S-4.2 - Act respecting health services and social services

Full text
chapter S-4.2
Act respecting health services and social services
HEALTH SERVICES AND SOCIAL SERVICESSeptember 4 1991September 4 1991
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;
(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.
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 and needs;
(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.
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 manner, health services and social services which are scientifically, humanly and socially appropriate.
1991, c. 42, s. 5.
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.
1991, c. 42, s. 8.
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.
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 subparagraph 28 of the first paragraph 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, on the order of a court or a coroner in the exercise of his functions, or where this Act provides that an institution may be required to release information contained in the record.
1991, c. 42, s. 19; 1992, c. 21, s. 2; 1999, c. 45, s. 1.
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. Notwithstanding section 19, 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 without the user’s consent.
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.
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.
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.
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.
28. Sections 17 to 27 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.
CHAPTER III
USERS’ COMPLAINTS
DIVISION I
EXAMINATION BY THE INSTITUTION
29. Every institution shall establish a procedure for the examination of the complaints filed by users. The executive director shall designate a member of the institution’s personnel as the complaints officer responsible for the application of the complaints examination procedure, and cause the designation to be confirmed by the board of directors.
1991, c. 42, s. 29; 1998, c. 39, s. 1.
30. The institution must publish the complaint examination procedure and inform each user of the existence of the publication and of the means of obtaining a copy thereof.
However, the institution shall give a copy of the publication to every user who is lodged at the institution or who requests it.
1991, c. 42, s. 30.
31. The complaint examination procedure enables the user to file a complaint concerning the services that have or should have been provided to him by the institution or by an intermediate resource or family-type resource whose services are called upon by the institution.
1991, c. 42, s. 31; 1998, c. 39, s. 2.
32. The examination procedure must permit the user and, where applicable, the intermediate resource or family-type resource to express their views.
1991, c. 42, s. 32; 1998, c. 39, s. 3.
33. The complaint may be made in writing or verbally.
The complaints officer responsible for the application of the complaints examination procedure must assist or ensure that assistance is given to the user who requires it for the formulation of his complaint or for any step he wishes to take in relation to his complaint.
1991, c. 42, s. 33; 1998, c. 39, s. 4.
34. The complaints officer must give the user who has filed a complaint in writing a notice indicating the date on which he received the complaint.
1991, c. 42, s. 34; 1998, c. 39, s. 5.
34.1. Users, intermediate resources, family-type resources, the personnel members of an institution, and midwives practising under a service contract entered into with the institution pursuant to section 259.2 must provide the information required by the complaints officer for the examination of the complaint and, unless they have a valid reason, must attend any meeting to which they are called by the complaints officer.
1998, c. 39, s. 6; 1999, c. 24, s. 25.
35. The complaints officer must examine a complaint within 45 days of receiving it.
Before the expiry of the time limit, he must inform the user of his conclusions, giving the reasons on which they are based, and of the terms and conditions governing the remedy available to the user before the regional board. If the complaint is in writing, the information must be given in writing.
The complaints officer must also, where applicable, inform the intermediate resource or family-type resource of his conclusions without delay, giving reasons.
1991, c. 42, s. 35; 1998, c. 39, s. 7.
36. Where the complaints officer fails to inform the user of his conclusions within the time prescribed in section 35, he is deemed to have transmitted negative conclusions to the user on the date on which the prescribed time expires.
Such failure gives rise to the remedy before the regional board.
1991, c. 42, s. 36; 1998, c. 39, s. 8.
37. The complaints officer may, on summary examination, dismiss any complaint he judges to be frivolous, vexatious or in bad faith.
He must inform the user, in writing if the complaint is in writing.
1991, c. 42, s. 37; 1998, c. 39, s. 9.
38. When a user’s complaint concerns a medical, dental or pharmaceutical act and there is a council of physicians, dentists and pharmacists in the institution, the complaints officer must refer the complaint to the council and so inform the user in writing.
If there is no council of physicians, dentists and pharmacists, the complaints officer must refer the complaint to the physician designated for that purpose by the board of directors and so inform the user in writing.
The complaints officer shall transmit a copy of the complaint he has received to the professional who is the subject of the complaint. During examination of the complaint, the user and the professional must be allowed to express their views.
The professional who is the subject of the complaint shall have access to the user’s record of complaint.
The person to whom the complaint is referred must transmit his recommendation to the board of directors.
1991, c. 42, s. 38; 1992, c. 21, s. 3; 1998, c. 39, s. 173.
39. The executive director shall advise the complaints officer of the board of directors’ decision, giving the reasons on which it is based, concerning the user’s complaint contemplated in section 38. The complaints officer shall inform the user and the professional concerned of the decision in writing.
1991, c. 42, s. 39; 1992, c. 21, s. 4; 1998, c. 39, s. 173.
40. The executive director of the institution must send the board of directors any recommendation or report referred to him by the complaints officer in the performance of the duties entrusted to him under section 29.
1991, c. 42, s. 40; 1998, c. 39, s. 173.
41. Where the board of directors considers that the seriousness of the complaint justifies it, it must send it to the professional order concerned.
Where, following a user’s complaint, the board of directors takes disciplinary measures in respect of a physician, dentist, pharmacist or midwife or in respect of any employee who is a member of a professional order, it must inform the professional order in writing.
In such case, the complaints officer shall inform the user thereof, in writing.
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.
DIVISION II
EXAMINATION BY THE REGIONAL BOARD
42. A user having filed a complaint with an institution may address his complaint to the regional board if he disagrees with the conclusions sent to him by the complaints officer of the institution or deemed to have been sent to him under section 36, or if the complaints officer has refused or ceased to examine his complaint.
1991, c. 42, s. 42; 1998, c. 39, s. 10.
43. The regional board shall establish a procedure for the examination of the complaints filed by users. The executive director shall designate a member of the regional board’s personnel as the complaints officer responsible for the application of the complaints examination procedure, and cause the designation to be confirmed by the board of directors.
1991, c. 42, s. 43; 1998, c. 39, s. 11.
44. The procedure for the examination of complaints must enable the user, the intermediate resource, the family-type resource and the institution to express their views.
1991, c. 42, s. 44; 1998, c. 39, s. 12.
45. The complaint must be in writing and accompanied with the conclusions, if any, which have been sent by the executive director of the institution and the reasons on which they are based.
The complaints officer of the regional board must assist or ensure that assistance is given to the user who requires it for the formulation of his complaint and for any step he wishes to take in relation to that complaint.
1991, c. 42, s. 45; 1998, c. 39, s. 173.
46. The complaints officer of the regional board shall send a copy of the complaint submitted to him to the institution, the intermediate resource or the family-type resource concerned and, within five days of receiving the copy, the institution must transmit the complete record of complaint to the complaints officer.
1991, c. 42, s. 46; 1998, c. 39, s. 13.
47. Users, intermediate resources, family-type resources and institutions must provide the information required by the complaints officer of the regional board for the examination of the complaint and, unless they have a valid reason, must attend any meeting to which they are called by the complaints officer.
1991, c. 42, s. 47; 1998, c. 39, s. 14.
48. The complaints officer of the regional board shall give the user who has submitted a complaint a notice in writing indicating the date on which his complaint was received.
1991, c. 42, s. 48; 1998, c. 39, s. 173.
49. The complaints officer of the regional board must examine a complaint within 45 days of receiving it.
Before the expiry of the time limit, he must inform the user, in writing, of his conclusions and give the reasons on which they are based and, at the same time, inform the user of the terms and conditions governing the remedy available to him before the complaints commissioner appointed by the Government under section 55. He must also inform the institution concerned and, where applicable, the intermediate resource or family-type resource of his conclusions without delay, giving reasons.
1991, c. 42, s. 49; 1998, c. 39, s. 15.
50. Where a complaints officer of the regional board fails to inform the user of his conclusions within the time prescribed in section 49, he is deemed to have transmitted negative conclusions to the user on the date on which the precribed time expires.
1991, c. 42, s. 50; 1998, c. 39, s. 173.
51. The complaints officer of the regional board may, on summary examination, dismiss any complaint he judges to be frivolous, vexatious or in bad faith and inform the user in writing.
1991, c. 42, s. 51; 1998, c. 39, s. 173.
52. The executive director of the regional board must transmit to the board of directors any recommendation or report referred to him by the complaints officer in the performance of his duties entrusted to him under this division.
1991, c. 42, s. 52; 1998, c. 39, s. 173.
53. Any natural person may file a complaint with the regional board in connection with any function or activity of the regional board by which the person is affected as regards services that have or should have been provided by an institution, an intermediate resource, a family-type resource or a community organization.
Sections 43, 44 and 47 to 52, adapted as required, apply to such a complaint.
1991, c. 42, s. 53; 1998, c. 39, s. 16.
53.1. A complaint may be filed under section 53 in oral or written form.
The complaints officer must assist or ensure that assistance is given to any person requiring it for the formulation of a complaint and for any step to be taken in relation to that complaint.
1998, c. 39, s. 17.
DIVISION III
ASSISTANCE BY COMMUNITY ORGANIZATION
54. The Minister must, after consulting the regional board, the users’ committees of the institutions of the region and interested associations, give a community organization of the region the mandate to assist and accompany, on request, users wishing to file a complaint with an institution in the region, the regional board or the complaints commissioner.
1991, c. 42, s. 54; 1998, c. 39, s. 18.
DIVISION IV
COMPLAINTS COMMISSIONER
55. The Government shall appoint a complaints commissioner for the purposes of this division.
1991, c. 42, s. 55.
56. The function of the complaints commissioner is to examine complaints
(1)  from users who disagree with the conclusions transmitted to them by the complaints officer of a regional board pursuant to section 49;
(2)  from persons referred to in section 72 who disagree with the conclusions transmitted to them by the complaints officer of a regional board pursuant to section 75;
(3)  from persons who disagree with the conclusions transmitted to them by the complaints officer of a regional board pursuant to section 53.
The examination of such complaints may include an inquiry if the complaints commissioner judges it to be advisable.
In conducting an inquiry, the complaints commissioner is vested with the powers and immunity provided for in the Act respecting public inquiry commissions (chapter C-37), except the power to impose imprisonment.
1991, c. 42, s. 56; 1998, c. 39, s. 19.
57. The complaints commissioner must establish a complaint examination procedure which allows the user or person or the institution, the intermediate resource, the family-type resource, the community organization, the holder of nursing home accreditation or the regional board, as the case may be, to present their views to him.
1991, c. 42, s. 57; 1998, c. 39, s. 20.
58. The complaint must be in writing and submitted with the conclusions, if any, transmitted by the complaints officer of the regional board.
The complaints commissioner must assist or ensure assistance to the user or person requiring it for the formulation of his complaint or for any other step relating to that complaint.
1991, c. 42, s. 58; 1998, c. 39, s. 21.
59. The complaints commissioner shall transmit a copy of every complaint submitted to him to the institution, intermediate resource, family-type resource, community organization, holder of nursing home accreditation or regional board, as the case may be, and within five days of receiving that copy, the institution and the regional board must transmit the complete record of the complaint to him.
1991, c. 42, s. 59; 1998, c. 39, s. 22.
60. Every user or person and every institution, intermediate resource, family-type resource, community organization, holder of a nursing home accreditation or regional board, as the case may be, must furnish to the complaints commissioner the information he requires for examining a complaint and attend, unless excused for valid reasons, any meeting which he convenes.
1991, c. 42, s. 60; 1998, c. 39, s. 23.
61. The complaints commissioner may, on summary examination, dismiss any complaint the commissioner judges to be frivolous, vexatious or in bad faith.
The complaints commissioner may also refuse or cease to examine a complaint in either of the following situations:
(1)  where the complaints commissioner has reasonable grounds to believe that an intervention will clearly serve no useful purpose;
(2)  where the time that has elapsed between the events that gave rise to the dissatisfaction of the user or the person and the filing of the complaint makes it impossible to examine the complaint.
In such cases, the complaints commissioner shall inform the user or person who transmitted the complaint accordingly.
1991, c. 42, s. 61; 1998, c. 39, s. 24.
62. The complaints commissioner must, without delay, transmit the conclusions of the examination and the reasons on which they are based, together with any recommendations made, to the user or the person, to the intermediate resource, family-type resource, institution, community organization or holder of nursing home accreditation concerned, and to the regional board.
An intermediate resource, family-type resource, institution, community organization, holder of nursing home accreditation or regional board that receives a recommendation from the complaints commissioner must, within 30 days of reception, inform the complaints commissioner and the user or person who filed the complaint of the action it intends to take in response, or, if it intends to take no action, of the reasons for its decision.
1991, c. 42, s. 62; 1998, c. 39, s. 25.
62.1. The complaints commissioner may, whenever he considers it necessary, advise the Minister on any matter relating to the respect of users’ rights and the subjects of users’ complaints.
1998, c. 39, s. 26.
63. The commissioner shall be appointed for a term of not more than five years. He shall remain in office at the expiry of his term until reappointed or replaced.
The Government shall fix the salary or fees and the other terms of employment of the commissioner.
1991, c. 42, s. 63.
64. If the complaints commissioner is absent or unable to act, he may be replaced by a person appointed by the Government to exercise the commissioner’s functions and powers for the duration of his absence or inability to act. The Government shall fix, as the case may be, the salary or fees and the other terms of employment of that person.
1991, c. 42, s. 64; 1999, c. 40, s. 269.
65. The personnel needed by the complaints commissioner shall be appointed and remunerated in accordance with the Public Service Act (chapter F-3.1.1).
The commissioner shall define the duties of the personnel members at his disposal and shall direct their work. He may delegate, in writing, the exercise of each of his powers.
1991, c. 42, s. 65.
65.1. The complaints commissioner may give a person who is not a member of the complaints commissioner’s personnel a written mandate to carry out an inquiry or to seek a settlement between the interested parties, and require that the person submit a report within the time fixed by the complaints commissioner.
The last paragraph of section 56 applies, with the necessary modifications to the person.
1998, c. 39, s. 27.
DIVISION V
USER’S RECORD OF COMPLAINT
66. The content of the record of a user’s complaint shall be determined by regulation under paragraph 23 of section 505.
1991, c. 42, s. 66.
67. The provisions of sections 17 to 28 apply to every record kept by an institution, a regional board or the complaints commissioner in the performance of functions entrusted to them by Divisions I, II and IV, respectively.
1991, c. 42, s. 67.
DIVISION VI
REPORTS
68. Each institution shall send to the regional board, once a year and whenever required by the board, a report on the application of the complaint examination procedure.
The report shall describe the grounds on which complaints were made and indicate for each type of complaint,
(1)  the number of complaints received, dismissed after a brief examination, examined, refused or abandoned since the last report;
(2)  the time needed for the examination of complaints;
(3)  the action taken following their examination.
1991, c. 42, s. 68.
69. Each regional board must send to the Minister, once a year and whenever required by him, a report compiling all the reports received from each institution.
Each report shall describe the types of complaints received and indicate for each type,
(1)  the number of complaints received, dismissed on summary examination, examined, refused or abandoned since the last report;
(2)  the action taken following their examination;
(3)  the name of each institution concerned;
(4)  the time needed for the examination of complaints.
In addition, the report shall describe the kinds of complaints filed with the board and indicate for each kind,
(1)  the number of complaints received, dismissed on summary examination, examined, refused or abandoned since the last report;
(2)  the time needed for the examination of complaints;
(3)  the action it has taken following their examination.
1991, c. 42, s. 69; 1998, c. 39, s. 28.
69.1. Each institution and regional board must send to the complaints commissioner, whenever required by him, a report concerning the complaints under examination.
1998, c. 39, s. 29.
70. The complaints commissioner must send to the Minister, once a year and whenever required by him, a report on the application of the complaint examination procedure.
The report shall describe the grounds on which complaints received are founded and shall indicate, for each type of complaint,
(1)  the number of complaints received, dismissed on summary examination, examined, refused or abandoned since the last report;
(2)  the action taken after examination.
The complaints commissioner may also, in the report, give his opinion on the following matters:
(1)  the degree of satisfaction of users of institutions, intermediate resources and family-type resources, users of the services of community organizations and persons residing in an accredited nursing home, and whether or not their rights are respected;
(2)  the complaint examination procedures established by institutions, regional boards and the complaints commissioner.
1991, c. 42, s. 70; 1998, c. 39, s. 30.
71. The Minister shall table the reports of the regional boards and the report of the complaints commissioner before the National Assembly within 30 days of receiving them or, if it is not in session, within 30 days of resumption.
1991, c. 42, s. 71.
CHAPTER IV
OTHER COMPLAINTS
72. Every user of the services of a community organization referred to in section 334 and every person residing in a nursing home accredited for purposes of subsidies within the meaning of section 454 may file a complaint with the regional board on services he has or should have received from the organization or home.
Section 43, applies, with the necessary modifications to such a complaint.
1991, c. 42, s. 72; 1998, c. 39, s. 31.
73. The procedure for the examination of complaints established by the regional board under section 43 must enable the person referred to in section 72 and the organization or the person holding the accreditation of the nursing home to present their views to the regional board.
1991, c. 42, s. 73; 1998, c. 39, s. 32.
74. The complaint may be made in writing or verbally.
The complaints officer responsible for the application of the complaints examination procedure must assist or ensure that assistance is given to the person who requires it for the formulation of his complaint or for any step he wishes to take in relation to that complaint.
1991, c. 42, s. 74; 1998, c. 39, s. 33.
75. The complaints officer of the regional board must give the person referred to in section 72 who has filed a complaint in writing a written notice indicating the date on which his complaint was received.
The complaints officer must examine the complaint within 45 days of receiving it.
Before the expiry of the time limit, he must inform the person of his conclusions and give the reasons on which they are based and of the terms and conditions governing the remedy available to him before the complaints commissioner. If the complaint is in writing, the information must be given in writing. He must also inform the community organization or holder of nursing home accreditation, as the case may be, of his conclusions without delay.
Where the complaints officer fails to inform the person of his conclusions within the time limit prescribed in the second paragraph, he is deemed to have transmitted negative conclusions on the date on which the prescribed time expires. Such a failure shall give rise to an examination by the complaints commissioner.
1991, c. 42, s. 75; 1998, c. 39, s. 34.
76. The complaints officer of the regional board may, on summary examination, dismiss any complaint he judges to be frivolous, vexatious or in bad faith and inform the person. He must do so in writing if the complaint is in writing.
