BILL NO. 34

1st Session, 58th General Assembly
Nova Scotia
49 Elizabeth II, 2000

Government Bill

Health Authorities Act

The Honourable Jamie A. Muir
Minister of Health

First Reading: March 29, 2000

Second Reading: April 7, 2000

Third Reading: June 8, 2000 (WITH COMMITTEE AMENDMENTS)

Be it enacted by the Governor and Assembly as follows:

1 This Act may be cited as the Health Authorities Act.

2 In this Act,

(a) "board of directors" means the board of directors of a district health authority;

(b) "Capital District Health Authority" means the district health authority for the Capital Health District;

(c) "Capital Health District" means the health district referred to in subsection 4(2);

(d) "community" means the area for which a community health board has been established or continued pursuant to this Act;

(e) "community health board" means a community health board established or continued pursuant to this Act;

(f) "community health plan" means a plan for community-based health services and the improvement of the health of the community that is to be considered by a district health authority in the development of health-services business plans;

(g) "community-based health services" means health-care services that can be provided to people in their communities and includes health education, health promotion, disease prevention, mental-health services, emergency health services, addiction services, public-health services, home care, long-term care, rehabilitation services, palliative-care services and treatment for illness and injury in relation to primary care;

(h) "district health authority" means a district health authority established for a health district by the regulations and includes the Nova Scotia Hospital and a provincial health-care centre except where provided otherwise in this Act;

(i) "foundation" means a foundation established by any enactment, trust or agreement with respect to a hospital;

(j) "health district" means a health district established pursuant to this Act;

(k) "health services" include services provided through hospitals and other health-care institutions, public-health services, addiction services, emergency health services, mental-health services, home-care services, long-term care and such other health services as the Minister may from time to time prescribe;

(l) "hospital" means a hospital as defined in the Hospitals Act;

(m) "IWK-Grace" means the Izaak Walton Killam-Grace Health Centre for Children, Women and Families;

(n) "Minister" means the Minister of Health;

(o) "provincial health-care centre" means a hospital referred to in Section 67;

(p) "Queen Elizabeth II" means the Queen Elizabeth II Health Sciences Centre;

(q) "regional health board" means a regional health board established pursuant to the Regional Health Boards Act that is repealed by this Act;

(r) "voting member" means a member of a board of directors appointed pursuant to clause 11(a).

3 The Minister is responsible for the general supervision and management of this Act.

DISTRICT HEALTH AUTHORITIES

4 (1) The Governor in Council may, by the regulations, designate one or more areas of the Province as a health district under the name determined by the Governor in Council in those regulations.

(2) One health district, to be called the Capital Health District, shall include the locations of the Nova Scotia Hospital, the IWK-Grace and the Queen Elizabeth II.

5 (1) The Governor in Council may, by the regulations, alter the boundaries of a health district.

(2) The Governor in Council may, by the regulations, annex the whole or any part of a health district to another health district.

6 (1) The Governor in Council may, by the regulations, establish a district health authority to govern and manage the delivery of those health services in a health district for which it has been made responsible pursuant to this Act.

(2) Each district health authority is a body corporate under the name determined by the Governor in Council in the regulations.

(3) The district health authority for the Capital Health District shall be called the Capital District Health Authority.

7 The Governor in Council may divide, amalgamate with another district health authority or reconstitute a district health authority established pursuant to this Act in accordance with the regulations.

8 A district health authority has the capacity and, subject to this Act, the rights, powers and privileges of a natural person.

9 (1) A district health authority is not an agent of Her Majesty in right of the Province.

(2) A person employed or engaged by a district health authority is not an officer, servant or agent of Her Majesty in right of the Province.

(3) Nothing in subsection (2) affects the application of the Public Service Superannuation Act to any person.

10 (1) The administration, management, general direction and control of the affairs of a district health authority are vested in a board of directors for that authority appointed by the Minister.

(2) The persons who from time to time are appointed to the board of directors of a district health authority are the members of the corporation.

11 A board of directors consists of

(a) the number of voting members specified in the regulations respecting the district health authority,

(i) one third of whom shall be appointed by the Minister, and

(ii) two thirds of whom shall be appointed by the Minister from among persons nominated by community health boards pursuant to Section 54; and

(b) such number of non-voting members as the Minister may appoint.

12 The chair of a board of directors shall be appointed by the Minister from among the voting members of the board.

13 (1) No person is qualified to be nominated or to serve as a member of a board of directors who is a member of

(a) the House of Commons or the Senate of Canada;

(b) the House of Assembly;

(c) a council of a regional municipality, an incorporated town or a municipality of a county or district;

(d) a school board; or

(e) another board of directors.

(2) Subject to subsection (3), no more than three of the maximum permitted number of voting members of a board of directors may be individuals who hold office or employment in the service of the district health authority or any hospital or service operated by the authority or who have privileges at any hospital in the health district.

(3) Where the regulations respecting a district health authority provide for more than twelve voting members on a board of directors, the Minister may provide in the regulations made by the Minister that more than three of the voting members may be individuals who hold office or employment in the service of the authority or any hospital or service operated by the authority or who have privileges at any hospital in the health district.

14 (1) The members of a board of directors hold office for the term provided by the regulations respecting the district health authority or, where the regulations do not specify the term, for the term provided in their appointments.

(2) Notwithstanding subsection (1), members of a board of directors hold office until such time as their successors are appointed, even if such appointments do not occur until after their terms of office have expired.

