Summer 2019

Mandatory Reporting to Prevent Patient Harm

Banner Summer 2019 Mandatory Reporting
Share this:

Learning from Ontario’s Long-Term Care Homes Public Inquiry

In July 2019, the Long-Term Care Homes Public Inquiry released its final report and recommendations. The inquiry was established to examine the events which led to the offences committed by Elizabeth Wettlaufer while working as a registered nurse in long-term care homes within Ontario.

The report outlined a total of 91 recommendations, including system-wide opportunities involving regulators, government and other stakeholders to improve the safety and quality of long-term care in the province.

The report also encouraged an increased role for pharmacists and pharmacy technicians in long-term care to help deter harm to residents through strengthened medication management systems. As government moves forward in responding to the report’s recommendations, the College welcomes any opportunity to work with the government and other stakeholders in our shared goal to protect the public and looks forward to the opportunities presented to us to contribute within our mandate to a safer long-term care system.


A major theme of the recommendations is that healthcare professionals should be educated on the possibility that healthcare providers may intentionally harm those in their care, especially vulnerable patients. The inquiry encouraged the adjustment of institutional (including regulators, education providers and healthcare facilities) training, investigative processes, and policies to reflect this possibility. The recommendations also noted that healthcare professionals, their employers and healthcare facility operators should be better educated on when and how they must file mandatory reports regarding a healthcare professional’s conduct or capacity.

Recognizing that the reporting of specific concerns regarding a healthcare professionals conduct, capacity or competence could help prevent harm to a patient, the College is reminding pharmacy professionals of our expectations regarding mandatory reporting.


As regulated healthcare professionals, and under the Regulated Health Professions Act and Health Professions Procedural Code, pharmacists, pharmacy technicians, employers and facility operators have obligations to report certain information to the College. These obligations are in place to protect patients and contribute to safe and effective pharmacy care.

  • Employers (e.g. pharmacy owner, DM) must file a report with the College if a registrant’s employment is terminated, they are suspended or other privileges are revoked for reasons of professional misconduct, incompetence or incapacity. This obligation remains even if the registrant resigned or relinquished any privileges prior to the employer having done so. Reporting is not required for employment-related reasons (e.g. issues such as lateness or personal incompatibility that don’t compromise patient safety or contravene standards of practice).
  • Facility operators must file a report with the College if they suspect a registrant has sexually abused a patient or if they suspect the registrant is incompetent or incapacitated.
  • All pharmacists and pharmacy technicians must file a report with the College if they suspect another registrant has sexually abused a patient.

Under the Code of Ethics, pharmacists and pharmacy technicians are expected to report professional incompetence or unethical behaviour by colleagues or other healthcare professionals to the appropriate regulatory body.

Note that the requirement to report to the appropriate regulatory college also applies to other healthcare professionals (e.g. physicians, nurses).

Pharmacists, pharmacy technicians, employers and facility operators may also report other concerns to the College that fall outside of mandatory reporting.


Please visit the College’s webpage on Mandatory Reporting.

Employers, facility operators, pharmacists and pharmacy technicians should use the Mandatory Reporting Form available on the College website. The form can be emailed, faxed or mailed. Please provide as much information as possible.

The College cannot assist employers, facility operators, or registrants in determining their legal obligation to make a mandatory report. If you are in doubt about whether a mandatory report is required, you may wish to submit one and allow the College to assess the information contained within the report to determine if further action is required.

Share this: