concerned and of any persons acting on their behalf.

Failure by the operator to give the agency concerned prior notice, in accordance with this section, of the intention to cease activities renders without effect all notices that, under the rules set out in the Civil Code respecting the lease of a dwelling, must be given to lessees prior to ceasing the activities of the private seniors' residence.

2011, c. 27, s. 18.

346.0.17.2. In the case of the alienation of a congregate residential facility in which a private seniors' residence is operated or in the case of the extinction of the title of the lessor of that facility, section 346.0.17.1 also applies, with the necessary modifications, to the new lessor, who, with respect to the lessees of that residence, has the rights and obligations arising from their leases if the former operator of the residence did not give the agency concerned a prior notice of intention in accordance with that section before the alienation of the facility or the extinction of the lessor's title.

2011, c. 27, s. 18.

346.0.18. When an agency revokes the temporary certificate of compliance or revokes or refuses to issue or renew the certificate of compliance of a certificate holder, it must ensure that a person who lives in the private seniors' residence operated by that holder obtains relocation assistance if the person requires it.

2005, c. 32, s. 141; 2011, c. 27, s. 38; 2011, c. 27, s. 19.

346.0.19. The operator of a private seniors' residence who wishes to cease activities, whose temporary certificate has been revoked, who has been denied a certificate of compliance or whose certificate of compliance has been revoked or has not been renewed must return the certificate to the issuing agency.

The agency must take the means necessary to inform the residents of any revocation of a temporary certificate or any revocation or refusal to issue or renew a certificate of compliance. To this end the agency may require the residence to provide it with the contact information of the residents and of any persons acting on their behalf.

2005, c. 32, s. 141; 2009, c. 46, s. 9; 2011, c. 27, s. 38; 2011, c. 27, s. 20.

346.0.20. The rights conferred by a certificate of compliance or a temporary certificate of compliance may not be validly transferred to another person except with the written permission of the agency.

The Government must, by regulation, identify which of the requirements referred to in the second paragraph of section 346.0.3 must be fulfilled in order for the agency to authorize the transfer requested. The third paragraph of that section also applies to a transfer request, with the necessary modifications.

2005, c. 32, s. 141; 2009, c. 46, s. 10; 2011, c. 27, s. 21.

346.0.20.1. No person may operate a congregate residential facility under a name that includes private seniors' residence or any other word specified by government regulation, or otherwise purport, in any way, to be authorized to operate such a residence if the person does not hold a certificate of compliance or a temporary certificate of compliance.

2011, c. 27, s. 22.

346.0.20.2. In addition to the powers provided for in section 346.0.11, an agency may evacuate and relocate the residents of a private seniors' residence if the agency has reasonable grounds to believe that the operator of the residence is tolerating a situation or engaging in practices, including acts of negligence or violence, that present a danger to the health or safety of those persons.

Before proceeding, the agency must serve an evacuation order in writing on the operator, setting out the reasons for the evacuation, and allow the operator to submit observations within a period determined by the agency. It must also take the necessary means to inform the persons concerned and, to that end, it may require the operator to provide the contact information of the residents and, if applicable, of the persons acting on their behalf. If the danger is imminent, the reasons for the evacuation may first be transmitted verbally, and then in writing once the evacuation has been completed.

Once the evacuation order has been served, any person designated by the agency may enter the residence, including the rooms or apartments at any time, until the evacuation has been completed.

If the situation calls for the evacuation of all the residents, the holder's certificate of compliance or temporary certificate of compliance ceases to have effect on the issue of the evacuation order and until the holder demonstrates to the satisfaction of the agency that the situation or practices described in the first paragraph have been remedied, unless the agency revokes the certificate under section 346.0.11.

The costs, fees and expenses incurred by the agency for the evacuation and relocation procedure may be claimed from the operator of the private seniors' residence.

The first, second, third and fifth paragraphs also apply to a congregate residential facility where a private seniors' residence is operated without a certificate.

2011, c. 27, s. 22.