(3) The Minister may, where the Minister considers there is cause or incapacity, remove or suspend any member of a board of directors and may re-appoint, reinstate or replace that member, whether the member's term has expired or not.

15 (1) Subject to subsection (2), members of a board of directors shall not receive any honoraria or other remuneration for their activities as members.

(2) Subject to the regulations and to any more restrictive policy adopted by a board of directors, the members of the board may be reimbursed by the district health authority for the reasonable expenses necessarily incurred by them in the performance of their duties.

16 A majority of the voting members appointed to a board of directors is a quorum of the board.

17 A vacancy in the membership of a board of directors does not impair the ability of the remaining members to act.

18 A board of directors shall conduct at least two public forums in the health district in each year for the purpose of providing information on the operations and activities of the district health authority and seeking input from the public.

19 The objects of a district health authority are

(a) to govern, plan, manage, monitor, evaluate and deliver health services in a health district in accordance with this Act and any other enactment in order to

(i) maintain the most beneficial allocation of health-care resources,

(ii) avoid duplication of health services, and

(iii) meet the needs of the health district,

having regard to policies, directives and standards established pursuant to this Act; and

(b) to endeavour to maintain and improve the health of the residents of the health district.

20 A district health authority shall

(a) determine priorities in the provision of health services in the health district and allocate resources accordingly;

(b) implement the health-services business plan for the health district approved pursuant to Section 61;

(c) recommend to the Minister which health services should be available in all health districts;

(d) identify to the Minister those organizations or persons that should be responsible for the delivery of the health services referred to in clause (c);

(e) participate in the development of and implementation of Provincial health policies and standards, Provincial health-information systems, Provincial human-resource plans for the health system and other Provincial health-care system initiatives;

(f) provide information to the public about health care and the health-care system and the operations and activities of the authority; and

(g) carry out other such responsibilities as the Minister may assign or as are prescribed by regulations.

21 (1) A district health authority shall, in the form and with the content required by the Minister, provide to the Minister

(a) monthly and quarterly financial statements;

(b) audited year-end financial statements and any management letters issued by auditors;

(c) such information as is required by the Minister for the purpose of the monitoring and evaluation of the quality, accessibility and comprehensiveness of health services; and

(d) such other reports as are required by the Minister.

(2) A district health authority shall prepare, in relation to each fiscal year, an annual report that includes

(a) the audited financial statements of the authority for that fiscal year; and

(b) a report on the results achieved by the authority with respect to any performance objectives established for the authority, including those established in an approved health-services business plan for that fiscal year.

(3) A district health authority shall submit the annual report referred to in subsection (1) to the Minister no later than September 1st following the end of the fiscal year to which it relates.

(4) The Minister shall table the annual report in the House of Assembly within fifteen days after receiving it or, if the Assembly is not then sitting, within fifteen days after the Assembly next sits.

(5) The Minister may, from time to time, establish different deadlines for the provision of the reports, statements, letters and other information required pursuant to subsections (1) to (3) and may extend any of the deadlines.

22 (1) Where the Minister considers it appropriate to confer on a district health authority some or all the Minister's responsibility for the delivery, governance or management of health services that were previously delivered, governed or managed in the district by the Minister, the Minister may do so on such terms and conditions as the Minister considers appropriate.

(2) For the purpose of subsection (1), the Minister may delegate to the district health authority such duties and powers under any enactment that the Minister considers necessary, subject to the approval of the Governor in Council.

(3) The Minister may authorize agreements between district health authorities, or between district health authorities and provincial health-care centres, respecting the joint delivery, governance or management of health services, or for the delivery, governance and management of health services by one or more authorities or provincial health-care centres on behalf of other authorities or provincial health-care centres.

23 (1) The Minister shall make by-laws with respect to the conduct and management of the affairs of a district health authority including, without limiting the generality of the foregoing, by-laws

(a) respecting the appointment, removal, functions and duties of officers, agents and servants of the authority;

(b) establishing standing and special committees of the board of directors;

(c) respecting the delegation of powers and duties to officers and committees;

(d) designating banking authorities and signing officers;

(e) respecting the conflict of interest of members;

(f) governing the calling of meetings of the board and the rules of procedure at such meetings; and

(g) respecting the management and administration of the board and associated institutions.

(2) Subject to the approval of the Minister, the board of directors for a district health authority may amend by-laws made respecting that authority pursuant to subsection (1).

24 The Minister shall make by-laws

(a) respecting the granting, variation, suspension and revocation of medical staff privileges; and

(b) establishing a Provincial Appeal Board that shall make final decisions respecting the granting of credentials, privileges and membership in the medical staff of the board generally, including, without limiting the generality of the foregoing, the granting, variation, suspension of such privileges or membership and the discipline of members of the medical staff.

25 (1) Subject to the approval of the Minister, a district health authority may make by-laws respecting medical staff including, without limiting the generality of the foregoing, by-laws respecting

(a) the membership of a medical advisory committee;

(b) categories of physician privileges;

(c) the duties and functions of senior medical officers appointed by the authority; and

(d) the rules and regulations governing medical staff.

(2) Where there is a conflict between by-laws made pursuant to Section 24 and by-laws made pursuant to subsection (1), those made pursuant to Section 24 prevail.