1991, c. 42, s. 76; 1998, c. 39, s. 35.
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.
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.
1991, c. 42, s. 80; 1998, c. 39, s. 36.
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 Act respecting young offenders (Revised Statutes of Canada, 1985, chapter Y-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.
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, psychosocial or family difficulties, alcoholism or other problems of 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 suffering from and, mainly on referral, persons suffering from alcoholism or other problems of 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.
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;
(2)  rehabilitation centres for physically impaired persons;
(3)  rehabilitation centres for persons suffering from alcoholism or other problems of addiction;
(4)  rehabilitation centres for young persons with adjustment problems;
(5)  rehabilitation centres for mothers with adjustment problems.
1991, c. 42, s. 86.
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.
1991, c. 42, s. 87.
88. The Minister may, after consulting the Minister of Education and the Minister of 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 Fonds de la recherche en santé du Québec established by the Act respecting the Ministère de la Recherche, de la Science et de la Technologie (chapter M-19.1.2).
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.
89. The Minister, after consulting the Minister of Education and the Minister of 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 Fonds de la recherche en santé du Québec.
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.
90. The Minister may, after consulting the Minister of Education and the Minister of 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, provides advanced services in a special multidisciplinary field, contributes to the training of professionals working in the field of health or social services under the terms of a contract of affiliation entered into under section 110, manages a research centre or research institute recognized by an organization engaged in the development of social research, and 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.
91. The Minister may, after consulting the Minister of Education and the Minister of 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 subparagraph 1 of the first paragraph of section 110.
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.
92. The Minister may designate as a health care centre an institution which operates a local community service centre and which, owing to the low population density and the size of the territory, also operates a centre mentioned in paragraph 2 or 4 of section 79.
1991, c. 42, s. 92.
93. The regional board, within the scope of its regional service organization plans, 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.
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 is not an institution.
A private health facility is a facility, situated elsewhere than in a facility 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 providing their patients with lodging.
1991, c. 42, s. 95.
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 II
FUNCTIONS
100. The function of institutions is to ensure the provision of 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 and financial resources effectively and efficiently and cooperate with other intervening parties.
1991, c. 42, s. 100.
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 subparagraph 27 of the first paragraph 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 subparagraph 27 of the first paragraph 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.
Not in force
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 and in accordance with the regional service organization plan established by the regional board.
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 regional board.
1991, c. 42, s. 105; 1998, c. 39, s. 37.
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 regional board or to the Minister on request.
1991, c. 42, s. 106.
107. Every institution must, at the request of the Minister or the regional board, take part in the assessment of the overall performance of the health and social services system.
1991, c. 42, s. 107.
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 of certain health services or social services;
(2)  the provision or exchange of professional health or social services.
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 regional board.
The agreement must be transmitted to the regional board.
1991, c. 42, s. 108; 1998, c. 39, s. 38.
109. No physician or dentist is bound by an agreement referred to in section 108 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 section 108 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.
110. An institution may, after consulting the regional board and obtaining the authorization of the Minister,
(1)  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;
(2)  enter into a service contract or agreement for the purpose of participating in university training or research programs.
An institution may enter into a contract of association with any other educational institution recognized by the Minister of Education 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 regional board.
The terms and conditions of the contracts and agreements referred to in the first or second paragraph must be consistent with the principles and general rules established by the Minister in cooperation with the Minister of Education.
1991, c. 42, s. 110; 1993, c. 51, s. 55; 1994, c. 16, s. 50; 1998, c. 39, s. 40.
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 regional board,
(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.
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 regional board before granting his authorization.
1991, c. 42, s. 113.
114. A public institution may
(1)  operate a day care centre, a nursery school or a stop over centre, in accordance with the Act respecting childcare centres and childcare services (chapter C-8.2) and the regulations;
(2)  where it has been designated by the Minister of Child and Family Welfare under section 45.1 of the said Act to be that Minister’s regional representative, act in that capacity and exercise the functions attached thereto;
(3)  exercise any power whose exercise is authorized by the Office des services de garde à l’enfance under the said Act;
(4)  make an agreement with the said Minister under section 10 of the Act respecting the Ministère de la Famille et de l’Enfance (chapter M-17.2).
1991, c. 42, s. 114; 1996, c. 16, s. 67; 1997, c. 58, s. 135.
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 consultation with the Conseil consultatif de pharmacologie established under section 53 of the Act respecting prescription drug insurance (chapter A-29.01). 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 of publication in the Gazette officielle du Québec, or on any later date fixed therein, of a notice from the Minister stating that the list is drawn up or updated and that the list or updating has been published by the Régie.
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. Where the opinion is favourable, it shall be transmitted to the Conseil consultatif de pharmacologie.
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 second or third 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.
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 Fonds de la recherche en santé du Québec 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.
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 Conseil consultatif de pharmacologie.
1991, c. 42, s. 118; 1994, c. 40, s. 457.
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 shall be established to administer all the institutions having their head offices in the territory of a regional county municipality and operating a residential and long-term care centre, or both a residential and long-term care centre and a general and specialized hospital centre with less than 50 beds.
For the purposes of this section, in areas where there is no regional county municipality, the territory concerned shall be the territory served by an institution which operates a local community service centre, unless the regional board, after taking into account the criteria mentioned in section 128, proposes another territory. Every such proposal requires the approval of the Minister.
1991, c. 42, s. 119; 1992, c. 21, s. 70.
120. A board of directors shall be established to administer all institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for mentally impaired persons.
1991, c. 42, s. 120.
121. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for persons with a physical impairment.
However, for the application of this section as regards the territory of the regional board established for the Montréal Centre region, the Minister may, on a proposal of the regional board, determine the organization referred to in the first paragraph otherwise than on the basis of the territory of the regional board.
1991, c. 42, s. 121; 1996, c. 36, s. 1.
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 shall be established to administer all the institutions having their head offices in the territory of a regional board and operating a rehabilitation centre for persons who suffer from alcoholism or other problems of addiction.
1991, c. 42, s. 124.
125. A board of directors shall be established to administer all the institutions having their head offices in the territory of a regional board 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 regional board established for the Montréal Centre region, the Minister shall determine otherwise than on the basis of the territory of the regional board, 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.
126. A board of directors shall be established to administer an institution which operates a local community service centre or an institution designated as a health care centre.
The same applies to an institution which operates a hospital centre and to an institution which operates both a residential and long-term care centre and a general and specialized hospital centre with 50 beds or more.
1991, c. 42, s. 126; 1992, c. 21, s. 70.
126.1. In order to develop a network of continuous service for users while protecting the mission of the institutions concerned, a regional board may, after consulting the institutions concerned, propose to the Minister that the following institutions be administered by the same board of directors: an institution operating a local community service centre and one or more institutions operating either a residential and long-term care centre or both a residential and long-term care centre and a hospital centre with less than 50 beds providing only emergency care and general care and related consultations, or only such a hospital centre, if all the institutions have their head offices in the territory of the institution operating the local community service centre and if that territory does not form part of the territory of the Montréal or Québec urban communities.
Where warranted by circumstances, such as the density of the population served or the organization of the services established on the basis of policies determined by the Minister, a regional board may, after consulting the institutions concerned, propose to the Minister that two or more institutions operating a local community service centre be administered by the same board of directors if they have their head offices in the territory of the same regional county municipality.
1996, c. 36, s. 2.
126.2. A regional board may, after consulting the institutions concerned, proposes to the Minister that two or more institutions operating a general and specialized hospital centre with 50 or more beds and having their head offices in the territory of the regional board, be administered by the same board of directors.
1996, c. 36, s. 2.
126.3. Every decision made by the Minister pursuant to section 126.1 or 126.2 must be approved by the Government, which shall determine the day and month when the elections and appointments of the persons referred to in sections 135 and 137 are to take place.
The Minister shall table every order made under the first paragraph before the National Assembly within 30 days of the day on which it is made or, if the National Assembly is not sitting, within 30 days of resumption.
1996, c. 36, s. 2.
126.4. If the election or appointment of a member pursuant to section 126.3 does not take place, the regional board shall make the apppointment within the following 30 days.
The invitation to the population for the purposes of the election held under section 135 shall be made jointly by the boards of directors of the institutions concerned.
Notwithstanding the first paragraph of section 149, the terms of office of the members of the first board of directors established pursuant to section 126.1 or 126.2 shall, for certain members, run only until the month of October or November of the year in which an election is held under section 135, and for the remaining members, until elections, appointments and cooptations have taken place under sections 137 and 138.
From the thirtieth day following the day on which the cooptation referred to in section 138 is completed, the institutions concerned by a decision of the Minister made pursuant to section 126.1 or 126.2 shall cease to be administered by the boards of directors established pursuant to section 119 or 126, as the case may be, and shall begin to be administered by the first boards of directors established pursuant to section 126.1 or 126.2, as the case may be.
1996, c. 36, s. 2; 1998, c. 39, s. 41.
126.5. The Government may, if it considers that the circumstances so require and in order to ensure that a decision made by the Minister under section 126.2 is implemented in the best possible conditions, allow the Minister to designate provisional members for a maximum period of two years after consulting the institutions concerned.
From the tenth day following the day on which the provisional members are designated, the institutions concerned shall cease to be administered by the boards of directors established pursuant to section 126 and shall be administered by the provisional members.
1996, c. 36, s. 2; 1998, c. 39, s. 42.
127. Where, by reason of the centres it operates and according to sections 119 to 126, an institution could be administered by more than one board of directors, the Minister shall determine, after consulting the regional board, which board of directors will administer the institution.
For the purposes of sections 183 to 208, the institution is deemed to operate only the centre corresponding to the type of board of directors that must be established in accordance with the Minister’s decision.
1991, c. 42, s. 127; 1998, c. 39, s. 43.
128. A regional board may propose to the Minister that he modify the organizational structure provided for in sections 119 to 126 where the nature or size of the territory or the nature, the number, the special characteristics or the capacity of the centres situated in the territory, the type of clientele served, the density of the population served or the sociocultural, ethnocultural or linguistic characteristics of part of the population or the institutions warrant it. The regional board shall, more particularly, take into account the institutions recognized under section 29.1 of the Charter of the French language (chapter C-11).
The modifications must be approved by the Government.
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.
1991, c. 42, s. 128; 1994, c. 23, s. 2; 1996, c. 36, s. 3.
§ 2.  — Composition of the board
1.  — Mode of appointment of members
129. The board of directors of the institutions referred to in each of sections 119 to 124 shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed:
(1)  four persons elected by the population at the election held pursuant to section 135;
(2)  three persons elected by and from among the persons employed by the institutions or practising their professions in one of the centres operated by the institutions, provided, however, the position titles of the elected persons are different and, where applicable, those persons are members of different professional orders;
(3)  two persons elected by the users’ committees of the institutions or, if there is only one institution with a users’ committee, appointed by that committee;
(4)  three persons appointed by the members of the legal person where one of the institutions concerned is a legal person designated by the Minister under section 139 or, if there is more than one institution of that type, appointed jointly by the members of the legal persons;
(5)  where applicable, one person or, if paragraph 4 cannot be applied, two persons appointed by the board of directors of the foundation of one of the institutions concerned or, if there is more than one institution in that situation or more than one foundation for a single institution, elected jointly by the boards of directors of the foundations concerned;
(6)  one person appointed by the members referred to in paragraphs 1 to 5 and chosen from a list of names provided by bodies representing the school sector, where one of the institutions concerned operates a centre serving children;
(7)  the executive director of the institutions concerned;
(8)  two persons, in the case of an institution referred to in section 119, or four persons, in the case of an institution referred to in sections 120, 121 and 124, appointed by the members referred to in paragraphs 1 and 3 to 6.
1991, c. 42, s. 129; 1994, c. 40, s. 457; 1996, c. 36, s. 4; 1998, c. 39, s. 44.
130. The board of directors of the institutions referred to in section 125 shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed:
(1)  four persons elected by the population at the election held pursuant to section 135;
(2)  one person elected by and from among the persons employed by the institutions which operate rehabilitation centres for young persons with adjustment problems or for mothers with adjustment problems or the persons practising their professions in one of the centres operated by the institutions, one person elected by and from among the persons employed by the institution operating the child and youth protection centre and one person elected by and from among the persons employed by one of the institutions or practising in one of the centres operated by one of the institutions; however, in the case of an institution operating a child and youth protection centre and also, alone or with other institutions, a rehabilitation centre for young persons with adjustment problems or for mothers with adjustment problems, the three persons elected must be elected by and from among the persons working for the institution or institutions concerned or practising their professions in one of the centres operated by the institution or institutions concerned and must, in all cases, hold different position titles and, where applicable, be members of different professional orders;
(3)  one person appointed by the users’ committee of the institution operating the child and youth protection centre and another person elected by the users’ committees of the other institutions; however, where the institution operating the child and youth protection centre also operates, jointly with other institutions, a rehabilitation centre for young persons with adjustment problems or a rehabilitation centre for mothers with adjustment problems, the two persons must be elected by the users’ committees of all those institutions and, where the institution operating the child and youth protection centre is the only institution operating a rehabilitation centre for young persons with adjustment problems or a rehabilitation centre for mothers with adjustment problems, the two persons must be appointed by the users’ committee of that institution;
(4)  three persons appointed by the members of the legal person where one of the institutions concerned is a legal person designated by the Minister under section 139 or, if there is more than one institution of that type, appointed jointly by the members of the legal persons;
(5)  where applicable, one person or, if paragraph 4 cannot be applied, two persons appointed by the board of directors of the foundation of one of the institutions concerned or, if there is more than one institution in that situation or more than one foundation for a single institution, elected jointly by the boards of directors of the foundations concerned;
(6)  two persons appointed by the members referred to in paragraphs 1 to 5, one of whom must be chosen from a list of names provided by bodies representing the judicial sector and the other after consultation with bodies representing the education sector;
(7)  the executive director of the institutions concerned;
(8)  four persons appointed by the members referred to in paragraphs 1 and 3 to 6.
1991, c. 42, s. 130; 1994, c. 40, s. 457; 1996, c. 36, s. 5; 1998, c. 39, s. 45.
131. The board of directors of an institution which operates a local community service centre or of an institution designated as a health care centre shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed:
(1)  five persons elected by the population at the election held pursuant to section 135;
(2)  three persons elected by and from among the persons employed by the institution or practising their professions in one of the centres operated by the institution, provided, however, the position titles of the elected persons are different and, where applicable, those persons are members of different professional orders; however, in the case of an institution which operates both a local community service centre and a hospital centre, four persons or, where the institution has entered into a service contract under section 259.2 with not fewer than five midwives, five persons shall be elected, one by and from among the physicians, dentists and pharmacists practising in one of the centres operated by the institution, one by and from among the nurses employed by the institution, one, where applicable, by and from among the midwives who have entered into such a contract, one by and from among the members of the multidisciplinary council referred to in section 226, including persons performing nursing assistant activities for the institution, and the last by and from among the other persons employed by the institution;
(3)  where applicable, two persons appointed by the users’ committee of the institution;
(3.1)  three persons appointed by the members of the legal person where the institution is a legal person designated by the Minister pursuant to section 139;
(4)  where applicable, one person or, if paragraph 3.1 cannot be applied, two persons appointed by the board of directors of the foundation of the institution or, if there is more than one foundation for the institution, elected jointly by the boards of directors of those foundations;
(5)  the executive director of the institution;
(6)  two persons appointed by the members referred to in paragraphs 1 and 3 to 4.
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.
131.1. The board of directors of the institutions referred to in section 126.1 shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed;
(1)  five persons elected by the population at the election held under section 135;
(2)  two persons elected by and from among the persons employed by the institution operating the local community service centre or practising their profession in the centre and one person elected by and from among the persons employed by the other institution or institutions concerned or practising their profession in one of the centres operated by the institution or institutions; however, if among the other institutions concerned, an institution or institutions operate only a residential and long-term care centre and an institution or institutions operate either a hospital centre with less than 50 beds or both a residential and long-term care centre and a hospital centre with less than 50 beds, one of the three persons shall be elected by and from among the persons employed by the institution operating the local community service centre or practising their profession in the centre, the second shall be elected by and from among the persons employed by the institution or institutions operating only a residential and long-term care centre or practising their profession in the centre operated by that institution or those institutions and the third person shall be elected by and from among the persons employed by the other institution or institutions concerned or practising their profession in one of the centres operated by that institution or those institutions; moreover, in the case of the institutions referred to in the second paragraph of section 126.1, the three persons elected shall be elected by and from among the persons employed by the institutions or practising their profession in a centre operated by the institutions; the elected persons shall, in all cases, hold different position titles and, where applicable, be members of different professional orders;
(3)  where applicable, two persons elected by the users’ committees of the institutions or, if there is only one institution with such a committee, appointed by that committee;
(4)  three persons appointed by the members of the legal person, where one of the institutions concerned is a legal person designated by the Minister under section 139 or, if more than one institution is such a legal person, appointed jointly by the members of the said legal persons;
(5)  where applicable, one person appointed by the board of directors of the foundation of the institution operating the local community service centre or, if there is more than one foundation for that institution, elected jointly by the boards of directors of those foundations and, if paragraph 4 cannot be applied, one person appointed by the board of directors of the foundation of one of the other institutions concerned or, if there is more than one institution in that situation or more than one foundation for a single institution, elected jointly by the boards of directors of the foundations concerned; however, in the case of the institutions referred to in the second paragraph of section 126.1, one person shall be appointed by the board of directors of the foundation of one of the institutions concerned or, if there is more than one institution in that situation or more than one foundation for a single institution, elected jointly by the boards of directors of the foundations concerned;
(6)  the executive director of each institution concerned;
(7)  two persons appointed by the members referred to in paragraphs 1 and 3 to 5.
1996, c. 36, s. 7; 1998, c. 39, s. 47.
132. The board of directors of an institution which operates a hospital centre or of an institution which operates both a residential and long-term care centre and a general and specialized hospital centre with 50 beds or more shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed:
(1)  four persons elected by the population at the election held pursuant to section 135;
(2)  one person elected by and from among the physicians, dentists and pharmacists practising in one of the centres operated by the institution, one person elected by and from among the nurses employed by the institution, one person elected by and from among the members of the multidisciplinary council, including persons performing nursing assistant activities for the institution, and one person elected by and from among the other persons employed by the institution;
(3)  where applicable, two persons appointed by the users’ committee of the institution;
(4)  three persons appointed by the members of the legal person where the institution concerned is a legal person designated by the Minister under section 139;
(5)  where applicable, one person or, if paragraph 4 cannot be applied, two persons appointed by the board of directors of the foundation of the institution or, if there is more than one foundation for the institution, elected jointly by the boards of directors of those foundations;
(6)  the executive director of the institution;
(7)  four persons appointed by the members referred to in paragraphs 1 and 3 to 5.
