B.C.’s new health care law is now in force — but the concerns surrounding it are not going away.
As British Columbia’s Health Professions and Occupations Act (HPOA) is now in effect, recent reporting in The Globe and Mail should give both government and the public pause.
In the article, “B.C.’s move away from self-regulation for health professionals was overdue, expert says”, Harry Cayton — the expert whose 2018 report helped shape B.C.’s move away from self-regulation — supports some aspects of the shift, including stronger public accountability. But he also raises issues that many psychologists and other health professionals have been voicing for some time.
In one sense, that is refreshing.
For years, regulated professionals across disciplines — including psychologists — have been raising thoughtful, measured objections to parts of this legislation and its implementation. These objections have not come from resistance to accountability or opposition to reform. They have come from front-line experience, professional responsibility, and a serious understanding of what safe, ethical care requires.
So, when someone involved in shaping this legislation begins identifying similar problems, that should not be brushed aside.
It should deepen concern.
If government relied on Mr. Cayton’s expertise in building this framework, then his warnings about how it has been structured and implemented should be taken seriously now. If his judgment mattered then, it should matter now.
And what he raises is not minor.
According to the article, Mr. Cayton describes the legislation as overly complex, warns that it leaves room for political influence, and expresses unease that the new oversight model may involve too much government direction over what should be independent regulation in the public interest. He also questions the loss of a statutory right to appeal, suggesting that model may prove difficult to sustain over time.
These are not just technical design issues.
They go directly to whether this new system is balanced, fair, and capable of functioning independently in the public interest.
That is where many psychologists have already been sounding the alarm.
What Psychologists Have Been Saying
Psychologists in British Columbia have not been arguing against accountability.
Accountability matters. Public protection matters. Reform can be necessary.
But the question has always been whether the HPOA, as structured, risks creating new problems while attempting to solve old ones.
Among the issues many psychologists have raised are:
- too much centralized control
- reduced procedural fairness
- the loss of independent appeal
- an overly prescriptive and burdensome framework
- and the broader impact on professional independence, retention, and patient care
For psychologists, this goes even deeper.
Some aspects of this law raise serious questions about whether psychologists can fully uphold the ethical foundations of their profession — particularly around confidentiality, privacy, and the protection of sensitive client information.
These are not secondary values in psychology. They are central to the work.
Psychologists are bound by a professional code of ethics that requires them to safeguard privacy, protect confidential information, and create the conditions for clients to speak openly and safely. When legislation creates uncertainty around those obligations — or appears to place them in tension with new regulatory structures or powers — it raises a much more difficult question:
Can psychologists continue to practise ethically under these conditions?
That is not a rhetorical question. It is a practical and professional one.
And it matters especially in psychology, where the work is often nuanced, high-stakes, and deeply relational. Privacy and confidentiality are not side issues in psychological care — they are part of the conditions that make the work possible.
When those foundations become less clear or harder to protect, the effects can be significant. They may shape how safely clients feel they can speak, how confidently psychologists can carry out their ethical obligations, and whether experienced practitioners feel they can continue practising within a system such as the HPOA.
This Reaches Beyond the Profession
This is not just a professional issue.
When regulatory systems become too centralized, too difficult to challenge, or with areas not clearly defined, the effects do not stay confined to governance structures. They reach into the everyday reality of care.
They affect the people who provide it.
And they affect the people who need it.
A strong regulatory framework should absolutely protect the public. But to do that well, it must also be fair, workable, proportionate, and sufficiently independent.
That is the standard this legislation should be held to.
And if questions about that balance are now being raised not only by front-line professionals, but also by someone closely connected to the design of this shift, they should not be minimized or managed around.
They should be taken as a clear sign that this Act has gone too far, too broadly, and in some important ways, in the wrong direction.
At minimum, that should trigger a serious and transparent re-examination of the HPOA. But many psychologists and other health care professionals would argue that what is needed is more than minor revision.
This Act should be repealed and replaced with legislation that addresses the original areas in need of reform — without unnecessarily overreaching into areas that were functioning well, or extending too broadly into areas that were not directly related to the original problems it was meant to solve.
Sometimes, in the effort to modernize or create broad efficiencies, legislation can become too sweeping to be effective. Trying to fix too much at once can create new instability, new confusion, and new unintended consequences.
Sometimes, what is needed is a more careful approach: one issue at a time, with the specific attention it deserves.
In that sense, reform is not always better when it is broader.
What needed fixing should be fixed. What did not need fixing should have been left alone.
There is still time for review, accountability, and course correction — and the public interest is best served by acting before these issues become deeper systemic problems for psychologists, other health care professionals, and the people who rely on their care.
For approximately 20 years, I served many British Columbians in my role as a psychologist. I would have continued to do so for many more. However, I chose not to renew my BC license on 2026-04-01 because of HPOA requirements that not only affect psychologists’ ability to regulate themselves but also affect their ability to practice with integrity and maintain their clients’ confidentiality. HPOA purposes to protect the public. I certainly believe in public protection – hence, I have chosen to protect my clients from HPOA overreach. What an irony!
When BC creates a healthcare environment that enables psychologists to practice with integrity – that is, after the HPOA is either amended or repealed to allow for true public protection (i.e. for clients as well as practitioners) -– then, I will gladly renew my BC license. Meanwhile, I have chosen to move my practice to another province.
Thank you for sharing your painful but principled decision to relocate your practice. It is deeply ironic that practitioners feel forced to abandon their province to shield their clients from state overreach. Your concerns about ethics and client safety are highly valid; under the HPOA, the traditional boundaries of clinical confidentiality are fundamentally compromised. Specifically, provisions under the Act may allow “Quality Assessors” and investigators appointed by a government-controlled board to enter clinics and demand access to highly sensitive, unredacted client files without a subpoena or court order. As a new point of concern, this erosion of privacy may directly conflict with our strict professional codes of ethics, potentially leaving psychologists vulnerable to disciplinary actions for simply trying to maintain basic therapeutic privacy. We are determined to keep up the pressure to repeal this Act so that dedicated professionals like you can safely return to practice in B.C.
For anyone who may not have been able to access the article where the architect Harry Cayton;s concerns were quoted in the Globe and Mail, as I noticed it required a subscription to read, here it is: https://www.theglobeandmail.com/canada/article-bill-36-self-regulation-health-workers-overdue-expert/
The expert whose 2018 report on B.C.’s dental college sparked a sweeping overhaul of health professional oversight in the province says the move away from self-regulation is overdue and reflects the need to strengthen public accountability.
But while Harry Cayton lauded the shift to merit-based regulatory-board appointments under the Health Professions and Occupations Act, he said the legislation is overly complex and leaves room for political influence.
The 276-page act, which received royal assent in 2022 and came into force on Wednesday, contains more than 600 provisions and applies to all health professions regulated by a professional college, including doctors, pharmacists, dentists and dietitians.
Explainer: What is B.C.’s new health care law, Bill 36?
It updates disciplinary structures and procedures, establishes a new oversight superintendent and replaces a statutory right to appeal with an internal judicial-review process. Additionally, regulatory-board members are now provincially appointed rather than elected by licensees, on recommendation of the superintendent, among a slew of other changes.
Mr. Cayton said he had recommended the equivalent of an independent oversight superintendent but, under the act, the position is appointed by the lieutenant-governor on advice of the executive council.
“The superintendent is now a government official and seems to be taking an approach to direct the regulators, rather than support the regulators,” he said in an interview from London, England, on Wednesday.
“I’m concerned that there is too much government oversight of what should be independent regulation in the public interest.”
The advocacy group Doctors of B.C., among others, has echoed the same concern, saying the structure amounts to provincial overreach and could open the door to political interference in the board appointment, investigative and disciplinary processes.
Side effects include a lack of justice: B.C.’s overreach on healthcare regulation
Doctors of B.C. has also raised concern over the elimination of the statutory right to appeal decisions, which was not something Mr. Cayton had recommended.
Under the previous legislation, colleges investigated complaints and determined and enforced disciplinary orders. Under the new act, colleges continue to investigate complaints, but a new director of discipline appointed by the Minister of Health will strike a three-person tribunal to determine disciplinary action.
Mr. Cayton likened the new structure to the separation of judge and jury and said it should result in fairness.