(3) Where the district health authority has not made by-laws pursuant to subsection (1), the Minister may, if the Minister considers it advisable, make the by-laws referred to in that subsection.

(4) Where the Minister makes by-laws pursuant to subsection (3), the district health authority may amend those by-laws subject to the approval of the Minister.

(5) Where, on the coming into force of this Act, by-laws respecting the matters referred to in Section 24 and subsection (1) have been made by

(a) the Nova Scotia Hospital;

(b) the Queen Elizabeth II;

(c) the IWK-Grace;

(d) the Cape Breton Regional Hospital;

(e) the Glace Bay Healthcare System Corporation;

(f) the New Waterford Consolidated Hospital Commission; or

(g) the Northside Harbor View Hospital,

those by-laws remain in effect until such time as they are replaced with other by-laws by regulations made pursuant to clause 85(1)(j).

(6) Notwithstanding subsection 23(2) and subsection (1), the Minister may revoke and replace any of the by-laws made pursuant to Sections 23 and 24 and subsection (1), either in whole or in part.

(7) For greater certainty, by-laws made pursuant to subsection 23(2) and subsection (1) have no effect until approved by the Minister.

26 (1) A board of directors may establish advisory and other committees to assist the board in carrying out its responsibilities, including any committees it considers necessary to ensure adequate opportunity for consultation and participation by the public with respect to health services provided by the district health authority.

(2) Committee members need not be members of the board of directors.

27 No member of a board of directors is personally liable for anything done or omitted to be done or for any neglect or default in the bona fide exercise or purported exercise in good faith of a power conferred upon the member by this Act.

28 The fiscal year of a district health authority begins on April 1st and ends on March 31st in the following year.

29 (1) A district health authority may, for the purpose of providing health services in the health district,

(a) acquire, hold, operate and maintain real and personal property; and

(b) subject to this Act, lease, sell or convey any real or personal property.

(2) Where a district health authority determines that real property formerly owned by a hospital is no longer useful for the purpose of the authority, the authority shall convey the real property, subject to any lien, mortgage or other charge to which it was subject when acquired by the authority pursuant to this Act, to any municipalities, foundations, trustees or other group or person to whom the property would have been transferred upon the dissolution of the hospital but for this Act.

(3) The property of a district health authority is exempt from taxation pursuant to any Act of the Legislature.

30 A district health authority may

(a) execute and carry out any trusts respecting real or personal property that is donated, devised, bequeathed, granted, conveyed or given to the authority;

(b) make, accept, draw, execute, issue and endorse bills of exchange, cheques, promissory notes, hypothecations or other instruments necessary or convenient in the conduct of the business of the authority;

(c) subject to this Act and to the Trustee Act, invest money received by it;

(d) subject to this Act, erect, maintain, improve, repair or alter buildings for its purpose;

(e) retain any investment, bequest, devise or gift in the form in which it comes into its hands for as long as it considers proper and may invest the proceeds;

(f) subject to this Act, hold any real or personal property subject to and upon any trusts, terms or conditions imposed in the acquisition of it.

31 A district health authority shall not make any expenditure for the acquisition of capital items unless the acquisition is provided for in a capital plan in a health-services business plan approved pursuant to Section 61 or has the prior written approval of the Minister.

32 (1) A district health authority shall not plan for or, in any fiscal year, incur or make expenditures that will result in the total of operating expenditures and capital expenditures from revenue exceeding the total of its revenues from all sources in that fiscal year.

(2) Notwithstanding subsection (1), an amount in excess of revenue may be expended in a fiscal year for operating expenditures and capital expenditures if the district health authority has entered into an agreement with the Minister providing that the amount will be replaced during the following fiscal year.

(3) Where operating expenditures, including capital expenditures, from revenue for a fiscal year exceed total revenue from all sources for that year, the resulting deficit as shown on the annual financial statements of the district health authority for that fiscal year shall be recovered, no later than the end of the fiscal year following the fiscal year in which the deficit occurred, by a reduction in expenditures or an increase in revenue, or both.

33 Where a district health authority realizes a budget surplus at the end of a fiscal year, the Minister may authorize the authority to retain all or a part of the surplus on such terms and conditions as the Minister considers appropriate.

34 (1) A district health authority may not borrow except in accordance with subsection (2) or the provisions of a health-services business plan approved pursuant to Section 61 or with the prior written approval of the Minister.

(2) A district health authority may borrow to cover the working capital requirements of the annual current expenditure of the authority included in the budget contained in the health-services business plan for the year, approved pursuant to Section 61, or with the prior written approval of the Minister.

(3) Any borrowing carried out by a district health authority is on the account of the Province except for borrowing for working capital, which is the responsibility of the authority.

35 (1) A board of directors shall appoint a person or firm licensed as a public accountant pursuant to the Public Accountants Act to be the auditor of the district health authority.

(2) A board of directors may, with the consent of the Auditor General, appoint the Auditor General to be the auditor of the district health authority on such terms as to compensation as the board and the Auditor General may agree.

(3) The auditor shall report to the board of directors on all accounts and funds administered by the board and all accounts and funds where the control is apparent or implied in the board.

(4) The audited statements of the district health authority shall contain the information and be in the form required by the Minister.

(5) The audited statements and the auditor's report shall be filed with the board of directors and the Minister on or before July 1st in each year or such other date as the Minister may approve.