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.
132.1. The board of directors of the institutions referred to in section 126.2 shall be composed of the following persons, who shall be members of the board as and when they are elected or appointed:
(1)  four persons elected by the population at the election held under section 135;
(2)  one person elected by and from among the physicians, dentists and pharmacists practising in one of the centres operated by the institutions, one person elected by and from among the nurses employed by the institution, one person elected by and from among the members of the multidisciplinary council or councils, as the case may be, including persons performing nursing assistant activities for the institutions, and one person elected by and from among the other persons employed by the institutions;
(3)  where applicable, two persons elected by the users’ committees of the institutions or, if there is only one institution with a users’ committee, appointed by that committee;
(4)  three persons appointed by the members of the legal person, where one of the institutions concerned is a legal person designated by the Minister under section 139 or, where more than one institution is such a legal person, appointed jointly by the members of the said legal persons;
(5)  where applicable, one person or, if paragraph 4 cannot be applied, two persons appointed by the board of directors of the foundation of one of the institutions concerned or, if there is more than one institution in that situation or more than one foundation for a single institution, elected jointly by the boards of directors of the foundations concerned;
(6)  the executive director of each institution concerned;
(7)  four persons appointed by the members referred to in paragraphs 1 and 3 to 5.
1996, c. 36, s. 9; 1998, c. 39, s. 49.
132.2. For the purposes of paragraph 5 of each of sections 129, 130, 131.1, 132 and 132.1 and paragraph 4 of section 131, 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.
133. The composition of the board of directors of an institution which operates a centre designated as a university hospital centre, university institute or affiliated university centre shall be governed by any of sections 129 to 132.1, as the case may be.
The board of directors shall also include
(1)  where the institution operates a hospital centre designated as a university hospital centre, four persons apppointed by the university with which the institution is affiliated, two of whom carrying on mainly teaching activities and two mainly research activities, and a medical resident elected by and from among the medical residents practising at the hospital centre;
(2)  where the institution operates a centre designated as a university institute, two persons appointed by the university with which the institution is affiliated, one of whom carrying on mainly teaching activities and one mainly research activities and, where the institution operates a hospital centre designated as a university institute, a medical resident elected by and from among the medical residents practising at the hospital centre;
(3)  where the institution operates a centre designated as an affiliated university centre, one person appointed by the university with which the institution is affiliated and carrying on mainly teaching or research activities and, where the institution operates a hospital centre designated as an affiliated university centre, a medical resident elected by and from among the medical residents practising at the hospital centre.
In addition, those persons shall participate in the cooptation provided for in paragraph 8 of section 129 or 130, in paragraph 6 of section 131 or in paragraph 7 of each of sections 131.1 to 132.1, as the case may be.
1991, c. 42, s. 133; 1992, c. 21, s. 70; 1996, c. 36, s. 10.
133.1. In the case of an institution to which the Minister has assigned a supra-regional vocation pursuant to paragraph 1 of section 112, the board of directors shall also include two persons in addition to those referred to in paragraph 8 of section 129 or section 130, paragraph 6 of section 131 or paragraph 7 of any of sections 131.1 to 132.1, as the case may be. The two persons shall, however, be chosen from a list of names supplied by the regional boards concerned by the supra-regional vocation of the institution.
This section does not apply to an institution operating a hospital centre designated as a university hospital centre.
1996, c. 36, s. 11.
133.2. New members may be elected, appointed or coopted as soon as one of the following situations occurs:
(1)  the Minister designates a centre operated by an institution as a university hospital centre, university institute or affiliated university centre, pursuant to any of sections 88 to 91;
(2)  the Minister assigns a supra-regional vocation to an institution pursuant to paragraph 1 of section 112;
(2.1)  a users’ committee is established pursuant to the second paragraph of section 209;
(3)  a foundation of an institution within the meaning of section 132.2 is established;
(4)  paragraph 4 of any of sections 129, 130, 131.1, 132 and 132.1, or of paragraph 3.1 of section 131, cannot be applied and, consequently, a member can be added under paragraph 5 of section 129, 130, 131.1, 132 or 132.1, or paragraph 4 of section 131.
The election or appointment of such persons shall be carried out in accordance with the procedure set out in section 137, and cooptation shall be carried out in accordance with section 133.1.
The term of office of a person elected, appointed or coopted pursuant to this section shall end, notwithstanding section 149, at the same time as the term of office of the other members of the board of directors.
1996, c. 36, s. 11; 1998, c. 39, s. 51.
134. For the purposes of paragraph 2 of each of sections 129 to 132.1, a medical resident is regarded as a physician practising in a centre operated by the institution, except if the centre is designated as a university hospital centre, university institute or affiliated university centre.
1991, c. 42, s. 134; 1996, c. 36, s. 12; 1998, c. 39, s. 52.
135. Every institution shall, every three years, on such day in the month of October or November as the Minister determines, invite the population to elect the persons referred to in paragraph 1 of each of sections 129 to 132.1, as the case may be. No minor is entitled to vote.
In addition to the restrictions and limitations set out in sections 150 and 151, 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 an institution operating a local community service centre serving the population of the territory in which the person’s principal residence is situated;
(2)  one of the elections held in the region to elect members to the board of directors of an institution referred to in section 125;
(3)  one of the elections held in the region to elect members to the board of directors of an institution referred to in section 119;
(4)  one of the elections held in the region to elect members to the board of directors of an institution referred to in sections 120, 121 and 124;
(5)  one of the elections held in the region to elect members to the board of directors of an institution referred to in sections 132 and 132.1.
The mechanisms whereby candidates may address the population before an election, and the election procedure to be followed shall be determined by by-law of the regional board, as well as the standards relating to advertising, financing, the powers and duties of election officers and campaign literature. The by-law must be submitted to the Minister for approval; once approved, it shall come into force on the date of its publication in the Gazette officielle du Québec.
1991, c. 42, s. 135; 1992, c. 21, s. 13; 1996, c. 36, s. 13; 1998, c. 39, s. 53.
136. (Repealed).
1991, c. 42, s. 136; 1996, c. 36, s. 14; 1998, c. 39, s. 54.
137. The regional board shall, by by-law, determine the procedure for electing or appointing the persons referred to in paragraphs 2 to 6 of section 129, paragraphs 2 to 6 of section 130, paragraphs 2 to 4 of section 131, paragraphs 2 to 5 of each of sections 131.1 to 132.1 or the second paragraph of section 133, as the case may be.
Elections or appointments under the first paragraph shall take place on the date fixed by the regional board but within the 30 days preceding the date fixed by the Minister for the holding of an election pursuant to section 135; however, appointments under paragraph 6 of each of section 129 and 130 shall take place during the 30 days following the holding of such an election.
1991, c. 42, s. 137; 1992, c. 21, s. 14; 1996, c. 36, s. 15; 1998, c. 39, s. 55.
138. Once the elections and appointments of the persons referred to in sections 135 and 137 are completed, these persons shall, within the next 30 days, proceed with the cooptation provided for in paragraph 8 of section 129 or 130, in paragraph 6 of section 131, in paragraph 7 of each of sections 131.1 to 132.1 or in section 133.1, as the case may be.
Those persons must, in proceeding with the cooptation, enable persons whose competence and qualifications are judged to be useful for the administration of the institutions concerned to become members of the board of directors, ensure better representation of the different parts of the territory, and better sociocultural, ethnocultural, linguistic or demographic representation of the population served by the institutions on the board of directors and the most equitable representation possible of women and men.
An appointment made under this section must, to be valid, be submitted to the regional board for approval.
1991, c. 42, s. 138; 1996, c. 36, s. 16; 1998, c. 39, s. 56.
139. The Minister shall designate, from among the legal persons referred to in paragraph 1 of section 98 which own all or part of the immovables used for the activities of the institution, those whose members may, where applicable, take part in the appointment of the persons referred to in paragraph 4 of section 129 or 130, paragraph 3.1 of section 131 or paragraph 4 of each of sections 131.1 to 132.1, as the case may be.
The Minister must designate such a legal person if the latter proves to him that the acquisition or construction or the work performed on the immovables of the legal person has been financed by funds other than funds provided, in whole or in part, by government subsidy or other than funds provided entirely by public subscriptions and that the investments have not been the subject of a reimbursement or compensation.
1991, c. 42, s. 139; 1992, c. 21, s. 15; 1996, c. 36, s. 17.
140. A legal person referred to in section 139 may appeal to the Court of Québec from a decision rendered by the Minister refusing it the designation provided for in the said section.
1991, c. 42, s. 140; 1996, c. 36, s. 51.
141. Appeals are brought by means of a motion filed, within 30 days of the Minister’s decision, at the office of the Court of Québec in the judicial district where the head office of the institution is situated.
The motion must first be served on the Minister.
Service shall be governed by the Code of Civil Procedure (chapter C-25).
1991, c. 42, s. 141.
142. Within 10 days of the service of the motion on the Minister, the latter shall send the record relating to his decision to the office of the court.
1991, c. 42, s. 142.
143. Appeals shall be heard and decided by preference.
1991, c. 42, s. 143.
144. Subject to any additional proof it may require, the court shall render its decision on the record sent to it by the Minister after allowing the parties to express their views.
1991, c. 42, s. 144.
145. The Court of Québec may, in the manner prescribed by the Courts of Justice Act (chapter T-16), adopt the rules of practice deemed necessary for the purposes of sections 141 to 144.
1991, c. 42, s. 145.
146. The decision of the Court of Québec is final and without appeal.
1991, c. 42, s. 146.
147. If a position cannot be filled by the application of section 135, 137 or 138, the regional board shall appoint a person to the position within 60 days.
1991, c. 42, s. 147; 1998, c. 39, s. 57.
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 a board of directors other than the executive director is three years.
The members shall remain in office notwithstanding the expiry of their terms until they are reappointed, reelected or replaced.
1991, c. 42, s. 149.
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 regional board 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.
151. No person employed by the Ministère de la Santé et des Services sociaux, a regional board, an institution or any other organization providing services related to the field of health and social services and receiving subsidies from a regional board or the Minister, or employed by the Régie de l’assurance maladie du Québec or remunerated by the Régie, or a person practising under a service contract entered into pursuant to section 259.2, may vote or be elected at an election held under section 135.
Scholarships, subsidies or sums of money granted or paid under a research contract are not deemed to be remuneration for the purposes of the first paragraph.
A person employed by an institution or practising his profession in a centre operated by an institution may be elected or appointed as member of the board of directors of the institution only in that capacity in accordance with the relevant provisions of sections 129 to 132.1 and 133.1, respectively. The person may, in other capacities, be elected or appointed member of the board of directors of any other institution.
No member of a legal person referred to in paragraph 4 of section 129 or 130, paragraph 3.1 of section 131 or paragraph 4 of each of sections 131.1 to 132.1 may be elected at an election held under section 135.
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.
152. A person ceases to be a member of a board of directors upon becoming disqualified for appointment or election as such.
In addition, a person elected pursuant to section 135 shall cease to be a member of the board of directors upon becoming disqualified pursuant to the first or the fourth paragraph of section 151.
1991, c. 42, s. 152; 1996, c. 36, s. 19; 1998, c. 39, s. 59.
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 regional board 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 regional board, the institution or the Minister.
1991, c. 42, s. 155.
156. Any vacancy occurring after the election or appointment of a member of a board of directors shall be brought to the attention of the regional board and filled, for the unexpired portion of the term of office of the member to be replaced, as follows:
(1)  in the case of a member referred to in paragraph 2 or 3 of sections 129 to 132.1, every vacancy occurring less than two years after an election shall be filled in accordance with the election procedure prescribed for the election of that member;
(2)  in every other case, the members of the board of directors remaining in office shall fill the vacancy by resolution provided the person thus appointed has the qualifications required to be a member of the board of directors in the same capacity as the member he replaces, and provided the appointment takes into account the cases of ineligibility set out in the first and fourth paragraphs of section 151, in the case of a person appointed to replace a member elected under the first paragraph of section 135. The board of directors shall inform the regional board of the appointment.
If the board of directors fails to fill a vacancy within the next 60 days, the vacancy may be filled by the regional board.
Any unexplained absence from a number of regular and consecutive sittings of the board of directors determined in the rules of internal management, in the cases and circumstances provided therein, also constitutes a vacancy.
1991, c. 42, s. 156; 1996, c. 36, s. 20.
§ 3.  — Operation
1.  — Chairman, vice-chairman and secretary
157. Each year, the members of a board of directors shall elect a chairman, a vice-chairman and a secretary from among their number.
1991, c. 42, s. 157.
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.
159. In no case may the chairman or the vice-chairman of the board of directors 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.
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. A member of the board of directors may, where a quorum of members is physically present at the place where a meeting of the board of directors is to be held and where a majority of those members have consented thereto, participate in the meeting by means of videoconferencing, telephone or other communications equipment by means of which all persons participating in the meeting can hear each other. In such a case, the member is deemed to have attended the meeting.
The minutes of such a meeting must mention
(1)  the fact that the meeting was held with the assistance of the communications equipment they indicate;
(2)  the name of the members physically present at the meeting, and the names of the members who agreed to the use of the communications equipment;
(3)  the name of the member who participated in the meeting using the communications equipment.
1998, c. 39, s. 60.
162. A majority of the members 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.
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, if there is a quorum and if all the members have consented thereto, participate in a special meeting by way of a telephone conference call.
The minutes of such a meeting must mention the fact that the meeting was held by way of a telephone conference call, and that all the members who participated in the meeting agreed to the procedure. The decisions made at the meeting must be tabled at the following public meeting.
1991, c. 42, s. 164; 1998, c. 39, s. 62.
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 any of sections 119 to 125 or under section 126.1 or 126.2, 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.
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 in accordance with any of sections 119 to 125 or established in accordance with section 126.1 or 126.2 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.
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 shall manage the affairs and exercise all the powers of every institution under its administration, except the powers assigned to the members of a legal person designated by the Minister pursuant to 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.
171. The board of directors shall establish priorities and orientations for every institution under its administration and see to it that they are observed.
Priorities 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 regional board under section 378 and with the regional service organization plans provided for in section 347.
1991, c. 42, s. 171.
172. The board of directors must in addition, for every institution under its administration, ensure
(1)  the pertinence, quality and effectiveness of the services provided;
(2)  respect for users’ rights and promptness in processing users’ complaints;
(3)  economical and efficient use of human, material and financial resources;
(4)  the participation, motivation, enrichment, maintenance of professional standards and development of human resources.
1991, c. 42, s. 172.
173. The board of directors must,
(1)  appoint the executive director and senior management officers;
(2)  confirm the designation by the executive director of the complaints officer responsible for the application of the procedure for the examination of complaints filed by users referred to in section 29;
(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 to the intermediate resources attached to the institutions.
1991, c. 42, s. 173; 1998, c. 39, s. 63; 1999, c. 24, s. 30.
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 ten 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.
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 referred to in section 68 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.
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 designated by the Minister under 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.
181. The board of directors may, by by-law, establish the councils and committees necessary for the pursuit of its objects and determine their composition, functions, powers and duties, 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.
§ 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 designated by the Minister pursuant to 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.
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 129 to 132.1, 179, 180, 262.1, 327, 330 and 550 may be entrusted to the board of governors or delegates.
1992, c. 21, s. 18; 1996, c. 36, s. 23.
DIVISION II
ADMINISTRATION OF PRIVATE INSTITUTIONS
182. The functions, duties and responsibilities entrusted to a board of directors under sections 29, 38 to 41, 171 to 173, 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.
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 regional board 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.
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. These elements must be determined taking into account the permit of the institution operating the hospital centre, the financial resources at its disposal and the regional service organization plans drawn up by the regional board, 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 regional board 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 regional board, 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 regional board decides on its revision.
1991, c. 42, s. 184; 1992, c. 21, s. 70; 1998, c. 39, s. 67.
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.
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 and the regional service organization plans drawn up by the regional board, 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.
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 regional board for approval in accordance with section 378. Once approved by the regional board, 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 regional board decides on its revision.
1991, c. 42, s. 186; 1992, c. 21, s. 20; 1998, c. 39, s. 69.
187. The organization plan of every institution must also provide for any element required under this Act or a regulation made under subparagraphs 11 and 13 of the first paragraph 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;
(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.
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;
(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 role described in subparagraph 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.
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 a council exists.
1991, c. 42, s. 192.
§ 3.  — Executive director of a public institution
193. The executive director of a public institution shall be appointed by the members of the board of directors of that institution. Where the board of directors administers more than one institution, the executive director shall also act as the executive director of each of the institutions.
1991, c. 42, s. 193; 1992, c. 21, s. 21; 1998, c. 39, s. 70.
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.
He 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.
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 regional board 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 regional board 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.
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 regional board 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.
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 regional board 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 regional board for the period of disqualification determined in the judgment. That period shall not exceed three years.
1991, c. 42, s. 200.
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, suspension, remuneration, renewal of engagement or his other terms of employment.
1991, c. 42, s. 201.
§ 4.  — Director of professional services
202. A director of professional services must be appointed by any institution which operates a hospital centre or by any institution designated as a health care centre which operates both a local community service centre and a hospital centre. In the latter case, 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.
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. The director of professional services of an institution operating a general and specialized hospital shall, when a person whose death is imminent is a potential donor and, in accordance with the Civil Code, consent to the removal of organs or tissue from his body has been given, transmit with diligence to the agency or the person designated by the Minister all necessary medical information concerning the donor and the organs or tissue which could be removed.
The director of professional services shall be informed of such situations in accordance with the procedure established by the institution.
1993, c. 14, s. 1.
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 institution designated as a health care centre. 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.
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;
(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;
(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.
208. Subject to the provisions of a regulation under subparagraph 13 of the first paragraph 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 subparagraph 13 of the first paragraph 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. Each institution shall, once it operates a residential and long-term care centre of 20 beds or more, a rehabilitation centre, a psychiatric hospital centre or a child and youth protection centre, set up a committee for the users of those centres and, in the case of a public institution or of a private institution which is a party to an agreement 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, the amount paid for that purpose by the Minister.