346.0.20.3. A resident evacuated under section 346.0.20.2 is exempted from paying rent for the evacuation period. Unless the agency revokes the temporary certificate of compliance or the certificate of compliance under section 346.0.11, as soon as the situation necessitating the evacuation and relocation is remedied to the satisfaction of the agency, the operator is required to notify the evacuated resident, if the resident informed the operator of the resident's new address. The resident is then required to notify the operator within 10 days as to whether or not the resident intends to move back into the room or apartment. If the resident refuses to move back into the room or apartment or did not inform the operator of the resident's new address or the resident's intention to move back into the room or apartment, the lease is resiliated by operation of law. The resident retains all other remedies under the lease against the operator, including the right to claim damages.

2011, c. 27, s. 22.

346.0.20.4. Any resident bound by a lease of a dwelling to the operator of a private seniors' residence in respect of which the agency has revoked the temporary certificate of compliance or revoked or refused to issue or renew a certificate of compliance may, with at least 15 days' prior notice, resiliate the lease. The notice must state the date on which the resident plans to leave the room or apartment. The lease is resiliated by operation of law as of that date. The notice must be sent not later than 60 days after the activities of the residence cease.

A resident of a private seniors' residence referred to in the first paragraph also has the remedies provided for in article 1863 of the Civil Code against the operator.

An operator of a private seniors' residence may not claim compensation from a resident on the grounds of the resiliation of a lease under this section or section 346.0.20.3.

2011, c. 27, s. 22.

346.0.20.5. The Minister must enter into a framework agreement with the Minister of Public Security to establish the procedures that Québec police forces will be called upon to follow in order to verify, for an agency or the operator of a private seniors' residence, compliance with the third paragraph of section 346.0.3 and paragraph 4 of section 346.0.11 and the security conditions prescribed by regulation.

2011, c. 27, s. 22.

346.0.21. The provisions of this subdivision apply, with the necessary modifications, to all resources and categories of resource offering lodging determined by government regulation except intermediary resources, family-type resources and specialized medical centres within the meaning of this Act.

However, subparagraph 4 of the first paragraph of section 346.0.6 does not apply in the case of a resource established for non-profit purposes.

For the purposes of section 346.0.20.1, the Government may specify, by regulation, the words that can only be used in the name of a resource offering lodging determined under the first paragraph.

2009, c. 46, s. 11; 2011, c. 27, s. 23.

§ 3. —  Functions relating to the organization of services

346.1. In accordance with province-wide orientations and recognized standards of accessibility, integration, quality, effectiveness and efficiency, and taking into account available resources, the agency is responsible for preparing a multi-year strategic plan for its region containing the following elements:

 (1) a description of the mission of the agency;

 (2) a statement of the social and health needs and the distinctive characteristics of the population, based on an understanding of the health and well-being of that population;

 (3) a description of the context in which the agency acts and the main challenges it faces;

 (4) the directions and objectives to be pursued with respect to, among other things, the accessibility, continuity, quality and safety of care and services with a view to improving the health and well-being of the population;

 (5) the results targeted over the period covered by the plan; and

 (6) the performance indicators to be used in measuring results.

For the purpose of preparing the strategic plan, an agency must obtain the opinion of the people's forum, if applicable, call on the participation of the institutions and community organizations of its region, and ensure the collaboration of the stakeholders in other sectors of activity that have an impact on health services and social services.

2001, c. 24, s. 51; 2005, c. 32, s. 142; 2011, c. 15, s. 51.

346.2. The strategic plan of the agency must be approved by the Minister.

2011, c. 15, s. 52.

346.3. The agency shall establish a regional coordination committee composed of the president and executive director of the agency and the executive directors of the institutions.

The agency shall ensure that the chairmen of the boards of directors of the institutions are present at any meeting of the committee at which the strategic orientations of the region or the whole network are to be defined.

2011, c. 15, s. 52.

347. An agency may propose to the Minister to modify the organization of integrated health services and social services established in its territory under the Act respecting local health and social services network development agencies (chapter A-8.1), provided that the establishment of any new local health and social services network ensures compliance with the objectives set out in section 99.3.