(6) The auditor shall report any management letter and any communication detailing weaknesses in internal control, deficiencies in management information systems or other areas requiring attention for improvement, including all audit reports and the auditor's observations and recommendations to management relating to the audit activity, to the board of directors and to the Minister.

36 (1) The auditor shall have access at all times to the books, accounts and records of the district health authority and is entitled to require from the employees of the authority such information and explanations as may be necessary for the performance of the auditor's duties.

(2) The employees of a district health authority shall promptly provide access, information and explanations to the auditor when requested.

37 (1) The Minister may at any time direct an audit or review of a district health authority or any program, facility or service of an authority by a person appointed by the Minister.

(2) The person appointed by the Minister to make an audit or review shall, for that purpose, have free access to all health records, books of account, securities, cash, documents, bank accounts, vouchers, correspondence and records of every description of the district health authority.

38 (1) A board of directors shall annually appoint an audit committee.

(2) The responsibilities of an audit committee include

(a) detailed review of the financial statements of the district health authority with the auditor;

(b) evaluation of internal control systems and any management letter with the auditor;

(c) review of the conduct and adequacy of the audit;

(d) such other matters as may be prescribed by the board of directors;

(e) such matters arising out of the audit as may appear to the committee to require investigation; and

(f) such additional matters as may be prescribed as duties of an audit committee.

COMMUNITY HEALTH BOARDS

39 (1) The community health boards established pursuant to the Regional Health Boards Act are continued and shall serve as community health boards pursuant to this Act.

(2) The Minister shall, after consulting community health boards, determine which of the continued community health boards mentioned in subsection (1) shall operate under each district health authority.

(3) For the purpose of subsection (2), the Minister may determine that a continued community health board operates under more than one district health authority.

40 (1) A district health authority may establish community health boards in addition to those continued pursuant to Section 39.

(2) The district health authority shall, subject to any guidelines and criteria established by the Minister in the regulations, appoint the initial members of a community health board established pursuant to subsection (1) after such consultation with the residents of the community as the authority considers appropriate.

(3) One third of the initial membership shall be appointed for a term of two years, one third shall be appointed for a term of three years, and the remaining one third shall be appointed for a term of four years.

41 There shall be a minimum of nine and a maximum of fifteen members of a community health board unless otherwise prescribed in the by-laws for the district health authority.

42 Each member of a community health board shall be ordinarily resident within the boundaries of the community and eighteen years of age or older.

43 (1) Subsequent members of a community health board, whether continued pursuant to Section 39 or established pursuant to Section 40, shall serve a term of three years and shall be selected under an open and transparent selection process determined by the community health board in accordance with guidelines and criteria established by the Minister in the regulations.

(2) No community health board member who has served two consecutive terms of three years or more may be re-elected, re-appointed or selected again until at least two years after the expiry of the second term.

(3) Terms are deemed to be consecutive if less than one year elapses between the expiry of the first term and the commencement of the next term.

44 A district health authority may, subject to the Minister's approval, determine or alter the boundaries of the community for which a community health board is responsible.

45 A community health board shall select its chair from among its members.

46 A community health board shall not govern or manage the delivery of health services.

47 A community health board is not a body corporate.

48 A community health board does not have the capacity to enter into contracts of any kind.

49 Subject to the regulations and to any more restrictive policy adopted by the district health authority, the members of a community health board may be reimbursed by the authority for the reasonable expenses necessarily incurred by them in the performance of their duties.

50 A community health board shall

(a) foster community development that encourages the public to actively participate in health planning and service delivery;

(b) construct a community profile that identifies the deficiencies and strengths of the community with respect to factors that affect health, including income and social status, social support networks, education, employment, physical environments, inherited factors, personal health practices and coping skills, child development and health services in the community;

(c) prepare and maintain an inventory of community-based health services delivered in the community;

(d) assess community health needs and community-based health services in relation to those needs;

(e) subject to the approval of the district health authority, make by-laws;

(f) provide such other advice and assistance that the district health authority requests;

(g) manage, or assist in the management of, community development grants on behalf of the Minister or the district health authority, or with the approval of the Minister or the district health authority; and

(h) perform such other functions as the Minister may authorize in the regulations.

51 A community health board may establish advisory committees.

52 (1) The district health authority shall provide a community health board with administrative support services and technical health-planning support services.

(2) The district health authority may enter into contracts with any person for the purpose of subsection (1).

53 No member of a community health board is liable for anything done or omitted to be done or for any neglect or default in the bona fide exercise or purported exercise in good faith of a power conferred upon that member of the community health board by this Act.

54 (1) Whenever requested to do so by the Minister, the community health boards in a health district shall strike a nomination committee consisting of the chair or designate of each community health board for the purpose of preparing a list of nominees for appointment to the board of directors of the district health authority pursuant to subclause 11(a)(ii), and shall submit the list of nominees to the Minister by the date requested.

(2) In selecting nominees, the nomination committee shall use an open and transparent process in accordance with guidelines and criteria established by the Minister in the regulations, and shall have regard to the need for broad representation of communities in preparing the list of nominees.

(3) The Minister may request the nominating committee struck pursuant to subsection (1) to prepare and submit lists of additional nominees where the Minister considers it necessary to have a larger group of nominees to consider.

(4) This Section does not affect the Minister's power to appoint the full membership of a board of directors on an interim basis pursuant to subsection 65(4).