An institution which operates a residential and long-term care centre of less than 20 beds, a general and specialized hospital centre or a local community service centre may set up such a committee at the request of the users to whom it provides services.
The committee shall be composed of at least five members elected by the users of the institution. A majority of the members must be users. However, where it is impossible to obtain a majority of users on the committee, the users may elect any other person of their choice, provided the person is not a person working for the institution or practising a profession in a centre operated by the institution.
Where the institution operates more than one centre or uses several facilities for the same centre, the composition of the committee must ensure an equitable representation of the users of each of those centres and of the users lodged in each of those facilities.
1991, c. 42, s. 209; 1992, c. 21, s. 24; 1992, c. 21, s. 70; 1998, c. 39, s. 73.
210. No person under curatorship may be a member of a users’ committee.
1991, c. 42, s. 210.
211. The executive director of the institution must foster the proper functioning of the users’ committee and inform, in writing, every user of the existence of the committee.
He must make a room available for the activities of the users’ committee and make it possible for the committee’s records to be kept confidential.
1991, c. 42, s. 211.
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 IV of Chapter III of Title II.
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 regional board.
1991, c. 42, s. 212; 1998, c. 39, s. 74.
§ 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 formed in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2 may, 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.
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;
In force: 1993-09-01
(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, except the processing of a complaint, 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 in such a case have access to the user’s record.
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.
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.
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.
§ 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 in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2, may, 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.
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;
(2)  making recommendations on the rules of nursing care 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.
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 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.
224. The responsibilities of the council of nurses shall be exercised by an executive committee composed of four nurses designated by the council, the chairman 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.
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.
The board of directors formed in accordance with the second paragraph of section 126.1 may, however, determine that a single council of midwives is to be established for all the institutions under its administration.
1999, c. 24, s. 32.
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 in accordance with one of sections 119 to 125 or in accordance with section 126.1 or 126.2 may, 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.
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 prepare a plan of action for personnel development, with the participation of its employees and of the unions to which they belong, where that is the case.
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 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.
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 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.
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.
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 medical and dental staffing plan of the institution as approved by the regional board.
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.
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.
1991, c. 42, s. 238; 1992, c. 21, s. 70; 1998, c. 39, s. 77.
239. Subject to sections 240, 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.
240. The board of directors must, before accepting a physician’s or dentist’s application for privileges, submit the application to the regional board for approval in the following cases:
(1)  where the number of physicians or dentists specified in the medical and dental staffing plan of the institution has been reached;
(2)  where the organization plan of the institution has not received the approval of the regional board.
1991, c. 42, s. 240; 1998, c. 39, s. 79.
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.
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.
243. The physician or dentist may 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.
1991, c. 42, s. 243.
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 regional board of all applications for appointment or renewal of appointment that have been accepted by the board of directors.
1991, c. 42, s. 245.
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.
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.
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.
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.
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 regional board 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.
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.
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.
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 subparagraph 22 of the first paragraph 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 subparagraph 22 of the first paragraph 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 regional board under section 347 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.
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 regional board under section 347 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.
259.11. An institution that operates a local community service centre designated by the regional board under section 347 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.
DIVISION IV
MATERIAL AND FINANCIAL RESOURCES
§ 1.  — Rules relating to material resources
260. No public institution may, without having obtained the advice of the regional board 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 of Québec (Statutes of Québec, 1991, chapter 64);
(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.
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 regional board, the sum and the revenues may also be used to finance a specific operating expenditure of the institution.
1991, c. 42, s. 262.
262.1. Any institution which is a legal person designated by the Minister pursuant to 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 regional board 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.
263. No public institution or private institution under agreement may, without having obtained prior authorization from the regional board,
(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.
264. A contract made by an institution without the prior authorization of the Conseil du trésor, the Minister or the regional board 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.
An action for nullity of a contract made by an institution contrary to this section may be instituted by the Minister, the regional board 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.
265. No public institution may
(1)  acquire shares in another legal person or operate a commercial enterprise, except with the advice of the regional board 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 regional board, 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 regional board 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.
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 regional board, 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 regional board 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 regional board 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 regional board or the Minister.
1991, c. 42, s. 268; 1998, c. 39, s. 86.
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 regional board 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.
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 regional board, 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.
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 regional board 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 regional board 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)  where, regardless of the amount of assistance, the utilization sought lies outside the scope of the activities of the institution as defined in the regional services organization plans prepared by the regional board;
(4)  (subparagraph repealed).
The application must be accompagnied with such documents and contain such information as are determined by the regional board.
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 regional board shall notify the institution of the eligibility of the project or of the requirements for its approval.
However, the regional board 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 regional board or the Minister.
1991, c. 42, s. 272; 1996, c. 36, s. 51; 1998, c. 39, s. 90.
273. The regional board 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 regional board 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.
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 to the regional board and to the Minister 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 regional board.
1991, c. 42, s. 278.
279. Every institution must, at the request of the regional board, 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 regional board. 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.
280. The information contained in a report or document prescribed by this subdivision is public.
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.
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 regional board, 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.
285. Before 1 April each year, the regional board shall inform every board of directors of the institutions referred to in sections 119 to 125 and in sections 126.1 and 126.2 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 regional board, 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 regional board 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 regional board, within 60 days, along with the operating budget of the institution.
1991, c. 42, s. 285; 1996, c. 36, s. 28.
286. Before 1 April each year, the regional board 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 regional board 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 regional board, within 60 days, along with the operating budget of the institution.
1991, c. 42, s. 286.
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 regional board 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.
288. Each institution shall transmit to the regional board, 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 regional board or the Minister.
The regional board shall furnish a copy of these reports to the Minister at his request.
1991, c. 42, s. 288.
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 regional board or the Minister.
1991, c. 42, s. 293.
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 regional board 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 regional board or by the Minister.
The regional board shall transmit a copy of the annual financial report of the institution to the Minister, at his request.
1991, c. 42, s. 295.
296. Notwithstanding any legislative provision inconsistent herewith, an institution may, with the prior authorization of the regional board 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 regional board may allow borrowings to be made under the first paragraph, and the maximum amount of such borrowings.
1991, c. 42, s. 296.
297. At the request of the regional board 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.
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 regional board 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 regional board, 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.
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 regional board.
1991, c. 42, s. 300; 1998, c. 39, s. 93.
DIVISION V
INTERMEDIATE AND FAMILY-TYPE RESOURCES
§ 1.  — Intermediate resources
301. A public institution identified by the regional board 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. Every resource attached to a public institution through which the institution provides lodging and support or assistance services to a user, according to his needs, with a view to maintaining or integrating him into the community is an intermediate resource.
1991, c. 42, s. 302.
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 within the framework of regional service organization plans, the Minister shall propose to regional boards a classification of the services offered by intermediate resources based on the degree of support or assistance required by users.
The classification shall be accompanied with the rates of compensation applicable to each type of service so classified.
The Minister shall also identify the policy to be followed by regional boards in determining the rules and procedures governing access to the services provided by intermediate resources, including the general criteria for admission to such resources.
1991, c. 42, s. 303.
304. The regional board 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 professional follow-up;
(3)  allocate to the institutions concerned the amounts necessary for making payments to intermediate resources in accordance with the applicable compensation rates;
(4)  ensure that mechanisms for concerted action between institutions and their intermediate resources are established and put into operation.
1991, c. 42, s. 304.
305. Public institutions identified by the regional board shall themselves recruit and assess intermediate resources with a view to their recognition by the regional board.
1991, c. 42, s. 305.
306. With the authorization of the regional board, several institutions may call upon the services of the same intermediate resource. The regional board shall, however, see to it that the institutions concerned agree on the professional follow-up and on the payments made to the resource.
1991, c. 42, s. 306.
307. Every person responsible for an intermediate resource may apply to the regional board for review of a decision made by the public institution to which the resource is attached to settle any misunderstanding concerning them.
The regional board 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 regional board shall transmit its decision to the institution and to the person responsible for the intermediate resource.
1991, c. 42, s. 307.
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 regional board 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 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.
311. Family-type resources comprise foster families and foster homes.
1991, c. 42, s. 311.
312. One or two persons receiving in their home 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 home 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 home.
1991, c. 42, s. 312.
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 to 308 apply, with the necessary modifications, to family-type resources.
1991, c. 42, s. 314.
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 Inspector General of Financial Institutions, 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.
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.
In the cases referred to in section 319.1, the letters patent shall indicate the names of not less than five and not more than the number of persons who must be elected or appointed under sections 129 to 133.1, as the case may be; such persons shall be members of the board of directors until the elections or appointments provided for in the said sections have taken place. The executive director of the institution shall, once appointed, be 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.
319.1. The second paragraph of section 319 shall apply
(1)  to an institution resulting from the amalgamation of all the institutions referred to in section 125;
(2)  to an institution referred to in section 129 if, in the territory in which the head office of the institution is situated, no board of directors has been established to administer other institutions of the same type that have their head offices in that territory;
(3)  to an institution referred to in section 129 if the regional board, after taking into account the criteria set out in section 128, has recommended to the Minister that the institution be excluded from the group of similar institutions in the territory and that a board of directors be established to administer only that institution;
(4)  to an institution referred to in section 131 or 132.
However, the provisions of subparagraphs 2 and 4 of the first paragraph do not apply where the new institution results from the amalgamation or conversion of institutions that, pursuant to section 126.1 or 126.2, were already administered by a board of directors established to administer at least one other institution that remains in existence.
1996, c. 36, s. 30.
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 Inspector General of Financial Institutions 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.
322. To amend the constituting instrument of a public institution, other than an institution to which paragraph 1 of section 98 refers, the Inspector General of Financial Institutions 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.
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 regional board, between the institution and the Minister.
1991, c. 42, s. 325.
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 designated by the Minister under 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.
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 regional board, 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 Inspector General of Financial Institutions.
After publication of the notice, the Minister shall give the institutions concerned the opportunity to present their views.
1991, c. 42, s. 328.
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 regional board, 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.
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 Inspector General of Financial Institutions.
The Inspector General of Financial Institutions, 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.
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 Inspector General of Financial Institutions 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.
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. A regional board 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 included in the regional service organization plan of the regional board;
(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.
A regional board may also subsidize a community organization committed, at the regional level, to promoting health and social development where so provided for in the regional service organization plans.
1991, c. 42, s. 336.
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 not provided for in the regional service organization plan of the regional board;
(4)  provincial groups of community organizations.
1991, c. 42, s. 337.
338. Every community organization or provincial group which receives a subsidy in cases covered by section 336 or 337 must, not later than 30 June each year, hold a public information meeting to which the users of its services and the users of health or social services whom it has served are invited. It must present them with a report of its activities and a financial statement.
It must also, not later than the said date, transmit the report of its activities and its financial statement to the authority from which it received a subsidy in cases covered by section 336 or 337.
1991, c. 42, s. 338.
PART III
COORDINATION, CONTROL AND REGULATION OF HEALTH SERVICES AND SOCIAL SERVICES
TITLE I
REGIONAL INSTITUTIONS
CHAPTER I
REGIONAL HEALTH AND SOCIAL SERVICES BOARDS
DIVISION I
STATUS AND OBJECTS
339. The Government shall establish, for each region it delimits, a regional health and social services board.
1991, c. 42, s. 339.
340. The main object of a regional board is to plan, organize, implement and evaluate, in the region, the orientations determined and policies established by the Minister.
The other objects of a regional board 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;
(2)  formulating priorities in matters of health and welfare according to the needs of the population of the region and within the scope of the objectives fixed by the Minister;
(3)  establishing service organization plans in its territory and evaluating the effectiveness of services. Any part of the service organization plans dealing with medical services requires the advice of the regional medical commission established under section 367 which shall be obtained in the manner provided for in subparagraph 1 of the first paragraph of section 369 and the advice of the regional department of general medicine established pursuant to section 417.1;
(4)  allocating the budgets intended for the institutions and granting subsidies to community organizations and accredited private resources;
(5)  ensuring the coordination of the special medical activities of physicians who are under agreement pursuant to section 360 and the activities of the institutions, community organizations, intermediate resources and nursing homes accredited for the purposes of subsidies under section 454 and promoting their cooperation with the other agents of community development;
(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.
1991, c. 42, s. 340; 1992, c. 21, s. 35; 1996, c. 36, s. 31; 1998, c. 39, s. 98.
341. The name of a regional board must include the expression “regional board” and indicate the region for which it is established.
1991, c. 42, s. 341.
342. A regional board is a legal person.
1991, c. 42, s. 342; 1996, c. 36, s. 51; 1999, c. 40, s. 269.
342.1. Each regional board 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 regional board.
A copy of the by-laws adopted by a regional board must be forwarded to the Minister at the Minister’s request.
1998, c. 39, s. 99.
DIVISION II
SPECIAL FUNCTIONS
§ 1.  — Functions in respect of the population and the rights of users
343. The regional board shall see that mechanisms for public participation provided for in this Act, such as users’ committees, are implemented.
The regional board shall supervise the election and appointment of the members of the board of directors of public institutions where such election or appointment is provided for by this Act.
1991, c. 42, s. 343; 1996, c. 36, s. 32.
344. The regional board must, in addition to the functions entrusted to it by sections 42 to 53.1, 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.
345. The regional board shall ensure that each institution establishes and implements a complaint examination procedure.
1991, c. 42, s. 345.
§ 2.  — Functions relating to priorities in matters of health and welfare
346. The regional board shall see to it that health and welfare priorities are respected and that health and welfare objectives are achieved. 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 for the preparation of regional service organization plans;
(3)  inform the Minister of the needs of the population for the preparation and update of the health and welfare policy and 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 regional board 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.
§ 3.  — Functions relating to the organization of services
347. A regional board must, in collaboration with the institutions and community organizations in its region and, where applicable, with persons involved in sectors of activity having an impact on health and social services, develop and implement service organization plans.
The plans must be consistent with the orientations determined and policies established by the Minister.
In addition, the plans shall identify the services required to respond to the needs of the population in the region, taking into account
(1)  (subparagraph repealed);
(2)  the health and social resources in the region, particularly those of community organizations;
(3)  the mission of the centres operated by the institutions of the region;
(4)  the financial resources identified for such purposes;
(5)  the social, cultural and linguistic characteristics of the population of the region and, where applicable, of the institutions of the region coming under section 348;
(6)  the organization of teaching and research taking place in the institutions of the region.
The plans must identify the institutions operating a local community service centre which are authorized to offer midwifery services and which may enter into a service contract to that effect with a midwife pursuant to section 259.2.
The plans must specify the contribution expected from each institution and each community organization in the region in order to achieve the objectives formulated in the policy.
The Minister may, subject to the rights of third persons, cancel a decision made by a regional board pursuant to a service organization plan that is inconsistent with the Minister’s orientations and policies.
The part of the plans dealing with the highly specialized services determined by the Minister that are provided by the institutions in the region, and the part dealing with the services for which an institution has been granted a supraregional vocation by the Minister pursuant to paragraph 1 of section 112, must be submitted to the Minister for approval.
1991, c. 42, s. 347; 1996, c. 36, s. 34; 1998, c. 39, s. 102; 1999, c. 24, s. 36.
348. Each regional board, 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 regional boards, 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.
349. Each regional board 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.
§ 4.  — Functions relating to the allocation of financial resources
350. Each regional board shall allocate the financial resources put at its disposal for the implementation of the regional service organization plans developed for its region.
Each regional board 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 accredited private resources referred to in Chapter III of Title II of this Part.
The regional board 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 regional board 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 regional board 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 Corporation d’hébergement du Québec.
1991, c. 42, s. 350; 1992, c. 21, s. 36; 1998, c. 39, s. 103.
351. Each regional board 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.
§ 5.  — Functions relating to the coordination of health services and social services
352. Each regional board 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, community organizations and private facilities into account, eliminate duplication of services and allow the setting up of joint services.
1991, c. 42, s. 352.
353. The regional board shall cooperate with other bodies and agencies of the region, particularly municipalities, regional branches of government departments and of government agencies, institutions in the education and higher education sector and socio-economic organizations, in activities conducive to improving the health and welfare of the population.
1991, c. 42, s. 353.
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 regional board shall also determine, within the framework of its regional service organization plans and 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 regional board 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.
355. The regional board 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 board, intermediate resources attached to institutions and family-type resources of its region.
The regional board 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.
356. Every institution concerned with a mechanism of access to services established pursuant to section 355 must submit its criteria of access to services to the regional board for approval, in particular with respect to the admission and discharge of users and the policies for their transfer. However, the Minister may require that an institution, by reason of its special vocation, submit its criteria and policies directly to him for approval. The Minister shall in that case obtain the opinion of the board.
1991, c. 42, s. 356.
357. Each regional board shall, to ensure rational utilization of child placement services, see to it that every institution operating a child and youth protection centre and every other institution exercising responsibilities in matters of child placement coordinate their actions and comply with the measures determined for that purpose by regulation made under paragraph 10 of section 505.
1991, c. 42, s. 357.
358. Each regional board shall ensure that the institutions of the region carry out their functions of reception, assessment and referral of users, and that intermediate resources and family-type resources are developed in harmony with the capacity of the population concerned to accept them.
1991, c. 42, s. 358.
359. For the purpose of distributing emergency cases and ensuring a prompt and adequate response to the needs of the users, the regional board and the regional department of general medicine shall, after consultation with the regional medical commission,
(1)  approve admission criteria for and policies governing the transfer of users to centres operated by public institutions and private institutions under agreement;
(1.1)  designate the institutions that are to dispense emergency services;
(2)  ensure that adequate operating standards of emergency services are adopted by the institutions designated under paragraph 1.1 or, if not, fix such standards;
(3)  ensure that the institutions designated under paragraph 1.1 adopt and apply standards for the use and allocation of beds which are consistent with an adequate distribution of emergency cases or, if not, fix such standards;
(4)  develop and implement a regional information system to monitor, on a daily basis, the situation in the centres operated by the institutions designated under paragraph 1.1 as regards the number and nature of registrations and admissions of users and their transfer and transport by ambulance.
1991, c. 42, s. 359; 1992, c. 21, s. 37; 1998, c. 39, s. 105.
360. Every general practitioner having less than 10 years of practice and whose principal professional activity, as defined in an agreement entered into under the sixth paragraph of section 19 of the Health Insurance Act (chapter A-29), is carried on in private facilities, may apply to participate in such an agreement.
Not in force
Every specialist who does not hold the status of active member, within the meaning of the regulation made under paragraph 3 of section 506, in an institution which operates a hospital centre, may also apply to participate in such an agreement.
1991, c. 42, s. 360; 1992, c. 21, s. 70.
361. For the purposes of section 360, the regional board shall establish, on the basis of such recommendations as may be made by the regional department of general medicine, a list of specific medical activities based on its service organization plans. The list shall also specify the conditions of exercise of each activity offered, in accordance with the conditions of the agreement referred to in section 360.
In the case of a general practitioner applying to participate in an agreement referred to in section 360, the list of specific medical activities includes the following activities:
(1)  dispensing professional services in any centre, other than a local community service centre, operated by an institution;
(2)  being on duty in the first-line emergency services of certain institutions operating a local community service centre or designated as health care centres;
(3)  participating in a prevention program or in a home-care program;
(4)  according to the conditions established by agreement, participating in any other health care program or any other professional service determined by the regional board in order to meet the needs to which it assigns priority;
(5)  collaborating with the other resources in the territory in order to ensure the availability of medical services at all times;
(6)  dispensing professional services within the framework of an emergency prehospitalization system set up in the territory of the regional board, according to the conditions laid down by agreement.
A general practitioner who accepts to dispense medical services in any local community service centre operated by an institution is deemed to participate in an agreement referred to in section 360.
1991, c. 42, s. 361; 1992, c. 21, s. 38; 1998, c. 39, s. 106.
362. A physician shall submit his application to the regional board which shall transmit to him a list of specific medical activities from which he must choose.
1991, c. 42, s. 362.
363. The regional board shall authorize physicians to participate in the agreement referred to in section 360 if they undertake in writing to exercise one of the specific medical activities described in section 361.
The regional board, before authorizing a physician to participate in the agreement referred to in section 360, must take into account the number of physicians authorized in its medical staffing plan.
1991, c. 42, s. 363.
364. For as long as a physician respects the undertaking made by him in accordance with section 363, and until he is discharged in accordance with the terms of an agreement referred to in section 360, he shall remain subject to that agreement.
1991, c. 42, s. 364.
365. Where, in the opinion of the regional board, a physician ceases to respect the undertaking made by him in accordance with section 363, the board shall terminate his participation in the agreement and inform the physician, the regional department of general medicine and the Régie de l’assurance maladie du Québec. The regional board must give the physician an opportunity to present observations.
1991, c. 42, s. 365; 1997, c. 43, s. 730; 1998, c. 39, s. 107; 1999, c. 89, s. 53.
366. A physician who is not satisfied with a decision refusing or terminating his participation may submit that decision to the arbitration procedure provided for in the agreement referred to in section 360.
1991, c. 42, s. 366.
367. A regional medical commission is hereby instituted for each region of Québec where the Government institutes a regional board.
The commission is composed of:
(1)  three general practitioners elected by the general practitioners of the region from among their number;
(2)  three specialists elected by the specialists of the region from among their number;
(3)  one person appointed by the Dean of each Faculty of Medicine of the region, if any;
(4)  the Director of Public Health.
The executive director of the regional board or the physician he designates for that purpose shall also be a member of the commission.
To ensure better representation of the fields of medical practice in the centres operated by the institutions of the region, the regional board shall appoint not more than four physicians from the region who are members of the commission from the time of their appointment. However, the regional board, in making such appointments, must ensure that general practitioners and specialists are represented in equal numbers on the commission.
On the recommendation of the regional medical commission, the regional board may appoint four resource persons as observers. In regions where there is a Faculty of Medicine, the number of resource persons shall be six of whom one must be a medical resident. Such persons shall participate in the discussions of the commission but shall be without voting rights.
The chairman of the regional medical commission shall be elected by the members elected under subparagraphs 1 and 2 of the second paragraph from among their number.
1991, c. 42, s. 367.
368. The procedure of appointment or election of the members of the regional medical commission and of its chairman, their terms of office and the rules of internal management of the commission shall be determined by by-law of the regional board.
1991, c. 42, s. 368.
369. The regional medical commission is responsible to the board of directors of the regional board
(1)  for advising it on the organization and distribution of medical services in the territory and on the medical staffing plan referred to in section 377, on the basis of the regional service organization plans referred to in section 347;
(1.1)  for advising it on the quality of the medical services organization in the territory, and on the accessibility and coordination of services;
(2)  for advising it on the remuneration methods and the organization of the practice of physicians which are best suited to respond to the needs of the region;
(3)  (subparagraph repealed);
(4)  for carrying out any other mandate entrusted to it by the board of directors and submitting periodic reports thereon.
For the purposes of this section, the regional medical commission and the regional board may require the Régie de l’assurance maladie du Québec to send them the practice profiles and information referred to in the third paragraph of section 66.1 of the Health Insurance Act (chapter A-29).
1991, c. 42, s. 369; 1998, c. 39, s. 108; 1999, c. 89, s. 53.
370. The regional medical commission may establish the committees necessary for the pursuit of its objects.
1991, c. 42, s. 370.
§ 6.  — Functions relating to public health
371. Each regional board shall
(1)  manage the public health program determined by the Minister and, for such purpose, establish priorities, organize services and allocate resources;
(2)  establish a public health department.
A regional board may entrust activities relating to the public health program to the institutions it determines, within the framework of its regional service organization plans and in accordance with the orientations determined by the Minister.
1991, c. 42, s. 371; 1992, c. 21, s. 39; 1998, c. 39, s. 109.
372. The Minister, on the recommendation of the regional board, shall appoint a public health director.
The public health director must be a physician trained in community health care.
1991, c. 42, s. 372.
373. The public health director shall be responsible for
(1)  informing the population on its general state of health and of the major health problems, the groups most at risk, the principal risk factors, the interventions he considers the most effective, monitoring the evolution thereof and conducting studies or research required for that purpose;
(2)  identifying situations which could pose a threat to the population’s health and seeing to it that the measures necessary for its protection are taken;
(3)  ensuring the development of expertise in prevention and in the promotion of health.
1991, c. 42, s. 373; 1998, c. 39, s. 110.
374. The director shall carry out any other mandate entrusted to him by the regional board within the scope of his responsibilities.
1991, c. 42, s. 374.
375. The director must, without delay, inform the Minister of any emergency or of any situation posing a threat to public health.
1991, c. 42, s. 375.
375.1. (Repealed).
1992, c. 21, s. 40; 1998, c. 39, s. 111.
§ 7.  — Functions relating to human, material and financial resources management
376. Each regional board shall draw up a regional human resources development plan in keeping with the orientations determined by the Minister and the policies he establishes and in cooperation with the institutions and organizations concerned, and see to its implementation. To that end, the regional board shall
(1)  coordinate personnel development activities within the scope of the regional service organization plans;
(2)  coordinate personnel development activities for the members of the boards of directors of institutions;
(3)  assist community organizations with regard to human resource development activities for their members.
In addition, the regional board shall assist the institutions in preparing their plans of action for personnel development, if they so request, and identify priority needs so as to foster the pooling, by institutions, of services related to personnel development and mobility.
1991, c. 42, s. 376.
377. Each regional board shall prepare a regional medical staffing plan on the basis of the parts of the organization plans of institutions transmitted to it in accordance with sections 184 and 186, the number of physicians required to perform the specific activities referred to in section 361, and the number of general practitioners and medical specialists, listed by speciality, who are remunerated by the Régie de l’assurance maladie du Québec and practise in the region, including those who practise in a private health facility.
In preparing its regional plan, the regional board shall take into account the expansion or reduction objectives identified by the Minister, the medical activities of the physicians practising in the region who receive remuneration from the Régie de l’assurance maladie du Québec, and the number of positions determined by the Minister to be reserved for physicians having practised in other regions.
In preparing its regional plan, the regional board must also take into account the recommendations of the regional medical commission, obtained in the manner set out in subparagraph 1 of the first paragraph of section 369, and the recommendations of the regional department of general medicine, obtained in the manner set out in subparagraph 1 of the first paragraph of section 417.2.
The regional plan, together with the parts of the organization plans of institutions that were used in preparing the regional plan, must be submitted to the Minister for approval with or without amendment.
The regional plan must be reviewed at least every three years and shall continue in force until the Minister decides on its review.
1991, c. 42, s. 377; 1998, c. 39, s. 112; 1999, c. 89, s. 53.
377.1. In order to ensure compliance with the regional medical staffing plan, every physician in the region who is remunerated by the Régie de l’assurance maladie du Québec and practises in a private health facility shall be bound by an agreement entered into under the seventh paragraph of section 19 of the Health Insurance Act (chapter A-29).
1998, c. 39, s. 113; 1999, c. 89, s. 53.
378. Once its regional medical staffing plan is approved, the regional board shall approve the parts of the organization plans transmitted to it by institutions in accordance with sections 184 and 186.
However, before approving the parts of the organization plans referred to in the first paragraph that were transmitted to it by institutions which operate a centre designated as a university hospital centre or university institution, the regional board shall consult the university with which each institution is affiliated. Such consultation shall bear on all the parts of the organization plans of the institutions.
The regional board shall, on request, transmit to the Minister each part of an organization plan it has approved.
1991, c. 42, s. 378; 1992, c. 21, s. 70; 1998, c. 39, s. 114.
379. A regional board may, in exceptional circumstances and with the Minister’s authorization, depart from its regional medical staffing plan to enable a physician to be appointed by an institution, upon obtaining his licence to practise, subject to the terms it determines, if, on 1 October 1992, that physician was a student enrolled in a medical training program.
Sections 237 to 252 apply, with the necessary modifications, to such a student.
1991, c. 42, s. 379.
380. Where the Minister so requests, the regional board shall advise him on the methods of remuneration and on the organization of the practice of physicians practising in the region which best correspond to the needs of the region.
1991, c. 42, s. 380.
381. In performing its functions or at the request of the Minister, the regional board may require that the institutions and community organizations of its region furnish to it, in the form and within the time limit it prescribes or which are determined by the Minister, the information prescribed by regulation under paragraph 25 of section 505 concerning clientele, services requested and provided and resources used. No information may be transmitted that would permit a user of an institution or a person using the services of a community organization to be identified.
It shall furnish the Minister with any information he requires on the allocation and use of the financial and material resources of the institutions and community organizations of its region.
1991, c. 42, s. 381.
382. The regional board shall examine the institutions’ requests relating to material resources which must be submitted to it for advice or authorization in accordance with this Act or the regulations. It must reply to them with diligence.
1991, c. 42, s. 382.
383. The regional board shall ensure that the institutions of its region are grouped for the joint procurement of goods and services it determines. It may, if necessary, require institutions to participate in regional joint purchasing groups.
The institutions of a region may, with the authorization of the regional board and on the conditions determined by the Minister, establish a non-profit legal person representing the institutions of the region to manage the procurement of goods and services. They must, however, establish such a legal person where the regional board considers it necessary. If they fail to do so, the regional board may, with the authorization of the Minister, see to the establishment of a joint service legal person for the institutions of the region.
With the authorization of the Minister, the types and manner of grouping institutions for the joint procurement of goods and services may be determined for two or more regions.
The provisions of sections 260 to 265, 278 to 280, 282, 289 to 292, 294 to 297, 436, 485, 486, 489, 499 and 500 apply, with the necessary modifications, to a legal person referred to in this section.
The auditor appointed by a legal person pursuant to section 290 must, for the fiscal year of the appointment, audit the financial report of the legal person and perform the other duties included in the audit mandate determined by the legal person, the regional board or the Minister.
1991, c. 42, s. 383; 1996, c. 36, s. 51; 1998, c. 39, s. 115.
384. The regional board shall determine the procedure according to which, and the intervals at which, a public institution, a private institution under agreement, and an accredited private resource must respond to the questions of the regional board concerning their management.
The regional board shall also determine the procedure according to which it must, once a year, account for its management to the population of its territory, more specifically by presenting an annual report on its activities. The procedure must be submitted to the Minister for approval.
1991, c. 42, s. 384; 1998, c. 39, s. 116.
385. Upon ascertaining that an institution or one or several members of a board of directors is or are in one of the situations described in subparagraphs 3, 4 and 5 of the first paragraph of section 490, the regional board shall inform the Minister thereof.
1991, c. 42, s. 385.
DIVISION III
OPERATING BUDGET AND REPORTS
386. The fiscal year of the regional board ends on 31 March.
1991, c. 42, s. 386.
387. The executive director of the regional board shall submit to the board of directors, before the date determined by the latter, the operating budget of the regional board for the following fiscal year, prepared according to the budgetary parameters transmitted by the Minister.
The estimates of the expenditures and revenues must be balanced.
1991, c. 42, s. 387.
388. The Minister shall inform every regional board, before 1 April each year, of the total amount he 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 regional board is revised, if necessary, adopt the operating budget of the regional board and inform the Minister thereof.
Where a budget balancing plan is required to enable the regional board to adhere to its operating budget, the board of directors shall see to it that such a plan is prepared, adopted and transmitted to the Minister, within 60 days, along with the operating budget of the regional board.
In addition, the Minister may, if he considers it expedient, allocate a capital budget to a regional board on the conditions he determines.
1991, c. 42, s. 388.
389. If, on 1 April in a year, a regional board has not been informed by the Minister of the total amount allocated to its operating budget, one-quarter of the budget of 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 amount allocated to the budget of the fiscal year concerned.
1991, c. 42, s. 389.
390. A regional board is subject to the provisions of section 115 and the first paragraph of section 269.1, with the necessary modifications, with regard to the complementary activities it organizes and the rules governing the use of its own property.
1991, c. 42, s. 390; 1996, c. 36, s. 35; 1998, c. 39, s. 117.
391. Not later than 30 September each year, a regional board shall submit a report on its activities for the year ending on the preceding 31 March to the Minister.
The report must contain a description of the role of the regional board and a general statement of its operations for the preceding fiscal year, with a description of the objectives set at the beginning of the fiscal year, the results obtained, the new orientations adopted, and any changes affecting the activities and the human, material and financial resources of the board for that year.
The report must include financial statements, consisting of a balance sheet, a statement of revenue and expenditure and a statement of changes in financial position. The statements must be presented in a way that allows each item for the fiscal year just ended to be compared with the corresponding item for the previous fiscal year. The regional board must mention, in its financial statements and in the notes and tables to which the statements refer, if any, all the relevant information needed for a full disclosure of its financial position.
The report must also mention the activities of the institutions in the region and the community organizations that receive subsidies from the regional board under section 336 for the year ending on the preceding 31 March.
1991, c. 42, s. 391; 1996, c. 36, s. 36; 1998, c. 39, s. 118.
392. The Minister shall table the report of every regional board before the National Assembly within 30 days of its receipt or, if the Assembly is not in session, within 30 days after resumption.
The National Assembly shall refer the report to the Parliamentary Committee on Social Affairs, which shall examine it and, for that purpose, hear each regional board at least once every three years.
1991, c. 42, s. 392.
393. (Repealed).
1991, c. 42, s. 393; 1998, c. 39, s. 119.
394. Each regional board must provide the Minister, at his request and in the manner and within the time he determines, with any statement, statistics, report or other information that he requires with regard to the activities of the regional board or that he considers relevant to the carrying out of this Act. No information may be provided that would permit the user of an institution or a person using the services of a community organization to be identified.
1991, c. 42, s. 394.
395. The regional board is subject to sections 280 and 288 to 295, with the necessary modifications, with respect to the reports it must transmit to the Minister and the audits it must cause to be carried out.
1991, c. 42, s. 395; 1998, c. 39, s. 120.
396. Notwithstanding any inconsistent legislative provision, a regional board may, with the authorization of the Minister and on the conditions he determines, take out any form of loans recognized by law.
At the request of the Minister, a regional board shall, either directly or through the financial institutions with which it does business, provide the Minister with any information on its financial position.
1991, c. 42, s. 396.
DIVISION IV
BOARD OF DIRECTORS
§ 1.  — Composition, tenure and qualifications of members
397. The board of directors of a regional board shall consist of the following persons who shall become members of the board as and when they are elected or appointed:
(1)  six persons elected by institutions from among the members of the boards of directors of the public institutions referred to in paragraph 1 of each of sections 129 to 132.1 and the administrators and members of the boards of directors of private institutions;
(2)  four persons elected by the regional community organizations designated by the regional board from among the members of the boards of directors of those organizations;
(3)  four persons elected by regional county municipalities from among the elected municipal officers of the local municipalities whose territories are comprised within that of the regional county municipalities; in a region in which there is also an urban community, two of the four persons shall be elected by the urban community from among the elected municipal officers of the municipalities whose territories are comprised within that of the urban community; in the case of the regional board established for the Montréal Centre region, two persons shall be elected by the Communauté urbaine de Montréal from among the elected municipal officers of the municipalities, other than Ville de Montréal, whose territory is comprised within that of the Communauté urbaine de Montréal and two persons shall be appointed by Ville de Montréal from among its elected municipal officers; in the case of the regional board established for the Laval region, all four persons shall be elected by Ville de Laval from among its elected municipal officers;
(4)  two persons elected by the public educational institutions having their head offices in the region from among the members of the boards of directors of those institutions;
(5)  three persons elected by the regional organizations designated by the regional board as being the most representative of socio-economic groups, and by organizations and associations that have been designated by the regional board and whose activities are related to the field of health and social services;
(6)  three persons appointed by the persons elected under subparagraphs 1 to 5, in accordance with section 398;
(7)  the chairman of the regional medical commission;
(8)  the executive director of the regional board.
Except in the case of Ville de Montréal, no election under subparagraph 3 of the first paragraph may result in the election of more than one elected municipal officer from each regional county municipality or from each municipality whose territory is comprised within that of an urban community. No election under subparagraph 4 of the first paragraph may result in the election of more than one of the administrators or board members of such educational institutions.
No person may be a candidate in more than one election under subparagraphs 1 to 5 of the first paragraph.
1991, c. 42, s. 397; 1996, c. 36, s. 37; 1996, c. 59, s. 1; 1998, c. 39, s. 121.
397.1. (Repealed).
1992, c. 21, s. 41; 1996, c. 36, s. 38; 1998, c. 39, s. 122.
397.2. The Minister may determine, for each region he designates, the composition of each group referred to in subparagraphs 1 to 5 of the first paragraph of section 397 in order to ensure an equitable representation of institutions, reflecting the mission of the centres they operate, of community organizations, regional county municipalities and municipalities whose territories are comprised in the territory of an urban community, educational institutions and socio-economic groups, and of the organizations and associations whose activities are related to the field of health and social services. The Minister may also, in determining the composition of each group, take into account the representation of each part of the territory of the regional board.
The Minister may determine, for each region he designates, whether the groups referred to in each of subparagraphs 1 and 2 of the first paragraph of section 397 are to hold a single election or separate elections, according to the missions of the centres operated by the institutions or the type of services provided by the community organizations.
The Minister may determine, for each region he designates, the number of persons elected by organizations representing socio-economic groups and by organizations and associations whose activities are related to the field of health and social services.
1996, c. 36, s. 38; 1998, c. 39, s. 123.
397.3. The Minister shall determine, by regulation, the procedure to be followed for the election of the persons referred to in subparagraphs 1 to 5 of the first paragraph of section 397.
The Minister shall fix the date on which each election is to be held.
1996, c. 36, s. 38.
398. One the election of the members referred to in subparagraphs 1 to 5 of the first paragraph of section 397 has been completed, the members shall, within 30 days, elect three persons by cooptation to the board of directors.
The members shall, by means of the election by cooptation, allow for membership on the board of directors of persons whose competence and skills are considered useful to the administration of the regional board, and ensure just representation of the parts of the territory of the regional board, the sectors of activity or the sociocultural, linguistic or demographic groups of the region as well as the most equitable representation possible of men and women.
Appointments made under this section are not valid unless they are submitted to the Minister for approval.
1991, c. 42, s. 398; 1992, c. 21, s. 42; 1996, c. 36, s. 39.
398.0.1. If a position cannot be filled by the application of section 397 or 398, the Minister shall appoint a person to the position within 60 days.
1998, c. 39, s. 124.
398.1. Section 150 applies, with the necessary modifications to the members of the board of directors of a regional board.
In addition, with the exception of a director of a private institution, the executive director of the regional board and the chairman of the regional medical commission, no person who is employed by the Ministère de la Santé et des Services sociaux, a regional board, an institution or the Régie de l’assurance maladie du Québec, or who receives remuneration from the latter, and no person having made a service contract under section 259.2, may be a member of the board of directors of a regional board.
A bursary, a subsidy or an amount paid under a research contract is deemed not to be remuneration for the purposes of the second paragraph.
No person employed by a community organization may be elected or appointed as a member of the board of directors of a regional board, except under subparagraph 2 of the first paragraph of section 397.
1996, c. 36, s. 40; 1998, c. 39, s. 125; 1999, c. 24, s. 37; 1999, c. 89, s. 53.
398.2. A person ceases to be a member of a board of directors when the person no longer qualifies for appointment or election to the board of directors.
However, a person elected to the board of directors of a public institution under paragraph 1 of one of sections 129 to 132.1 is considered to remain qualified when the institution is amalgamated if the person is a member of the board of directors of the institution resulting from the amalgamation.
1998, c. 39, s. 126.
399. The term of office of persons elected or appointed under subparagraphs 1 to 6 of the first paragraph of section 397 is three years. Such persons shall, however, remain in office until re-elected, reappointed or replaced, notwithstanding any new election held under section 135 in the case of a person elected under subparagraph 1 of the said first paragraph.
The term of office of such persons cannot be renewed more than once.
1991, c. 42, s. 399; 1996, c. 36, s. 41.
400. Sections 153, 154, 155 and 165 apply, with the necessary modifications, to the members of the board of directors of a regional board.
1991, c. 42, s. 400; 1998, c. 39, s. 127.
401. Any vacancy occurring during the term of office of a member of a board of directors elected under any of subparagraphs 1 to 5 of the first paragraph of section 397 shall be filled for the unexpired portion of the term by way of a resolution of the board of directors, provided that the person so appointed possesses the same qualifications for membership of the board of directors as the person replaced.
Any vacancy occurring during a term of office in a seat held by a member of a board of directors elected by cooptation must be filled within a reasonable time in accordance with the mode of appointment prescribed in section 398, but only for the unexpired portion of the term of office of that member.
If the board of directors fails to fill a vacancy within 60 days, the Minister may fill the vacancy.
Absence from the number of meetings of the board of directors determined by the internal rules of management constitutes a vacancy in the cases and circumstances indicated by the board.
1991, c. 42, s. 401; 1995, c. 28, s. 2; 1996, c. 36, s. 42; 1998, c. 39, s. 128.
§ 2.  — Chairman, vice-chairman and secretary
402. The members of the board of directors shall, each year, elect a chairman, a vice-chairman and a secretary from among their number.
1991, c. 42, s. 402.
403. The executive director of the regional board may not be elected chairman or vice-chairman of the board of directors.
1991, c. 42, s. 403.
404. Section 158 applies, with the necessary modifications to the chairman of the board of directors.
1991, c. 42, s. 404.
§ 3.  — Functions of the board of directors
405. The board of directors of a regional board shall administer the affairs of the regional board and exercise all of its powers.
The board of directors shall be responsible, in particular, for
(1)  identifying priorities in relation to the needs of the population to be served and the services to be offered, taking into account the state of the health and welfare of the population of its region, the sociocultural and linguistic characteristics of that population and the sub-regional and socioeconomic characteristics of the region, and establishing orientations in respect thereof;
(2)  apportioning equitably the human, material and financial resources at its disposal, taking into account the same characteristics as those mentioned in paragraph 1;
(3)  appointing the executive director and the senior management officers and confirming the designation, made by the executive director, of the complaints officer responsible for implementing the users’ complaint examination procedure provided for in section 43;
(4)  (subparagraph repealed).
1991, c. 42, s. 405; 1992, c. 21, s. 43; 1996, c. 36, s. 43; 1998, c. 39, s. 129.
406. The members of the board of directors must act within the limits of the powers conferred on them, with the care, prudence, diligence and competence of any reasonable person in similar circumstances, with honesty and loyalty, and in the interest of the regional board and the population of the region for which the regional board is established.
1991, c. 42, s. 406.
407. Sections 175 and 181 apply, with the necessary modifications to the regional board.
1991, c. 42, s. 407; 1998, c. 39, s. 130.
§ 4.  — Operation
408. The procedure for calling meetings of the board of directors shall be determined by by-law of the board.
The board of directors shall meet at least six times a year.
However, it must meet at the request of the chairman or at the written request of one-third of its members in office.
1991, c. 42, s. 408.
409. Sections 161, 161.1, 162 and 164 apply, with the necessary modifications, to meetings of the board of directors.
1991, c. 42, s. 409; 1998, c. 39, s. 131.
410. Subject to section 201, which applies, with the necessary modifications to the regional board, decisions of the board of directors are made by a majority of the votes cast by the members present.
In the case of a tie-vote, the chairman or, in his absence, the vice-chairman has a casting vote.
1991, c. 42, s. 410; 1998, c. 39, s. 132.
411. (Repealed).
1991, c. 42, s. 411; 1998, c. 39, s. 133.
412. The board of directors may, by by-law,
(1)  set up the committees necessary for the pursuit of its objects;
(2)  determine the composition, functions, duties and powers of the committees and their operating procedures, internal management rules and financing;
(3)  determine the mode of appointment, qualifications, functions, duties and powers and the term of office of committee members and the dismissal procedure.
1991, c. 42, s. 412.
413. Sections 166, 168 and 169 apply, with the necessary modifications, to the documents and records of a regional board.
1991, c. 42, s. 413.
DIVISION V
EXECUTIVE DIRECTOR AND OTHER MEMBERS OF THE MANAGERIAL STAFF
414. The members of the board of directors of a regional board shall appoint the executive director of the regional board.
1991, c. 42, s. 414; 1992, c. 21, s. 44; 1998, c. 39, s. 134.
415. The executive director is responsible, under the authority of the board of directors, for the management and operation of the regional board within the scope of its by-laws.
He shall see that the decisions of the board of directors are implemented and ensure that any information it requires or needs to assume its responsibilities is transmitted to it.
1991, c. 42, s. 415.
416. Sections 197 to 200 apply, with the necessary modifications, to the executive director.
1991, c. 42, s. 416.
417. Sections 234 and 235 apply, with the necessary modifications, to the board of directors of a regional board.
1991, c. 42, s. 417; 1998, c. 39, s. 135.
DIVISION VI
REGIONAL DEPARTMENT OF GENERAL MEDICINE
1998, c. 39, s. 136.
417.1. A regional department of general medicine is hereby established within each regional board.
The department shall consist of all the general practitioners who are remunerated by the Régie de l’assurance maladie du Québec and practise in the region, including those who practise in a private medical facility.
1998, c. 39, s. 136; 1999, c. 89, s. 53.
417.2. Within the framework of the powers conferred on the regional board, the regional department of general medicine shall, while taking account of the responsabilities of the institutions in the territory of the regional board, exercise the following responsabilities under the authority of the executive director:
(1)  making recommendations concerning the part of the regional medical staffing plan relating to general practitioners that must be drawn up in accordance with section 377 and, once the plan has been approved by the Minister, ensuring the implementation and application of the regional board’s decision concerning the plan;
(2)  defining and proposing the regional organization plan for general medical care services, and ensuring its implementation and application of the regional board’s decision concerning the plan;
(3)  defining and proposing the system of access to general medical care, that may include an integrated duty roster and an on-call duty roster for services dispensed in residential and long-term care centres and under the home-care program and ensuring the implementation and coordination of the regional board’s decision concerning the system, the whole within the framework of the regional organization plan for general medical care services;
(4)  making recommendations on the nature of the general medical care services arising from priority programs, and ensuring the implementation of the regional board’s decision concerning such matters;
(5)  making recommendations concerning the list of specific medical activities referred to in section 361, and ensuring the implementation of the regional board’s decision concerning the list;
(6)  evaluating the degree to which the objectives of the regional organization plan for general medical care services and of the part of the regional medical staffing plan relating to general practitioners have been met;
(7)  giving its opinion on any project concerning the dispensing of general medical care services;
(8)  carrying out any other function assigned to it by the executive director of the regional board in connection with general medical services.
Where the regional department of general medicine fails to exercise its responsibilities under subparagraph 2 or 3 of the first paragraph, the board of directors of the regional board may request that they be exercised by the executive director.
1998, c. 39, s. 136.
417.3. The responsibilities of the regional department of general medicine shall be exercised by a supervisory committee comprising the following members:
(1)  three physicians elected by and from among the physicians who are members of the department;
(2)  two to nine physicians who are members of the department, co-opted by the physicians elected under paragraph 1 in the number fixed in accordance with section 417.4;
(3)  the executive director of the regional board, or a physician designated by the executive director.
1998, c. 39, s. 136.
417.4. The specific composition of the supervisory committee of the regional department of general medicine, the procedure governing the election and appointment of members under paragraphs 1 and 2 of section 417.3 and their terms of office shall be determined by a by-law made by the physicians who are members of the department and who are present at a general meeting called for that purpose.
The by-law must prescribe that a majority of the members of the supervisory committee are to be physicians practising in primary health care, and that the composition of the committee is to ensure equitable representation of each part of the territory of the regional board and each area of medical practice. The by-law shall come into force after being approved by the board of directors of the regional board.
1998, c. 39, s. 136.
417.5. The regional department of general medicine shall be directed by a department head appointment by the supervisory committee from among the members of the committee referred to in paragraphs 1 and 2 of section 417.3; the appointment must be approved by the board of directors of the regional board.
1998, c. 39, s. 136.
417.6. The supervisory committee of the regional department of general medicine may adopt by-laws concerning its internal management, the creation of committees and sub-territorial units together with their mode of operation, and the pursuit of the department’s objectives.
Such by-laws may also prescribe the manner in which some or all of the responsibilities assigned to the supervisory committee may be entrusted to the department head of the regional department of general medicine. The by-laws shall come into force after being approved by the board of directors of the regional board.
1998, c. 39, s. 136.
CHAPTER II
Repealed, 1996, c. 36, s. 44.
1996, c. 36, s. 44.
418. (Repealed).
1991, c. 42, s. 418; 1996, c. 36, s. 44.
419. (Repealed).
1991, c. 42, s. 419; 1996, c. 36, s. 44.
420. (Repealed).
1991, c. 42, s. 420; 1996, c. 36, s. 44.
421. (Repealed).
1991, c. 42, s. 421; 1992, c. 21, s. 45; 1996, c. 2, s. 899; 1996, c. 36, s. 44.
422. (Repealed).
1991, c. 42, s. 422; 1996, c. 2, s. 900; 1996, c. 36, s. 44.
423. (Repealed).
1991, c. 42, s. 423; 1996, c. 36, s. 44.
424. (Repealed).
1991, c. 42, s. 424; 1996, c. 36, s. 44.
425. (Repealed).
1991, c. 42, s. 425; 1996, c. 36, s. 44.
426. (Repealed).
1991, c. 42, s. 426; 1996, c. 36, s. 44.
427. (Repealed).
1991, c. 42, s. 427; 1996, c. 36, s. 44.
428. (Repealed).
1991, c. 42, s. 428; 1996, c. 36, s. 44.
429. (Repealed).
1991, c. 42, s. 429; 1996, c. 36, s. 44.
430. (Repealed).
1991, c. 42, s. 430; 1996, c. 36, s. 44.
TITLE II
THE MINISTER
CHAPTER I
MINISTERIAL FUNCTIONS
431. In accordance with the policy on health and welfare, the Minister shall determine priorities, objectives and orientations in the field of health and social services and see to their implementation.
He shall, in particular,
(1)  establish health and social services policies, see that the policies are implemented and applied by the regional boards, and that they are assessed;
(2)  approve the priorities and, in the cases provided for in the last paragraph of section 347, the parts of regional service organization plans submitted to him by each regional board;
(3)  allocate human, material and financial resources equitably among the regions and monitor their utilization;
(4)  see to the promotion of teaching and research;
(5)  develop management frameworks for human, material and financial resources;
(6)  establish policies and orientations relating to the workforce in the health and social services network, monitor their implementation and evaluate them;
(7)  ensure inter-regional coordination of health services and social services, especially in order to make such services more accessible to all segments of the population of the regions of Québec;
(8)  establish the public health program, take the measures that are best suited to ensure the protection of public health, and ensure inter-regional coordination;
(9)  determine the orientations with which the procedure for the application of control measures adopted by an institution under section 118.1 must be consistent.
1991, c. 42, s. 431; 1992, c. 21, s. 46; 1997, c. 75, s. 50; 1998, c. 39, s. 137.
432. The Minister may, with the approval of the Government, enter into an agreement with a body representing pharmacists working for institutions, concerning the terms of employment of such pharmacists.
Institutions shall be bound by any agreement.
The Minister must consult each association grouping a majority of institutions carrying on activities specific to the mission of centres of the same nature.
The remuneration and other terms of employment agreed upon in the agreement binding the pharmacists in accordance with the second paragraph shall be administered by the institutions.
1991, c. 42, s. 432.
432.1. The Minister may, with the approval of the Government, enter into an agreement for the purposes of sections 259.2 and following with any body representing midwives.
Such an agreement may in particular provide for different methods of remuneration and the payment, as compensation or reimbursement, of various amounts such as premiums, expenses or allowances.
Failing an agreement, the Government may fix the remuneration and methods of remuneration by a regulation which shall stand in lieu of an agreement.
Such an agreement is binding on the regional boards and on the institutions.
The provisions of the Labour Code (chapter C-27) and the Act respecting labour standards (chapter N-1.1) do not apply to a midwife governed by an agreement entered into under this section, who provides midwifery services for an institution under a service contract entered into pursuant to section 259.2.
1999, c. 24, s. 38.
432.2. The provisions of an agreement entered into under section 432.1 shall continue to have effect after the expiry of the agreement ; they shall remain effective until the coming into force of a new agreement, which may include provisions that have effect upon the expiry of the agreement it replaces.
1999, c. 24, s. 38.
432.3. An agreement under section 432.1 is binding on all the midwives who are practising under a service contract entered into pursuant to section 259.2 whether or not they are members of the body with which the agreement was entered into.
1999, c. 24, s. 38.
433. In performing his duties under section 431, the Minister may require an institution to furnish to him, at the time and in the form he determines, the information, whether nominative or not, prescribed by regulation under paragraph 26 of section 505 concerning needs for and utilization of services.
1991, c. 42, s. 433; 1998, c. 39, s. 138.
434. The Minister, in performing his duties under this Act, may, notwithstanding any inconsistent provision, to the extent and on the conditions fixed by the Government, implement any experimental project concerning the organization of the human or material resources of institutions for the purpose of fostering integrated organization and the provision of health services and social services.
He may, for the purposes set out in the first paragraph, enter into agreements with institutions or professionals, except for health professionals within the meaning of the Health Insurance Act (chapter A-29) as regards matters referred to in section 19 of the said Act.
The Minister, for the purposes of this section, shall publish a notice in the Gazette officielle du Québec of his intention to propose to the Government, 45 days after publication of the notice, the implementation of such an experimental project, and he shall permit any interested person to submit his observations to him during that period.
1991, c. 42, s. 434.
435. The Minister may, to foster efficient management of the residential and long-term care centres operated in a territory defined in section 119, require an institution operating both a residential and long-term care centre and a hospital centre of 50 beds or more offering general and specialized care to transfer the management of all or part of its residential and long-term care centre to an institution referred to in section 119 which is designated for that purpose by the Minister.
The Minister, for the purposes of this section, shall in such cases be advised by the regional board and shall take into account the nature, the number or the special characteristics of the centres operated by the institutions concerned and the capacity and location of their facilities in the territory under consideration. The Minister must, pursuant to section 5 of the Act respecting administrative justice (chapter J-3), advise the institutions concerned and give them the opportunity to present observations.
The institutions concerned must take the necessary steps to implement the Minister’s decision within the following six months. If the institution which must transfer the management of a residential and long-term care centre is a legal person designated by the Minister under section 139, the Minister may allow the institution to retain ownership of the facilities used for the operation of the residential and long-term care centre and to grant, without claiming rent, a right of occupation of those facilities to the institution designated to ensure the continuity of operations.
The provisions of this section apply, with the necessary modifications, to any other institution operating different centres of which the management, whether of all or part of any one centre, may in the same manner be transferred to another institution better able to further the efficient management of that centre and centres of the same nature in the territory concerned.
The provisions of this section do not apply unless the centre to be transferred by an institution is operated in facilities used exclusively for that centre.
1991, c. 42, s. 435; 1992, c. 21, s. 70; 1996, c. 36, s. 51; 1997, c. 43, s. 731.
436. The Minister shall establish policies concerning the joint procurement of goods and services by the institutions, taking into account their impact on the regional economy. He shall see to their implementation and application by the regional boards and to their assessment.
The Minister may take any step to improve the effectiveness and efficiency of the institutions and limit expenditures relating to the acquisition of the goods and services he determines. He may in particular institute a provincial scheme for the acquisition of highly specialized equipment he determines.
1991, c. 42, s. 436.
CHAPTER II
PERMITS
DIVISION I
ISSUE AND MODIFICATION
1995, c. 28, s. 3; 1998, c. 39, s. 139.
437. No person may engage in activities inherent in the mission of a local community service centre, hospital centre, child and youth protection centre, residential and long-term care centre or rehabilitation centre unless he is the holder of a permit issued by the Minister.
No person may, in any way, purport to be authorized to engage in activities inherent in the mission of a centre mentioned in the first paragraph unless he is the holder of a permit issued by the Minister.
1991, c. 42, s. 437; 1992, c. 21, s. 70.
438. No person may operate a facility or engage in an activity under a name containing the words “local community service centre”, “hospital centre”, “hospital”, “child and youth protection centre”, “social service centre”, “residential and long-term care centre”, “rehabilitation centre” or “reception centre” unless he is the holder of a permit issued by the Minister.
Nothing in the first paragraph shall prevent a foundation of an institution within the meaning of section 132.2 from using the name of the institution in its name, or the use of the words “veterinary hospital” in a name.
1991, c. 42, s. 438; 1998, c. 39, s. 140; 1999, c. 40, s. 269.
439. The facilities of an institution may be identified by a name other than that of the institution.
However, no institution may operate a facility under a name other than that indicated on its operating permit for that facility, where such is the case.
1991, c. 42, s. 439.
440. The permit shall indicate the mission of each centre operated by the institution and, where applicable, the class to which a rehabilitation centre or a hospital centre belongs, the type to which a rehabilitation centre for physically impaired persons belongs, a list of the facilities at the disposal of the institution and, where pertinent, their capacity.
1991, c. 42, s. 440; 1992, c. 21, s. 70.
441. Every person applying for a permit must send his application to the regional board in accordance with the regulations. The person must possess the qualifications, fulfil the conditions and provide the information and documents prescribed by regulation.
After approving the application, the regional board shall transmit it to the Minister, who shall issue a permit if he is of the opinion that it is in the public interest.
1991, c. 42, s. 441.
442. A permit is valid until it is modified, cancelled or withdrawn.
1991, c. 42, s. 442; 1998, c. 39, s. 141.
442.1. The Minister, after consulting with the regional board and giving the holder the opportunity to present his views, may modify the permit of a public institution or private institution under agreement to modify the mission, class, type or capacity indicated on the permit if he is of the opinion that the public interest warrants it.
From the date on which the modified permit is issued, the holder is deemed to have the capacity and powers required to carry on his activities in conformity with the modified permit. The holder must, within six months from that date, and notwithstanding any inconsistent legislative provision, take the necessary measures to carry out the modifications required as a consequence of the Minister’s decision.
1995, c. 28, s. 4.
443. (Repealed).
1991, c. 42, s. 443; 1995, c. 28, s. 5; 1998, c. 39, s. 142.
DIVISION II
OBLIGATIONS OF PERMIT HOLDERS
444. The activities of a permit holder must be carried on within the scope of his permit.
1991, c. 42, s. 444.
445. No permit holder may transfer his permit without the written authorization of the Minister.
1991, c. 42, s. 445; 1999, c. 40, s. 269.
DIVISION III
SUSPENSION AND CANCELLATION
1998, c. 39, s. 143.
446. The Minister may suspend or cancel the permit of any holder who
(1)  has been convicted of an offence under this Act or the regulations or an indictable offence in connection with the performance of activities for which he holds a permit;
(2)  is unable, in the opinion of the regional board concerned, to ensure adequate health services or social services;
(3)  is or is about to become insolvent;
(4)  no longer fulfils the conditions required by regulation to obtain the permit.
1991, c. 42, s. 446; 1998, c. 39, s. 144.
447. Where a permit holder contravenes paragraph 2 of section 446, the Minister, instead of suspending or cancelling the permit, may order the holder to take the necessary remedial measures within the time he fixes.
If the permit holder fails to comply with the Minister’s order within the time fixed, the Minister may then suspend or cancel his permit.
1991, c. 42, s. 447; 1998, c. 39, s. 145.
448. Where the Minister has reasonable grounds to believe that a permit holder is contravening this Act or the regulations, he may accept a voluntary undertaking from the holder to comply with the Act and the regulations, and shall notify the regional board thereof.
If the holder fails to comply with his undertaking, the Minister may then suspend or cancel his permit.
1991, c. 42, s. 448; 1998, c. 39, s. 146.
449. The Minister shall, before suspending or cancelling a permit, notify the holder in writing as prescribed by section 5 of the Act respecting administrative justice (chapter J-3) and allow the holder at least 10 days to present observations.
Where the Minister suspends or cancels a permit, he shall notify the holder in writing, giving the reasons on which his decision is based.
1991, c. 42, s. 449; 1997, c. 43, s. 732; 1998, c. 39, s. 147.
450. A permit holder whose permit is suspended or cancelled may contest the Minister’s 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. 450; 1997, c. 43, s. 733; 1998, c. 39, s. 148.
451. (Repealed).
1991, c. 42, s. 451; 1997, c. 43, s. 734.
DIVISION III.1
WITHDRAWAL OF PERMITS
1995, c. 28, s. 6.
§ 1.  — Provisions applicable to public institutions and private institutions under agreement
1995, c. 28, s. 6.
451.1. The Minister, at the request of a regional board or of his own initiative, may, if he is of the opinion that the public interest warrants it, in particular to ensure effective and efficient management of the health and social services network, withdraw the permit of a public institution or private institution under agreement, with the authorization of the Government and on the conditions it determines.
The Minister shall cause a notice to be published in the Gazette officielle du Québec of his intention to recommend to the Government, 45 days after publication of the notice, that an order be made authorizing him to withdraw the permit.
After publication of the notice, the Minister must give the institution concerned and the regional board the opportunity to present their views.
1995, c. 28, s. 6.
451.2. Within 30 days after receipt of the Minister’s decision to withdraw its permit, the institution must submit a plan to the Minister, who shall approve it with or without modification, containing the measures required to ensure cessation of the institution’s activities and the timetable for implementing the measures. The plan must contain, in particular, measures relating to the cessation of medical activities and the relocation of users, the transmission of information in that respect to the physicians and dentists concerned, and the laying-off or placing on reserve of personnel.
Notwithstanding section 442, the permit of the institution remains valid until all the measures in the plan have been implemented.
1995, c. 28, s. 6; 1998, c. 39, s. 149.
451.3. At the request of the Minister, the institution must, within the time fixed by the Minister, provide him with any information he considers necessary for the purpose of granting his approval.
The institution must carry out the plan that has been approved and comply with the timetable submitted.
The Minister shall ensure that the institution receives the necessary assistance to implement and carry out the plan.
1995, c. 28, s. 6.
451.4. The institution shall transmit to the Minister, at his request, a report on the carrying out of the plan.
1995, c. 28, s. 6.
451.5. If the institution neglects or refuses to submit the plan required by section 451.2, or if it does not carry out the plan as it was approved or is unable to carry it out, the Minister shall appoint a person to exercise all the powers of the board of directors, in the case of a public institution, or those of the administrator or board of directors, in the case of a private institution under agreement.
Section 502, adapted as required, applies to that person.
1995, c. 28, s. 6.
451.6. Where the Minister is satisfied that the measures contained in the plan have been implemented, he shall cause a notice to be published in the Gazette officielle du Québec indicating the date from which the permit of the institution is withdrawn.
1995, c. 28, s. 6.
§ 2.  — Provisions applicable to public institutions
1995, c. 28, s. 6.
451.7. If the notice referred to in section 451.6 concerns a public institution, the affairs of the institution shall be liquidated and the Minister shall indicate in the notice the name and address of the liquidator as well as the address to which interested persons may send their claims.
The Minister shall, in addition, cause the notice to be published in a daily newspaper circulated in the locality in which the head office of the institution is situated.
1995, c. 28, s. 6.
451.8. The Minister shall fix the remuneration of the liquidator and specify whether the liquidator must give security to guarantee the performance of his obligations.
1995, c. 28, s. 6.
451.9. If a vacancy occurs in the office of liquidator by reason of death, resignation, revocation or otherwise, the Minister shall appoint a replacement liquidator and shall cause a new notice to be published in accordance with section 451.7.
1995, c. 28, s. 6.
451.10. From the date of publication of the notice referred to in section 451.6, any action or proceeding concerning the property of the institution, in particular, by seizure by garnishment, seizure before judgment or seizure in execution, shall be suspended.
The costs incurred by a creditor after learning of the liquidation personally or through his attorney may not be collocated on the proceeds of the property of the institution that are distributed owing to the liquidation.
A judge of the Superior Court of the district where the head office of the institution is situated may nonetheless, on the conditions he considers appropriate, authorize the institution or continuation of any action or proceeding.
1995, c. 28, s. 6.
451.11. The liquidator is seised of the property of the institution and acts as an administrator of the property of others entrusted with full administration.
1995, c. 28, s. 6.
451.12. The liquidator shall first pay the debts of the institution and the costs and expenses of the liquidation.
The liquidator shall then, if the assets include property deriving from contributions made by a member of a legal person referred to in paragraph 1 of section 98, remit the property to the member at the member’s request. If the assets are insufficient to do so, the liquidator shall partition the assets in proportion to the respective rights of the members concerned.
Any residue devolves, without compensation, to the Government or to a legal person it designates, notwithstanding any inconsistent legislative provision.
1995, c. 28, s. 6.
451.13. The liquidator shall, every three months, transmit a summary report of his activities for that period to the Minister. The report shall indicate the amounts collected and the amounts disbursed for the liquidation as well as a statement of assets and liabilities at the end of the period.
1995, c. 28, s. 6.
451.14. As soon as the liquidation has been completed, the liquidator shall file with the Minister a general statement of the manner in which the liquidation was conducted.
The liquidation of the institution is closed by the publication of a notice of closure by the Minister in the Gazette officielle du Québec. The Minister shall then request the Inspector General of Financial Institutions to cancel the constituting instrument of the institution, notwithstanding any inconsistent legislative provision. The cancellation takes effect on the 60th day after publication of a notice to that effect in the Gazette officielle du Québec, and the institution is then dissolved.
1995, c. 28, s. 6.
451.15. The Minister shall keep the books and registers of the institution for five years after the closure of the liquidation and shall subsequently dispose of them as he sees fit.
1995, c. 28, s. 6.
§ 3.  — Provisions applicable to private institutions under agreement
1995, c. 28, s. 6.
451.16. If the notice referred to in section 451.6 concerns a private institution under agreement, and a person has been appointed pursuant to section 451.5, that person shall surrender the control and administration of the property to the administrator or board of directors of the institution.
1995, c. 28, s. 6.
451.17. From the publication of a notice under section 451.6, the provisions of the constituting instrument of the private institution constituted as a legal person and under which the institution was empowered to carry on the activities concerned are inoperative until they are replaced or repealed.
1995, c. 28, s. 6.
DIVISION IV
OPERATION WITHOUT A PERMIT
452. Where, in a facility, activities for which a permit is required under section 437 are carried on without a permit, the Minister may, after consulting the regional board concerned, proceed with the evacuation and relocation of any persons lodged in that facility, if that is the case.
Before so doing, the Minister shall serve his decision giving the reasons therefor on the person maintaining the facility.
From receipt of the Minister’s decision, the person shall not, except in medical emergencies or with the written authorization of the Minister, allow the transfer of the persons lodged in the facility whose names appear in a list appended to the Minister’s decision giving reasons.
1991, c. 42, s. 452.
453. The person concerned by the Minister’s decision under section 452 may contest the decision before the Administrative Tribunal of Québec.
The Minister may, if no proceeding is brought within 10 days of notification of the decision and after obtaining the authorization of the Tribunal, evacuate and relocate the persons lodged in a facility referred to in section 452.
If the decision of the Minister is contested before the Tribunal, the Minister cannot act before a decision is rendered by the Tribunal.
1991, c. 42, s. 453; 1997, c. 43, s. 735.
453.1. The Minister may delegate the powers that may be exercised by the Minister pursuant to this division to each regional board.
1998, c. 39, s. 150.
CHAPTER III
ACCREDITATION OF CERTAIN PRIVATE RESOURCES FOR FUNDING PURPOSES
454. With a view to allowing people with decreasing autonomy to receive various health services or social services, the regional board may grant a financial allowance to a person operating a private nursing home or to a private institution not under agreement which operates a residential and long-term care centre; the allowance may vary according to the type of services offered.
1991, c. 42, s. 454; 1992, c. 21, s. 47.
455. Only a person to whom accreditation has been granted under this chapter may receive a financial allowance under section 454.
1991, c. 42, s. 455.
456. Any person who satisfies the requirements determined by the Minister and who applies for accreditation on the form provided by him is eligible therefor.
1991, c. 42, s. 456.
457. Every person applying for accreditation must file an application with the regional board.
The regional board, once it has approved the application, shall send it to the Minister who may grant accreditation on the conditions determined by the Minister.
1991, c. 42, s. 457; 1998, c. 39, s. 151.
458. Accreditation granted by the Minister remains in force as long as the person to whom it was granted complies with this Act, satisfies the requirements and fulfils the conditions determined by the Minister.
The Minister may, however, grant accreditation for a determined period, or temporary accreditation, whenever he considers it necessary.
1991, c. 42, s. 458.
459. Every person to whom accreditation has been granted must, prior to the fact, inform the regional board and the Minister in writing of any change of address of the residence or centre, of any alienation of assets or shares or of any transaction which entails ineligibility.
1991, c. 42, s. 459.
460. The Minister may cancel accreditation at the request of the person to whom it was granted or suspend or revoke it where the person no longer fulfils the conditions prescribed by this Act or the requirements or conditions determined by the Minister.
Before deciding to suspend or revoke an accreditation, the Minister must obtain the advice of the regional board and notify the person concerned in writing as prescribed by section 5 of the Act respecting administrative justice (chapter J-3) and allow the person at least 10 days to present observations.
1991, c. 42, s. 460; 1997, c. 43, s. 736.
461. The Minister must give notice of his decision in writing, giving the reasons therefor, to the person whose accreditation is suspended or revoked.
1991, c. 42, s. 461.
462. No person may use the terms “accredited residence” or “accredited institution”, or associate the notion of accreditation with a residence or institution, unless he has been granted accreditation under this Act.
1991, c. 42, s. 462.
CHAPTER IV
FUNDING OF SERVICES
463. The Minister shall see to it that the resources necessary for funding the health and social services system are allocated equitably among the regions, according to the population they serve and their social and health characteristics.
He shall establish resource allocation mechanisms in order to allow the regional boards to manage the resource envelope allocated to them.
He shall approve the part of the regional service organization plans referred to in the last paragraph of section 347 and the financial resource allocation plan submitted to him by each regional board.
1991, c. 42, s. 463; 1992, c. 21, s. 48; 1998, c. 39, s. 152.
464. Each year, after consultation with the regional boards, the Minister shall establish budgetary rules to determine the amount of operating and capital expenditures that is eligible for subsidies to be granted to regional boards.
In the budgetary rules, the Minister must provide for the payment of subsidies intended to eliminate inter-regional disparity.
The budgetary rules shall also provide for the amount of debt service expenditures which is eligible for subsidies to be granted to public institutions and the amount of subsidies to be granted to other persons and organizations eligible therefor who or which fulfil a special obligation pursuant to this Act or under an agreement entered into in accordance with this Act.
The budgetary rules established by the Minister must be submitted to the Conseil du trésor for approval.
1991, c. 42, s. 464; 1992, c. 21, s. 49.
465. Each year, the Minister shall establish special budgetary rules for the regional boards with respect to their management, the allocation of budgets to institutions and the granting of subsidies to the community organizations and accredited private resources to which this Act applies.
1991, c. 42, s. 465.
466. The budgetary rules referred to in sections 464 and 465 may provide that the granting of a subsidy may be made
(1)  on the basis of general standards applicable to all those eligible or on the basis of special standards applicable to only some of them;
(2)  subject to general conditions applicable to all those eligible or to special conditions applicable to only one or some of them;
(3)  subject to authorization by the Minister;
(4)  to only one or some of those eligible.
1991, c. 42, s. 466.
467. The budgetary rules may also deal with
(1)  the use of the revenue that may be collected and the financial contributions that must be demanded pursuant to this Act, and the effect thereof on the calculation or payment of subsidies;
(2)  the frequency of instalments and other terms and conditions of payment of a subsidy.
1991, c. 42, s. 467.
CHAPTER V
FUNDING OF OTHER SERVICES
468. The Minister may, on the conditions he determines, grant a subsidy on behalf of the Government to any regional board or public institution to provide, out of the funds voted annually for such purpose by Parliament, for the total or partial payment in principal and interest of any loan contracted or to be contracted by the regional board or public institution.
The regional board or public institution must allocate the proceeds of the loan referred to in the first paragraph to the payment of capital expenditures and related debt service, the repayment of loans made for the purposes of such expenditures or the payment of costs and expenses related to the said loan.
The Minister may deposit with the Minister of Finance, to be managed by him, all amounts intended as funds for the principal of the debentures issued by the regional board, the public institution or the Corporation d’hébergement du Québec to constitute a sinking fund for the repayment out of these sums, on the dates specified in the loan, of the principal of such debentures and, out of the proceeds or revenues of the fund, the loans of any regional board or public institution or of the Corporation.
The third paragraph applies only to loans contracted before 1 April 1991.
1991, c. 42, s. 468.
469. The Minister may deposit with the Minister of Finance, to be managed by him, sums intended for the repayment of the principal of a loan in respect of which a subsidy has been granted under section 468 or 471, in order to constitute a sinking fund for the purpose of repaying out of such sums the principal of the loan, on the maturity dates under the terms of the loan.
The revenue of the sinking fund shall be used for the repayment of any duly authorized loan of any regional board or any public institution or the loans of the Corporation d’hébergement du Québec, or shall be allocated to the repayment of any loan for which a sinking fund is constituted, in replacement of the sums that would otherwise be deposited under the first paragraph.
This section applies only to loans contracted on or after 1 April 1991.
1991, c. 42, s. 469.
470. The Minister may withhold or cancel the whole or part of the amount of a subsidy intended for a regional board, a public institution, a private institution under agreement, a community organization or an accredited private resource where it refuses or neglects to comply with a provision of this Act or the regulations applicable to it. A regional board may exercise the same powers with regard to subsidies intended for the institutions, community organizations and accredited private resources of its region.
The Minister cannot, however, withhold or cancel a subsidy granted under section 468 for the payment in capital and interest of any duly authorized loan obtained by a regional board or public institution.
1991, c. 42, s. 470.
471. The Minister may, on the conditions he determines, assume the performance of any obligation of the Corporation d’hébergement du Québec, or grant, on behalf of the Government, a subsidy of the same nature as that of a subsidy under section 468 to provide for the payment of any loan obtained by that Corporation, where the loan or obligation is obtained or undertaken, directly or indirectly, for one or other of the following purposes:
(1)  to acquire, build or convert an immovable used or to be used by an institution, a regional board or any other person, association or legal person specially designated by the Minister;
(2)  to administer and maintain such an immovable and acquire or procure, by supply contract, the required furnishings and equipment and all other services which may be required;
(3)  to finance such activities;
(4)  to carry out the activities mentioned in subparagraphs 1, 2 and 3 with respect to an institution governed by the Act respecting health services and social services for Cree Native persons (chapter S-5) or a regional council established under that Act.
This section applies only to obligations and loans contracted before 1 April 2000.
1991, c. 42, s. 471; 1992, c. 21, s. 50; 1994, c. 23, s. 4; 1996, c. 36, s. 51; 1999, c. 40, s. 269; 1999, c. 34, a. 56.
472. (Repealed).
1991, c. 42, s. 472; 1999, c. 34, s. 57.
472.1. The Corporation d’hébergement du Québec may guarantee the performance of any obligation which an association recognized by the Minister under section 267 is required to discharge in connection with the management of a deductible on an insurance contract negotiated and concluded by the association in favour of its members. The Corporation may also advance to the association any sum it considers necessary in connection with such management.
The Minister may, on the conditions determined by the Government, repay to the Corporation d’hébergement du Québec any sum the Corporation may be required to pay under the guarantee provided for in the first paragraph. The sums necessary for such purpose shall be taken out of the consolidated revenue fund.
1996, c. 59, s. 2.
473. (Repealed).
1991, c. 42, s. 473; 1999, c. 34, s. 57.
474. (Repealed).
1991, c. 42, s. 474; 1999, c. 34, s. 57.
475. A regional board may, if it considers it in the public interest and justified by the needs of the region, enter into an agreement with a private institution for either of the following purposes:
(1)  compensation for the health and social services it provides under the agreement, at a rate fixed by the Government for any class of centres or services it designates;
(2)  full or partial reimbursement for expenditures eligible for subsidies under the budgetary rules referred to in section 465.
The terms and conditions of financing set out in an agreement entered into pursuant to the first paragraph are subject to the provisions of section 476. The same applies in the case of the renewal of such an agreement.
In case of disagreement between a regional board and a private institution as regards the determination of the terms and conditions of financing applicable under an agreement or upon the renewal of an agreement, the regional board may, six months after the beginning of discussions, apply to the Minister for a determination of such terms and conditions.
1991, c. 42, s. 475; 1998, c. 39, s. 153.
476. The Minister shall determine, with the approval of the Conseil du trésor, the general terms and conditions relating to the financing of the activities of private institutions, and that shall be applicable, subject to the exceptions provided for by the Minister, to all financing agreements entered into pursuant to subparagraph 2 of the first paragraph of section 475.
The Minister shall also determine the minimum content, the duration and, where necessary, the form of agreements entered into pursuant to section 475. The content of such agreements may vary according to the region concerned, the nature or scope of the services dispensed by the institutions having a similar mission, or the users served by such institutions.
1991, c. 42, s. 476; 1998, c. 39, s. 154.
477. In order to ensure the uniform administrative and financial management of public and private institutions under agreement and of regional boards, the Minister shall publish and keep up to date a financial management manual.
1991, c. 42, s. 477.
CHAPTER VI
MATERIAL AID AND ASSISTANCE TO PERSONS
478. The Minister, a regional board or an institution designated for such purpose by the Minister, or an organization authorized by the Minister, may provide material or financial assistance for either of the following purposes:
(1)  to lodge any person who is the victim of violence, vagrant or homeless;
(2)  to maintain a person in his home.
He or it may also provide any other form of assistance determined by the Government, such as maintenance or transportation allowances or other allowances or payments for which the person is not eligible under another Act.
1991, c. 42, s. 478.
479. Where assistance is granted to a person under section 478, an assessment shall be made, in the cases prescribed by regulation under section 480, to determine whether the person is in need of assistance.
The assessment shall be made by comparing the income and assets of the person with the cost of his needs on a monthly basis. The income, assets and, if applicable, needs of the person taken into account for the assessment shall be those determined in the regulation referred to in the first paragraph.
1991, c. 42, s. 479.
480. The Government shall determine by regulation
(1)  the cases in which an assessment must be made to determine whether a person is in need of assistance;
(2)  the income, assets and, if applicable, needs to be taken into account, or excluded, in determining a person’s financial situation;
(3)  the amounts which may be paid and the goods and services which may be furnished as material and financial assistance.
1991, c. 42, s. 480.
481. Emergency lodging shall include lodging, feeding and providing assistance and various support services to a person whose physical or mental security is compromised and who, due to that fact, is in need of such services.
1991, c. 42, s. 481.
482. Amounts of money paid under this chapter for emergency lodging shall be deemed to be made to cover payment for the cost of lodging and of services rendered to persons recognized as being in need of assistance under the provisions of this chapter.
1991, c. 42, s. 482.
Not in force
483. Amounts of money paid before (insert here the date of coming into force of this section) to or for persons in need by the Minister, institutions or organizations, in the form of allowances or premiums, to foster attendance of the institution or organization, encourage continued participation in a rehabilitation program or for emergency lodging, shall be deemed to have been provided under section 478.
1991, c. 42, s. 483.
484. Aid granted under this chapter is unassignable and unseizable. Such aid must be used for the purposes for which it was granted. It is not taken into account when benefits, allowances or income replacement benefits are granted or calculated under any other legislative or regulatory provision, unless the provision expressly prescribes otherwise.
1991, c. 42, s. 484.
CHAPTER VII
REGULATIONS
485. The Minister may, with the approval of the Conseil du trésor, make regulations applicable to institutions and regional boards respecting the standards, conditions and procedure to be observed for procurement of goods and services, joint purchases and mandates given for that purpose, franchising of services, construction of immovables, alienation of property, leasing of immovables and contracts related to such matters.
1991, c. 42, s. 485; 1999, c. 34, s. 58.
486. The Minister, in making regulations under section 485, may determine cases where his approval or that of the regional board is required.
For the purposes of the regulations, the Minister may, in addition, prescribe and issue model contract forms or other standard documents.
1991, c. 42, s. 486.
487. The Government may, if it considers it warranted by exceptional circumstances, such as full funding by private sources, or where major financial, scientific or technological repercussions on the activities of an institution are at stake, permit the Minister to exclude a project involving the construction of an immovable from the application of all or some of the provisions of a regulation made under section 485.
The Government may, in that case, establish other specific terms and conditions for the carrying out of the project concerned.
1991, c. 42, s. 487.
487.1. The Minister may, by regulation, determine the information relating to the report on activities and the annual financial report that a public institution must present during its public information session.
1998, c. 39, s. 155.
487.2. The Minister may, by regulation, determine the standards and scales which must be used by regional boards, public institutions and private institutions under agreement for
(1)  the selection, appointment and engagement of and the remuneration and other terms of employment applicable to executive directors and senior and middle management personnel;
(2)  the remuneration and other terms of employment applicable to the other staff members, subject to the collective agreements in force.
The Minister may establish by regulation for persons referred to in subparagraphs 1 and 2 of the first paragraph who are not governed by a collective agreement, a procedure of appeal for cases of dismissal, termination of employment or non-renewal of employment, except when arising from forfeiture of office, and for cases of suspension without pay or of demotion. The regulation may also prescribe a procedure for the settlement of disagreements over the interpretation and application of the terms of employment established thereby. Lastly, the regulation may prescribe a method for the designation of an arbitrator, to which sections 100.1 and 139 to 140 of the Labour Code (chapter C-27) apply, and the measures the arbitrator may take after having heard the parties.
A regulation under this section must be submitted for approval to the Conseil du trésor.
1998, c. 39, s. 155.
488. The Minister may determine, in each regulation he makes under this chapter or in a regulation made under section 118, the provisions of that regulation the contravention of which shall constitute an offence.
1991, c. 42, s. 488.
488.1. (Repealed).
1993, c. 23, s. 6; 1994, c. 18, s. 49; 1999, c. 34, s. 59.
CHAPTER VIII
SUPERVISORY POWERS
DIVISION I
INSPECTION
489. A person authorized in writing by the Minister to make an inspection may at any reasonable time enter any premises in which he has reason to believe that operations or activities for which a permit is required by this Act are carried on, or any facility maintained by an institution, in order to ascertain whether this Act and the regulations are being complied with.
Such person may, during an inspection,
(1)  examine and make a copy of any document relating to the activities carried on in those premises or that facility;
(2)  demand any information relating to the application of this Act and the production of any document connected therewith.
Every person having custody, possession or control of such documents must, on request, make them available to the person making the inspection.
Any person making an inspection must, if so required, produce a certificate signed by the Minister attesting his quality.
1991, c. 42, s. 489; 1992, c. 21, s. 51.
489.1. The Minister may delegate the powers exercised by the Minister under this division to each regional board.
1998, c. 39, s. 156.
DIVISION II
PROVISIONAL ADMINISTRATION
490. The Minister may, for a period not exceeding 120 days, assume the provisional administration of a public institution,
(1)  where the institution no longer holds a permit, no longer satisfies the conditions required for obtaining a permit, or if its permit has been cancelled in accordance with this Act;
(2)  where the institution’s permit has been suspended for failure to comply with an order of the Minister directing that certain remedial measures be taken within the time fixed under section 447;
(3)  where the institution indulges in practices or tolerates a situation which could endanger the health or welfare of persons whom the institution receives or could receive or which are inconsistent with the pursuit of the mission of the centre it operates;
(4)  where he considers that there has been a serious fault, such as embezzlement, breach of trust or other misconduct by one or more members of the board of directors or if the board is seriously remiss in the performance of its obligations under this Act, such as incurring expenditures not provided for in the budget of an institution or not specially authorized in accordance with this Act;
(5)  or where the institution has failed to obtain the authorization provided for in section 113.
The first paragraph applies, with the necessary modifications, to private institutions under agreement.
1991, c. 42, s. 490.
491. The Minister may also assume the administration of a regional board for a period not exceeding 120 days where he considers that there has been a serious fault, such as embezzlement, breach of trust or other misconduct by one or more members of the board of directors or where the board is seriously remiss in the performance of its obligations under this Act.
1991, c. 42, s. 491.
492. The time limits prescribed in sections 490 and 491 may be extended by the Government provided that no period of extension exceeds 90 days.
1991, c. 42, s. 492.
493. Where the Minister assumes provisional administration of an institution or regional board, he shall make a preliminary report of his findings to the Government as soon as possible, together with his recommendations.
1991, c. 42, s. 493.
494. Before submitting his preliminary report to the Government, the Minister shall give the institution or the regional board, as the case may be, an opportunity to present observations. The Minister shall attach to his report a summary of the observations made to him.
1991, c. 42, s. 494; 1997, c. 43, s. 737.
495. Where the Minister assumes provisional administration in accordance with this division, the powers of the members of the board of directors of the public institution or regional board, or those of the director or of the members of the board of directors of the private institution under agreement, as the case may be, are suspended and the Minister shall exercise their powers.
1991, c. 42, s. 495.
496. No natural or legal person who, under the authority of the Minister, assumes provisional administration of an institution or regional board, as the case may be, may be prosecuted for any act performed in good faith in the performance of his or its functions.
1991, c. 42, s. 496.
TITLE III
THE GOVERNMENT
CHAPTER I
ADMINISTRATIVE MEASURES
497. The Government may, where the preliminary report made by the Minister pursuant to section 493 confirms the existence of a situation described in section 490 or 491,
(1)  attach such restrictions and conditions to the permit of the institution as it deems appropriate;
(2)  prescribe the time by which any situation described in section 490 or 491 must be remedied;
(3)  order the Minister to continue his administration or to relinquish it and not to resume it unless the institution or the regional board, as the case may be, fails to comply with the conditions imposed by the Government pursuant to subparagraph 1 or 2.
The Government shall, in addition, order the Minister to make a final report to it upon ascertaining that the situation described in section 490 or 491 has been corrected or that it will not be possible to correct it.
1991, c. 42, s. 497.
498. After receiving the final report of the Minister, the Government may take one or several of the following measures:
(1)  terminate the provisional administration on the date it fixes;
(2)  declare the members of the board of directors of the public institution, the members of the regional board or the members of the board of directors or the director of a private institution under agreement, as the case may be, forfeited of office and provide for the appointment or election of their replacements;
(3)  exercise any power conferred upon it by section 497.
1991, c. 42, s. 498.
499. The Government may designate a person who shall be responsible for ensuring that the public funds put at the disposal of an institution or regional board which does not exercise adequate budgetary control are properly used.
Every person performing administrative duties within the institution or regional board is bound to submit to the controller’s directives, within the limits of the powers assigned to him.
No undertaking may be entered into on behalf of the institution or regional board nor any disbursement made without the countersignature of the controller. Any agreement made in contravention of this paragraph is null.
1991, c. 42, s. 499.
500. The Government may designate a person who shall be responsible for investigating any matter pertaining to the quality of health services or social services and to the administration, organization and operation of an institution or regional board.
The investigator is vested, for the purposes of the investigation, with the immunity and powers of a commissioner appointed under the Act respecting public inquiry commissions (chapter C-37), except the power to impose imprisonment.
1991, c. 42, s. 500.
501. In designating a controller or an investigator, the Government may order that some or all of the powers of the board of directors of a public institution or of a regional board or of the director or board of directors of a private institution under agreement, as the case may be, be suspended for a period of not more than six months and appoint a person who shall exercise the powers thus suspended.
The Government may extend the suspension and the term of office of the director it has appointed for a period of not more than six months.
1991, c. 42, s. 501.
502. The administrator appointed by the Government may, subject to the rights of third persons in good faith, annul a decision taken before his appointment under the powers which have been suspended.
He cannot be prosecuted for an act performed in good faith in the performance of his functions.
1991, c. 42, s. 502.
503. The Government shall determine each year the number of positions for medical residents available in the post-doctoral medical training programs. This number includes
(1)  the general practice or family medicine training position;
(2)  the other training positions required for one or another of the specialties recognized by regulation under the Medical Act (chapter M-9).
In order to foster what it considers a rational distribution of medical resources among the regions, the Government may each year authorize certain of the positions provided for in subparagraph 2 of the first paragraph, on the condition that the trainees agree to sign an undertaking, which may contain a penal clause, to practise for a period not exceeding four years in the region or institution determined by the Minister. These positions cannot exceed 25 % of the number of positions intended for new trainees among the total number of positions provided for in subparagraph 2 of the first paragraph.
Where a position referred to in the second paragraph has not been filled, it automatically becomes a general practice or family medicine training position to which no undertaking to practise in a particular region or institution is attached.
The Government may also, if it deems it appropriate, authorize certain additional training positions in post-doctoral medical training programs intended for graduate students of a university or school situated outside Canada or the United States on the condition that the trainees agree to sign an undertaking, which may contain a penal clause, to practise for a period not exceeding four years in the region or institution determined by the Minister.
The number of the positions referred to in the second paragraph shall be determined after the Minister has consulted the Ordre professionnel des médecins du Québec, Québec universities having a faculty of medicine and the regional boards of the regions where the trainees are to practise.
1991, c. 42, s. 503; 1994, c. 40, s. 457.
504. The Government may determine each year a number of positions available to the doctoral medical training programs for students from outside Québec, on the condition that they agree to sign, before the start of their training program, an undertaking which may contain a penal clause, to practise for a period not exceeding four years in the region or institution determined by the Minister in the event that they practise medicine in Québec after obtaining their licence to practise.
1991, c. 42, s. 504.
CHAPTER II
REGULATIONS
DIVISION I
ADMINISTRATION OF THIS ACT
505. The Government may, by regulation,
(1)  determine the care and services to be included in the emergency services dispensed by the institutions designated by the regional board pursuant to paragraph 1.1 of section 359, and fix the maximum bed occupation time in emergency services;
(2)  fix the minimum amount of liability insurance that a physician or dentist is required to hold under section 258 or that a midwife is required to hold under section 259.9;
(3)  determine, for the purposes of the authorization required from the regional board for the work mentioned in paragraph 3 of section 263, the applicable amounts;
(4)  determine in what cases and circumstances and on what conditions the institutions may supply medicines;
(5)  determine the conditions and measures of hygiene and safety which must be maintained or taken, as the case may be, by an institution;
(6)  determine the by-laws a regional board or an institution must adopt;
(7)  (paragraph repealed);
(8)  determine the items which must be covered by the auditor in auditing the affairs of an institution or regional board;
(9)  (paragraph repealed);
(10)  prescribe measures relating to child placement services which must be complied with by an institution operating a child and youth protection centre and other institutions exercising responsibilities in that field;
(11)  determine the form of the organization plan of any institution, the items it must contain and the methods or rules according to which it must be prepared;
(12)  (paragraph repealed);
(13)  determine, for the institutions it indicates, the divisions, services and departments that the organization plan of the institution must include, the responsibilities and functions that must be exercised by the heads of those divisions, services and departments and the physician in charge referred to in section 186 and, where applicable, their mode of appointment and required qualifications;
(14)  determine, for institutions operating a hospital centre, the qualifications required of the head of a clinical department and the responsibilities and functions that he is required to carry out in addition to those entrusted to him under the organization plan of the institution;
(15)  determine, for institutions operating a centre other than a hospital centre, the mode of appointment of the heads of the divisions, services or departments referred to in paragraph 13 and the person or authority who will appoint them;
(16)