The Minister's decision to accept the agency's proposal, with or without changes, must be approved by the Government.

The Minister shall table each order made under the second paragraph in the National Assembly within 30 days of its adoption or, if the Assembly is not sitting, within 30 days of resumption.

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; 2005, c. 32, s. 142.

348. Each agency, 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 agencies, 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; 2005, c. 32, s. 227.

349. Each agency 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; 2005, c. 32, s. 227.

§ 3.1. —  Functions related to the services offered by associated medical clinics
2006, c. 43, s. 12.

349.1. With a view to improving the accessibility of specialized medical services and after consultation with the regional panel of heads of departments of specialized medicine, an agency may propose to the Minister that an institution in its area of jurisdiction that operates a hospital centre and consents to it be authorized to become associated with one of the following places for the provision, at that place, of certain specialized medical services to users of the institution:

 (1) a private health facility;

 (2) a laboratory governed by the Act respecting medical laboratories, organ and tissue conservation and the disposal of human bodies (chapter L-0.2); or

 (3) a specialized medical centre described in subparagraph 1 of the first paragraph of section 333.3.

For the purposes of this subdivision, a place mentioned in the first paragraph is to be called an “associated medical clinic”.

2006, c. 43, s. 12; 2009, c. 30, s. 58.

349.2. Before accepting an agency's proposal, the Minister must be convinced that it will improve the accessibility of the specialized medical services concerned and will not affect the capacity of the public health and social services network, in particular as regards staffing requirements for the operation of that network. The Minister must also consider the increase in efficiency and effectiveness that will result from the proposal's implementation.

The Minister's decision to accept the agency's proposal must specify the procedure to be followed by the agency to determine which associated medical clinic offering specialized medical services has the best quality/cost ratio.

The second paragraph applies despite the Act respecting contracting by public bodies (chapter C-65.1).

2006, c. 43, s. 12.

349.3. After completion of the procedure described in the second paragraph of section 349.2 and after obtaining the authorization of the Minister, the agency and any institution concerned must enter into an agreement with the operator of the associated medical clinic selected. The agreement must specify

 (1) the nature of the specialized medical services to be provided under the agreement;

 (2) the minimum and maximum number of specialized medical services that may be provided each year in the clinic, and how those services are to be distributed on a quarterly basis to ensure their continued availability;

 (3) the unit amount to be paid by the agency to cover the costs related to each specialized medical service provided in the clinic, according to the nature of the service, and the terms of payment;

 (4) the monitoring mechanisms that will allow the institution, or one of its boards, councils or committees determined in the agreement, to ensure the quality and safety of the medical services provided in the clinic;

 (5) the fees, determined in accordance with section 349.6, that may be charged to users who receive a specialized medical service in the clinic, and the manner in which the user is to be informed of how to pay the fees;

 (6) the bookkeeping and information system requirements with which the clinic operator is to comply, and the nature, form, content and frequency of the reports and information the operator is required to send to the other signatories and to the Minister; and

 (7) a mechanism to resolve disputes regarding the interpretation or application of the agreement.

The services covered by the agreement are subject to the complaint examination procedure of the institution that refers users to the associated medical clinic or to the complaint examination procedure of the agency, as the case may be, and are subject to the Act respecting the Health and Social Services Ombudsman (chapter P-31.1).

The agreement has a maximum five-year term. The parties may not terminate the agreement before its expiry, or amend or renew it, without the Minister's authorization. To renew the agreement, a draft renewal agreement must be sent to the Minister at least six months before the agreement expires.

An institution that is party to the agreement may communicate information contained in a user's record to a physician providing specialized medical services specified in the agreement in the clinic if that communication is necessary for the provision of those services. Despite any inconsistent provision, once the specialized medical services have been provided, the physician may communicate to the institution any information contained in the patient's record that is necessary to ensure continuity of service by the institution.

2006, c. 43, s. 12.

349.4. All physicians practising in an associated medical clinic must be subject to the application of an agreement under section 19 of the Health Insurance Act (chapter A-29).

2006, c. 43, s. 12.