55 Subject to the approval of the Minister, a board of directors may dissolve a community health board in the health district if the board of directors considers it appropriate and two thirds of those voting members who are present and voting at a special meeting held for the purpose of dissolving the community health board vote in favour of the dissolution.

COMMUNITY HEALTH PLANS

56 (1) A community health board shall develop a community health plan for each fiscal year of the district health authority, provide it to the district health authority of the health district and support the implementation at the community level of those components of the community health plan that are incorporated into the health-services business plan approved pursuant to Section 61.

(2) The community health plan shall include

(a) recommended priorities for the delivery of community-based health services;

(b) a demonstration that the recommended priorities have been established through community consultation;

(c) provisions identifying and making recommendations for the elimination of any unnecessary duplication of health services between district health authorities; and

(d) a list of the initiatives recommended by the community health board for the improvement of the health of the community.

(3) For the purpose of assisting the community health board to make recommendations pursuant to clause (2)(a), the district health authority shall make available to the community such information that will assist the community health board in assessing the financial feasibility of implementing the recommendations.

57 A district health authority shall ensure that community health plans are developed by community health boards and considered in the preparation of the health-services business plan.

HEALTH-SERVICES BUSINESS PLANS

58 (1) Each district health authority shall prepare a health-services business plan for each fiscal year.

(2) The health-services business plan prepared by each district health authority is subject to the approval of the Governor in Council and shall not be implemented until the Governor in Council has approved it.

(3) A health-services business plan shall include

(a) a district health services component covering the level and mix of health services needed in the health district and how and where health services are to be provided in the district;

(b) a district human resources component for district health services to ensure the availability of a proper mix of human resources to support health services;

(c) a district financial component to ensure the application of available financial resources to achieve district objectives and deliver health services;

(d) a community health board support and development component outlining the district health authority's plan to support the activities of the community health boards; and

(e) a capital plan that shall include

(i) a facilities management plan,

(ii) an explanation of the manner in which the capital that is proposed to be acquired relates to the delivery of health services, and

(iii) a description of capital items that the district authority intends to acquire or otherwise deal with, whether under the authority's budget or through donations given or purchases made by foundations.

(4) A health-services business plan shall demonstrate that the district health authority has considered the community health plans provided to it and, where the health-services business plan does not provide for implementation of elements of a community health plan, shall set out the reasons for those elements not being recommended for implementation.

(5) In considering whether to recommend approval of a proposed health-services business plan, the Minister shall have regard to the matters set out pursuant to subsections (3) and (4).

59 (1) A proposed health-services business plan shall be submitted to the Minister of Health for comment as required by the Minister.

(2) Comments from the Minister on the proposed health-services business plan shall be forwarded to the district health authority within thirty days after the date it is received by the Minister.

60 Each district health authority shall submit a final health-services business plan to the Minister for approval within thirty days after the date it receives comments from the Minister pursuant to subsection 59(2).

61 (1) The Minister may recommend that the Governor in Council approve the health-services business plan, or approve the plan with such amendments and conditions as the Minister recommends, or may refuse to recommend the plan for approval.

(2) Where the Minister refuses to recommend a health-services business plan, the Minister shall provide reasons and the district health authority shall submit for approval a plan that addresses the problems identified by the Minister.

(3) The Governor in Council may approve a health-services business plan recommended by the Minister for approval or for approval with amendments and conditions.

(4) The Minister shall inform each district health authority if the health-services business plan has been approved, approved with amendments or not approved, as the case may be, and, where an authority is not so informed by March 31st immediately preceding the fiscal year for which the plan was prepared, the authority may expend funds not exceeding one half of the total operating expenditures provided in its plan for the previous fiscal year before the plan is approved by the Minister.

MINISTER'S DUTIES AND POWERS

62 In addition to the other duties contained in this Act, the Minister shall

(a) be responsible for the strategic direction of the health-care system including the development, implementation and evaluation of Provincial health policy;

(b) develop or ensure the development of standards for the delivery of health services;

(c) monitor, measure and evaluate the quality, accessibility and comprehensiveness of health services;

(d) conduct financial and human-resource planning;

(e) administer the allocation of available resources for the provision of health services;

(f) establish requirements for information systems used in the health-care system; and

(g) be responsible for those services not assigned to district health authorities.

63 The Minister may

(a) determine the health services to be provided by the district health authorities and the associated funding levels;

(b) require the district health authorities to prepare, in addition to the health-services business plan, such plans, including human-resource plans and information management and information technology plans, as the Minister considers appropriate;

(c) determine the organization and internal management of district health authorities and may determine

(i) organizational structures and management responsibilities,

(ii) appropriate levels of administrative services,

(iii) the percentage of the total budget administered by district health authorities that can be spent on administrative expenses;

(d) subject to any enactment or an accounting policy of the Province, specify any accounting practices and principles that must be followed by district health authorities in the administration of their finances.

64 The Minister may delegate to the Deputy Minister of Health or any employee of the Department of Health, the power or duty conferred or imposed on the Minister pursuant to subsections 21(1) and 22(3), Sections 31, 32 and 34, subsection 35(4), Sections 37 and 62, clauses 63(b), (c) and (d) and Section 66.

65 (1) The Minister may dismiss the members of a district health authority if the authority has requested the appointment of an official administrator to replace the authority or if the Minister considers that

(a) the authority has contravened an agreement with the Minister;

(b) the authority has ceased to function;

(c) the authority has failed, or is about to fail, to pay any of its other debts or liabilities whatsoever when due;

(d) the authority has failed to comply with any order of the Minister or the Minister's delegate;

(e) the authority is not properly exercising its powers or carrying out its duties; or

(f) it is in the public interest to dismiss the members of the authority.