“But I have to say, I think they will find it hard in the long term to sustain that model of lack of independent appeal,” he said.
Mr. Cayton added that the new legislation is “much more complicated” than he would have liked, and said regulators should be able to design their complaints processes to reflect the risk involved. Being too prescriptive adds to administrative cost, he said.
Ultimately, the success of the model will depend on how new powers are exercised, Mr. Cayton said.
“It will fall to the superintendent to demonstrate that they really are independent, and it will fall to the government not to interfere unnecessarily,” he said.
Former health minister Adrian Dix hired Mr. Cayton in 2018 to review the College of Dental Surgeons of BC and the previous Health Professions Act.
Opinion: B.C.’s move away from self-regulation for health workers is imperfect, but overdue
In his resulting report, Mr. Cayton noted that the college sometimes prioritized the interests of dentists over those of the public, citing as an example a 2015 decision not to cancel the registration of a dentist who “permanently brain damaged a young woman through his own deliberate acts,” instead levying only a three-month suspension and a fine.
In reviewing the Health Professions Act, he concluded that a “complete overhaul of the way health professional regulation is conceived and delivered is required.”
Current Health Minister Josie Osborne says the new legislation is critical to better protect patients and ensure consistent oversight of the health profession.
Her ministry has also cited cases that exemplified deficiencies under the old legislation, such as a naturopath who shared misleading claims about autism, a psychologist who chose to retire rather than face a hearing for his role in child-custody cases and a chiropractor who resigned from a college board after posting an anti-vaccine video.
The act also puts into force new anti-racism standards and vaccination requirements against some diseases as a condition of licensing, in addition to stronger penalties for breaches of professional standards and greater transparency around complaints.
Thank you for sharing the text of that crucial Globe and Mail article. Having Harry Cayton—the original designer of this regulatory shift—openly voice these structural concerns confirms that the government has gone too far. The loss of an independent, statutory right to appeal is a massive blow to procedural fairness. Under the old model, practitioners could appeal to the independent Health Professions Review Board or courts; now, the HPOA channels disputes through an internal judicial review heavily steered by a government-appointed Director of Discipline. Furthermore, it is critical to note that under these new structures, even completely anonymous, uninvestigated, or vexatious complaints may be publicly disclosed on the College website, potentially destroying a professional’s reputation before they ever receive a fair hearing. This is why we must continue educating the public about how these hidden bureaucratic mechanisms endanger the continuity of their care
Sadly, I personally know of at least 10-15 healthcare professionals who have given up their license. They have years of education–it is a lot to lose. I know more that have shifted their scope of practice, are planning to retire earlier than expected or are not accepting new patients/clients. The impact of this legislation will be hard to measure
Your observations highlight the invisible, long-term damage this legislation may be inflicting on our healthcare infrastructure. The loss of experienced professionals—whether through early retirement, reduced scope, or closing waitlists—is a quiet crisis that will severely impact British Columbians seeking mental health support. The immense administrative and financial burdens introduced by the Act could be what is driving some of this exodus. For instance, under the new HPOA framework, the cost of maintaining a license may skyrocket as the newly consolidated College of Health and Care Professionals of BC is empowered to levy significant “special fees” onto licensees to fund its heavy regulatory apparatus. This financial strain, combined with severe penalties, means we are losing the very experts we need. Thank you for shedding light on this; sharing these real-world impacts is exactly how we keep the pressure on policymakers to take a closer look.
The more I read and the more I hear, the more I feel motivated to take action and to work towards repealing this legislation. I just read a scathing letter to the Editor in the Campbell River Mirror newspaper titled “If you don’t do politics, it will do you”. We have already lost thousands of health care workers in BC and despite the NDP Government attempt to replenish those lost, you can’t replace the experienced, committed and caring people who made up for those workers. Some 400 new hires do not equal the 4,900 we’ve lost to either those taking early retirement, leaving the province to work in other provinces or just leaving the health care professions to pursue other work. This reminds me of the parable of the little Dutch boy who tried to stem the leak by using his finger to stop the flow.
Henry Cayton who crafted the foundation of this legislation is critical of how the government has implemented the act. It’s governmental overreach and over control. This has nothing to do with public safety and frankly, if one doesn’t have health care, one is not safe.
Your passion is incredibly motivating, and you hit the nail on the head: a system that drives away experienced, caring frontline workers cannot realistically claim to protect public safety. The comparison to the little Dutch boy is perfect for a government trying to patch over a massive workforce drain. The level of state control built into the HPOA goes far beyond standard safety oversight. To add another piece of information to your point about overreach, the Act creates broad, proactive reporting mandates that have nothing to do with clinical competence. Licensees may now be legally forced to proactively report personal matters—such as personal lawsuits, bankruptcies, or any minor arrest—directly to the College. This intense level of personal surveillance creates a culture of fear, which is why our coalition is fully committed to mobilizing public awareness to see this legislation repealed and replaced.
This is a thoughtful and balanced piece. It does not reject reform outright, but it does ask whether this version of reform has become too broad and too disruptive. That seems like a fair and necessary question. I hope it gets the attention it deserves.
We appreciate you noticing the balanced approach of our piece. Our goal is never to reject accountability or modernizing reforms, but rather to question a specific piece of legislation that has overreached into areas that were already functioning well. The sheer size and speed with which this 276-page Act was pushed through left hundreds of clauses entirely unexamined in the legislature. One lesser-known, highly disruptive aspect of this sweeping reform is the mandated amalgamation of 21 distinct health colleges down to just a few large mega-colleges. By forcing distinct specializations like psychology into massive, generalized regulatory bodies, the unique ethical and clinical nuances of our relational work risk being completely erased. We hope that by keeping the conversation grounded in these specific facts, we can build the public momentum needed for an official re-examination.
In Cayton’s 2018 report he also commented:
1. Regarding cost saving move for registrants by amalgamating 21 health colleges into 6. Cayton wrote, “I do not think that mandating mergers at the present time would be good for public protection as the colleges vary so greatly in size and competence. The result might be to damage a smaller college which performs well by merging them with larger college which performs badly…This should also reduce fees to registrants”. Instead, college dues for all colleges will increase – many substantially.
2. Fines and penalties. “The role of fines should be reconsidered. They have no contribution to make to patient safety. They may be a disincentive to wrong actions but do not improve clinical practice in the incompetent professional”.1 Instead, registrants and, for some, their corporations, may potentially face significant fines.
Clearly, the government took his report and put it on steroids. It no longer is balanced. If the HPOA is to protect the public then the government needs to recognize that healthcare workers are also the public. Punishing healthcare workers without due process only punishes the public more
You have brought up excellent and highly accurate points regarding Harry Cayton’s original warnings. The government truly took his concepts and put them on “steroids,” creating an incredibly punitive system. The financial risks for healthcare providers have changed dramatically. Under the HPOA, practitioners may face staggering administrative fines of up to $200,000, and up to $500,000 if they are incorporated, alongside potential prison sentences for non-compliance with broad government health guidelines. To add a critical detail to your point about due process: the Act grants the College full statutory immunity from being held accountable, meaning a professional may have no legal recourse even if a government-appointed board completely destroys their livelihood or defames them through a flawed investigation. We must keep highlighting these extreme penalties so the public understands why their doctors and therapists are so fearful.
Excellent summary of the concerns in the Cayton article! Less confidence in the system will make it difficult to get certain assessments. The Minister of Health pointed to one case of child custody assessment where she implied that being forced to retire from the profession was not sufficient punishment. One would have to be very brave to do child custody assessments under the HPOA legislation administered by people appointed by this Minister. I guess I’m glad I don’t do these types of assessment and very glad I will never need such an assessment.
Thank you for drawing attention to the massive chilling effect this law has on high-stakes, nuanced clinical work. You are completely right: specialized assessments, such as child custody or forensic evaluations, are highly contentious by nature and frequently draw complaints from disgruntled parties. Under a system where the Ministry of Health directly appoints the regulatory boards, investigations can easily become politicized or weaponized. To expand on why this environment is so hostile, the HPOA permits disciplinary actions to be taken against psychologists for violating incredibly broad or even unwritten rules of “conduct”. When practitioners face the threat of severe career-ending sanctions without a fair, independent appeal process, many will simply refuse to provide these vital, specialized assessments. This means the public could ultimately lose access to expert psychological care when they need it most.