349.5. Despite section 22.0.0.1 of the Health Insurance Act (chapter A-29), no amount may be charged to a user who receives a specialized medical service in an associated medical clinic providing services under an agreement other than the fees that the institution that is party to the agreement would normally have charged for the provision of those services, provided, however, that the fees are specified in the agreement.

2006, c. 43, s. 12.

349.6. To provide specialized medical services specified in an agreement in an associated medical clinic, a physician must have been appointed beforehand to practise in a hospital centre operated by an institution with which the clinic is associated, fully meet the requirements of the hospital centre according to the assessment of the director of professional services, and fulfil at all times the obligations attached to the privileges granted him.

The operator of an associated medical clinic must not allow a physician who fails to comply with this section to provide specialized medical services specified in the agreement in the clinic.

2006, c. 43, s. 12.

349.7. On signing an agreement, the operator of an associated medical clinic must give the signatory institution a list of the physicians who are members of the institution's council of physicians, dentists and pharmacists and who are to provide specialized medical services in the clinic. The operator of the clinic must keep the list updated and inform the executive director of the institution without delay of any change to it.

The executive director shall ensure that the list is given to all members of the board of directors, and inform them of any change to it.

2006, c. 43, s. 12.

349.8. Despite the third paragraph of section 349.3, an agency may terminate an agreement if it has reasonable grounds to believe that the quality or safety of the specialized medical services provided in the associated medical clinic is not satisfactory, or that the operator of the associated medical clinic or a physician who practises in the clinic has failed to comply with any of sections 349.4 to 349.7.

The Minister may request the agency to terminate an agreement if the Minister has reasonable grounds to believe that a situation described in the first paragraph exists.

Before terminating an agreement, the agency must give the institution and the operator of the associated medical clinic an opportunity to submit observations in writing.

2006, c. 43, s. 12.

349.9. Despite the provisions of the Health Insurance Act (chapter A-29), an agreement under section 349.3 may cover insured services that are not considered insured services when provided outside a facility maintained by an institution if the agency considers that access difficulties exist with respect to those services in the institutions in its area of jurisdiction.

Furthermore, services provided by a physician under an agreement under section 349.3 are deemed, for the sole purposes of the physician's remuneration, to be provided in a facility of the institution that referred the user to the associated medical clinic.

2006, c. 43, s. 12.

§ 4. —  Functions relating to the allocation of financial resources

350. The agency shall allocate the financial resources put at its disposal for the implementation of its multi-year strategic plan. 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.

The agency 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 private resources referred to in section 454.

The agency 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 agency 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 agency 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 Société québécoise des infrastructures.

1991, c. 42, s. 350; 1992, c. 21, s. 36; 1998, c. 39, s. 103; 2001, c. 24, s. 53; 2005, c. 32, s. 143; 2011, c. 16, s. 188; 2013, c. 23, s. 164.

351. Each agency 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; 2005, c. 32, s. 227.

§ 5. —  Functions relating to the coordination of health services and social services

352. Each agency 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, specialized medical centres, community organizations and private facilities into account, eliminate duplication of services and allow the setting up of joint services.

1991, c. 42, s. 352; 2005, c. 32, s. 227; 2006, c. 43, s. 13.

353. The agency shall promote activities conducive to improving the health and well-being of the population and cooperate in implementing the activities with the other organizations of the region, particularly municipalities, regional branches of government departments and government agencies, institutions in the education and higher education sector, childcare services, regional community organizations and socio-economic organizations.

1991, c. 42, s. 353; 2005, c. 32, s. 144.

353.1. The Minister may give an agency instituted for a region the mandate to take the necessary measures to coordinate its services with the services of the agencies instituted for neighbouring regions.

2001, c. 24, s. 54; 2005, c. 32, s. 227.

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 agency shall also determine, 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 agency 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; 2005, c. 32, s. 145.

355. The agency 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 agency, intermediate resources attached to institutions and family-type resources of its region.

The agency 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; 2005, c. 32, s. 227.

356. Every institution concerned with a mechanism of access to services establis