(2) Where the Minister dismisses the members of a district health authority, the Minister shall appoint an official administrator to take the place of the board of directors.

(3) An official administrator appointed under this Section

(a) has all of the powers and authority of the district health authority;

(b) shall perform all of the duties of the authority; and

(c) shall be paid the salary and expenses as determined by the Minister at the cost of the authority.

(4) When the Minister considers that an official administrator is no longer required, the Minister shall provide for the appointment of new members to the district health authority.

66 Notwithstanding the duties and powers provided to district health authorities pursuant to this Act, the Minister may give binding directions to a district health authority with respect to any matter the Minister considers relevant to the exercise of the Minister's powers or discharge of the Minister's duties under this Act, including directions for the purpose of

(a) establishing priorities and guidelines for the authority to follow in the exercise of its powers;

(b) co-ordinating the work of the district health authority with the objectives and strategic direction of the health-care system in the Province in order to achieve the best possible results and to avoid duplication of effort and expense;

(c) ensuring the achievement of Provincial objectives and health services; and

(d) ensuring the proper discharge by the authority of its duties and powers regarding the boundaries, composition, membership, formation and support of community health boards.

PROVINCIAL HEALTH-CARE CENTRES

67 The IWK-Grace and the Queen Elizabeth II are provincial health-care centres.

68 (1) A provincial health-care centre shall continue to plan, manage, monitor and evaluate the delivery of the specialized health services it is delivering at the time this Act comes into force and shall deliver such other specialized health services for which it is made responsible pursuant to this Act.

(2) A provincial health-care centre shall deliver health services in the health district in which it is located in accordance with the health-services business plan referred to in Section 71.

69 (1) Notwithstanding the Nova Scotia Hospital Act, the Queen Elizabeth II Health Sciences Centre Act and clause 13(1)(e), the Minister shall appoint the same persons to be members of the board of directors of the Capital District Health Authority, members of the Board of Management of the Nova Scotia Hospital and members of the Board of Directors for the Queen Elizabeth II.

(2) Notwithstanding the Izaak Walton Killam-Grace Health Centre Act and clause 13(1)(e), the Minister may appoint the same persons who are appointed to be members of the board of directors for the Capital District Health Authority to be members of the Board of Directors for the IWK-Grace.

70 The Minister shall, when making appointments pursuant to subclause 11(a) and Section 69 have regard to the Provincial scope and mandates of the Nova Scotia Hospital, the Queen Elizabeth II and the IWK-Grace.

71 (1) The Capital District Health Authority, the Nova Scotia Hospital and the provincial health-care centres shall prepare and submit a joint health-services business plan in accordance with Sections 58 to 61 that provides for the delivery of both community-based health services and specialized health services by the provincial health-care centres.

(2) For greater certainty, the preparation of the joint health-services business plan referred to in subsection (1) fulfils the obligation of the Capital District Health Authority to prepare and submit a health-services business plan pursuant to Sections 58 to 61.

72 (1) A provincial health-care centre and the Nova Scotia Hospital are not district health authorities for the purpose of Sections 4 to 10, 19, 28, 29, 39 to 53, 55 to 57 and 73 to 82.

(2) Unless the Minister makes the appointments referred to in subsection 69(2), the IWK-Grace is not a district health authority for the purpose of Sections 11 to 17 and Section 54.

TRANSITIONAL PROVISIONS

73 Where the boundaries of a health district are the same as the boundaries of a health region established pursuant to the Regional Health Boards Act that is repealed by this Act,

(a) all assets and liabilities of the regional health board established for that health region become the assets and liabilities of the district health authority for the health district;

(b) all employees of the regional health board become employees of the district health authority;

(c) the continuity of employment of the employees of the regional health board is not broken by the effect of clause (b); and

(d) the district health authority is substituted for the regional health board with respect to any agreement to which the board was a party.

74 Where the boundaries of a health district encompass a part of a health region established pursuant to the Regional Health Boards Act that is repealed by this Act,

(a) all assets and liabilities of the regional health board established for that health region that relate to that part of the health region become the assets and liabilities of the district health authority for the health district, subject to the determination of the Minister of any question about what is an appropriate allocation of assets and liabilities among district health authorities for health districts replacing parts of the health region;

(b) all employees of the regional health board who are employed in that part of the health region become employees of the district health authority subject to the determination of which district health authority is the appropriate employer for the employees by

(i) agreement between authorities and employees where the employees are not represented by unions,

(ii) agreement between authorities and unions, or

(iii) an order of a court or other tribunal with jurisdiction to deal with the matter;

(c) the continuity of employment of the employees of the regional health board is not broken by the effect of clause (b); and

(d) the district health authority for the health district is substituted for the regional health board with respect to any agreement to which the board was a party in relation to the part of the health region that the health district encompasses and, in the case of any agreement other than an employment or collective agreement, the Minister shall determine which authority is substituted for the board for each such agreement and may direct one of the authorities to carry out the agreement on behalf of the others according to terms determined by the Minister.

75 The vesting of any asset of the regional health board in a district health authority pursuant to Section 73 or 74 does not void any policy of insurance with respect to the asset, including public liability policies, and the authority is deemed to be the insured party for the purpose of any such policy.

76 (1) Where the Cape Breton Regional Hospital, the Glace Bay Healthcare System Corporation, the New Waterford Consolidated Hospital Commission and the Northside Harbor View Hospitals are designated by the regulations, notwithstanding any special or general Act of the Legislature,

(a) those hospitals are dissolved and the assets and liabilities of those hospitals, including any assets and liabilities acquired by those hospitals collectively carrying on operations under the name "Cape Breton Healthcare Complex", become the assets and liabilities of the district health authority for the health district in which those hospitals are located;

(b) all employees of those hospitals, including any persons employed by those hospitals collectively carrying on operations under the name "Cape Breton Healthcare Complex", become the employees of the district health authority referred to in clause (a); and

(c) the continuity of employment of the employees referred to in clause (b) is not broken by the designation of those hospitals.

(2) Where the hospitals referred to in subsection (1) are designated by the regulations, notwithstanding any special or general Act of the Legislature, the district health authority referred to in clause (1)(a) is substituted for those hospitals with respect to any agreement to which those hospitals were parties, including any agreements entered into by those hospitals collectively carrying on operations and contracting under the name "Cape Breton Healthcare Complex".

77 (1) Subject to subsection (2), upon the establishment of a district health authority, all physicians, who at the time of the establishment of the authority held hospital privileges at a hospital in the health district, continue to hold the same hospital privileges for that hospital only until such time as the privileges would otherwise expire, subject to any limitations to which the hospital privileges were subject and subject to the right of the authority to vary, revoke or suspend hospital privileges in accordance with its by-laws.

(2) Subsection (1) does not apply to privileges at the IWK-Grace, the Queen Elizabeth II or the Nova Scotia Hospital.

78 Notwithstanding any enactment, trust or agreement by which a foundation is established with respect to a hospital, the foundation shall, as the foundation considers appropriate,

(a) continue to use its funds to benefit the hospital or for other charitable purpose for which the foundation is established; or

(b) where the hospital is no longer operated as a hospital or no longer exists, use its funds to benefit the health services of the district health authority responsible for the area formerly served by the hospital subject to the terms of any trusts relating to the use of those funds.

79 Notwithstanding Section 41, where a community health board continued pursuant to Section 39 consists of a number of members that does not comply with the limits referred to in Section 41, the board may continue to operate with that number of members until the district health authority adjusts the number of members by appointing more members or fewer members to produce compliance with that Section.

GENERAL

80 A foundation that uses its funds to benefit a district health authority or a hospital located in the health district for which that authority is established shall annually provide that authority with copies of its audited year-end financial statements.

81 District health authorities are hospitals for purpose of Sections 60 and 61 of the Evidence Act.

82 Notwithstanding Section 5 of the Hospitals Act, in the event of a conflict between this Act or the regulations and any enactment respecting a hospital, this Act and the regulations prevail.

83 District health authorities are hospitals for the purpose of the Health Act, the Revenue Act, and for the application of the Sales Tax Act.

84 Section 19 of the Hospitals Act does not apply to a district health authority.

85 (1) The Governor in Council may make regulations

(a) designating one or more areas of the Province as a health district and determining its name;

(b) determining or altering the boundaries of a health district;

(c) establishing a district health authority and determining or changing its name;

(d) establishing additional district health authorities and determining their names;

(e) annexing the whole or any part of a health district to another health district;

(f) providing for the dissolution of a district health authority and all matters consequent to the dissolution;

(g) providing for the dissolution, division, amalgamation or reconstitution of a district health authority for the purpose of Section 7 including regulations

(i) prescribing its membership and the manner of appointment of members,

(ii) naming or renaming it,

(iii) determining its organization and internal management, and

(iv) vesting in it such powers, rights, privileges, functions and duties as the Governor in Council considers advisable;

(h) prescribing services to be made available to every resident of the Province;

(i) prescribing the number of voting and non-voting members on the board of directors of each district health authority;

(j) revoking the corporate and medical staff by-laws made prior to the coming into force of this Act for the hospitals referred to in subsection 25(5) and replacing them with by-laws made pursuant to Sections 23 to 25;

(k) prescribing the terms of office of members of a district health authority;

(l) prescribing a procedure for removing a member of a district health authority;

(m) respecting the reimbursement for expenses of members of a district health authority or a community health board;

(n) prescribing responsibilities of a district health authority;

(o) designating hospitals for the purpose of this Act;

(p) authorizing the duties and prescribing the functions of a district health authority;

(q) defining any word or expression used but not defined in this Act;

(r) further defining any word or expression used in this Act;

(s) respecting any matter that the Governor in Council considers necessary or advisable to carry out effectively the intent and purpose of this Act.

(2) The Minister may make regulations

(a) prescribing the reporting requirements for any borrowing of funds;

(b) establishing guidelines and criteria respecting the selection and appointment of members of a community health board;

(c) respecting the number of voting members of a board of directors who hold office or employment in the service of the authority or any hospital or service of the authority or who have privileges at any hospital in the health district for the purpose of subsection 13(3);

(d) establishing guidelines and criteria respecting the selection of nominees for appointment to the boards of director of district health authorities.

(3) A regulation of the Governor in Council or of the Minister may apply to all persons or to a class of persons to whom this Act applies and there may be different regulations for different classes of persons.

(4) Regulations applicable to district health authorities apply to provincial health-care centres in the same manner unless the application of the regulation to a provincial health-care centre is specifically excluded in the regulation.

(5) The exercise by the Governor in Council of the authority conferred by subsection (1) and the exercise by the Minister of the authority conferred by subsection (2) are regulations within the meaning of the Regulations Act.

86 Chapter 91 of the Acts of 1950, The Aberdeen Hospital Act, is repealed.

87 Chapter 196 of the Acts of 1893, An Act to incorporate the All Saints Springhill Cottage Hospital Corporation of the Diocese of Nova Scotia, is repealed.

88 Chapter 93 of the Acts of 1939, An Act to Incorporate Annapolis General Hospital, is repealed.

89 Chapter 6 of the Acts of 1988, the Cape Breton Regional Hospital Act, is repealed.

90 Chapter 2 of the Acts of 1978-79, the Cobequid Multi-Service Centre Act, is repealed.

91 Chapter 98 of the Acts of 1950, the Colchester Hospital Commission Act, is repealed.

92 Chapter 120 of the Acts of 1975, the Dartmouth Hospital Commission Act, is repealed.

93 Chapter 137 of the Acts of 1925, An Act to Incorporate the Digby General Hospital, is repealed.

94 Chapter 97 of the Acts of 1947, An Act to Incorporate the Eastern Memorial Hospital, is repealed.

95 Chapter 98 of the Acts of 1974, the Eastern Shore Memorial Hospital Commission Act, is repealed.

96 Chapter 6 of the Acts of 1993, the Glace Bay Healthcare System Act, is repealed.

97 Chapter 81 of the Acts of 1946, An Act to Incorporate "Guysborough Memorial Hospital", is repealed.

98 Chapter 7 of the Acts of 1993, the Health Services Association of the South Shore Act, is repealed.

99 Chapter 126 of the Acts of 1973, the Highland View Regional Hospital Act, is repealed.

100 Clause 2(f) of Chapter 208 of the Revised Statutes, 1989, the Hospitals Act, is amended by adding ", or means, where the context requires, a body corporate established to own or operate a hospital, or a program approved by the Minister as a hospital pursuant to this Act or any other Act of the Legislature" immediately before the semicolon at the end of the clause.

101 Chapter 106 of the Acts of 1974, An Act to Incorporate Inverness Consolidated Memorial Hospital, is repealed.

102 Section 5 and subsections 6(1) and (2) of Chapter 26 of the Acts of 1996, the Izaak Walton Killam-Grace Health Centre Act, are repealed.

103 Chapter 162 of the Acts of 1928, An Act to Incorporate the Kentville Hospital Association, is repealed.

104 Chapter 94 of the Acts of 1951, An Act to Incorporate the Lillian Fraser Memorial Hospital, is repealed.

105 Chapter 134 of the Acts of 1948, An Act to Incorporate Musquodoboit Valley Memorial Hospital, is repealed.

106 Chapter 100 of the Acts of 1959, the New Waterford Consolidated Hospital Act, is repealed.

107 Chapter 98 of the Acts of 1951, An Act to Incorporate North-Cumberland Memorial Hospital, is repealed.

108 Chapter 66 of the Acts of 1943, An Act to Incorporate the North Victoria Cottage Hospital, is repealed.

109 Chapter 311 of the Revised Statutes, 1989, the Northside Harbor View Hospital Act, is repealed.

110 Section 7 of Chapter 313 of the Revised Statutes of Nova Scotia, 1989, the Nova Scotia Hospital Act, is repealed.

111 Sections 6 and 7 of Chapter 16 of the Acts of 1995-96, the Queen Elizabeth II Health Sciences Centre Act, are repealed.

112 Chapter 108 of the Acts of 1936, An Act to Incorporate The Queens General Hospital Association, is repealed.

113 Chapter 12 of the Acts of 1994, the Regional Health Boards Act, is repealed.

114 Chapter 104 of the Acts of 1977, the Roseway Hospital Act, is repealed.

115 Chapter 105 of the Acts of 1962, An Act to Incorporate Sacred Heart Hospital, and in the French Language Hôpital Du Sacre-Coeur, is repealed.

116 Chapter 144 of the Acts of 1975, the South Cumberland Memorial Hospital Act, is repealed.

117 Chapter 117 of the Acts of 1972, An Act to Incorporate St. Martha's Hospital, is repealed.

118 Chapter 84 of the Acts of 1946, An Act to Incorporate St. Mary's Memorial Hospital, is repealed.

119 Chapter 107 of the Acts of 1921, An Act Respecting "The Soldiers' Memorial Hospital, Middleton", is repealed.

120 Chapter 111 of the Acts of 1903, the Sutherland-Harris Memorial Hospital Act, is repealed.

121 Chapter 93 of the Acts of 1945, An Act to Incorporate Twin Oaks Memorial Hospital, is repealed.

122 Chapter 109 of the Acts of 1947, An Act to Incorporate Victoria County Memorial Hospital, is repealed.

123 Chapter 227 of the Acts of 1920, the Western Kings Memorial Hospital Act, is repealed.

124 Chapter 152 of the Acts of 1929, An Act to Incorporate the Westwood General Hospital Association, is repealed.

125 Chapter 91 of the Acts of 1963, the Yarmouth Regional Hospital Act, is repealed.

126 This Act comes into force on such day as the Governor in Council orders and declares by proclamation.