Last year, dozens of expectant parents in the Greater Toronto Area left a Pickering ultrasound clinic believing they had received images of their healthy gestating children. There was just one problem: they all had the same picture. The government isn’t currently taking any action to crack down on this kind of bungle: although it presented a major new health bill at Queen’s Park last week, it doesn’t plan to institute measures to restrict or regulate the non-medical use of ultrasound machines in Ontario.
Bill 160, introduced last week by Health and Long-term Care Minister Eric Hoskins, is a sprawling multi-part bill that will affect many aspects of the province’s health care system. One of the sections will require the regulation of sonographers (technicians who use ultrasound machines for medical imaging) — bringing them in line with others who work in imaging technology. Ontario traditionally lets medical professions self-regulate through legally established colleges, of which there are 26, on the grounds that doctors are better than bureaucrats at determining appropriate professional standards. If the bill passes the legislature, the current College of Medical Radiation Technologists of Ontario will be renamed and have an expanded mandate to regulate sonographers, who aren’t currently regulated by any medical college in the province.
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Linda Gough, CEO of CMRTO, welcomed the change, indicating it addresses a regulatory gap. “We’re well into the process [of regulation]. This is something we’ve been working on for a long time,” Gough says. “It’s our job to protect the public, and we’ve been working with the ministry to close that gap.”
Ultrasound technology is inherently safe: the energy levels used by ultrasound machines are low, and the machines themselves are regulated by the federal government. Problems can arise, though, if sonographers fail to properly capture an image, leaving the doctor, midwife, or nurse practitioner who ordered the sonogram with incomplete information.
The safety of the technology notwithstanding, numerous medical organizations — including the College of Physicians and Surgeons of Ontario and the Society of Obstetricians and Gynaecologists of Canada — have explicit policies that recommend against the use of ultrasound machines for non-medical purposes. But these policies have done little to stem the growth of the “entertainment ultrasound” business — Ontario is now home to a profusion of “3D ultrasound” clinics that promise to provide clearer images of a fetus’s appearance, and offer videos, too.
Gough says that with an expanded mandate, the CMRTO will be able to ensure that operators are competent and have up-to-date training, and to evaluate complaints of error or abuse — the kind of functions that colleges perform for other medical professions in the province.
“What this will do is bring sonographers in line with the rest of the province’s framework,” she says.
But the provisions of Bill 160 (formally, the Strengthening Quality and Accountability for Patients Act) would apply only to sonographers who become members of the new medical college. As long as someone didn’t falsely represent themselves as a college-licensed sonographer, they could still legally operate an ultrasound machine and produce entertainment ultrasounds of the kind provided by places like the now-infamous Pickering clinic.
The health ministry signalled last year that it was looking into regulating the non-medical ultrasound sector, but Hoskins’s office says the legislation introduced this week isn’t intended to target entertainment ultrasounds.
“That level of oversight and accountability that we have for x-rays, we don’t have that for ultrasounds,” says Hoskins. “It’s more about modernizing the oversight system built when some of these technologies didn’t exist.”
A blunder involving the wrong pictures isn’t the worst-case scenario ultrasound machines could produce. Sonograms are a necessary step in sex-selective abortions, which both medical colleges and provincial governments have tried to restrict. But the fact that commercial, non-medical ultrasound clinics will continue to operate largely unregulated poses a problem: professional sonographers in good standing with their medical college will of course refuse to perform sonograms simply for the purpose of identifying the sex of a fetus. But parents intent on terminating a female fetus will be able to find operators who will help them.
There’s also nothing in the legislation that would stop a sonographer who’d been stripped of their licence by the college (for incompetence, say, or abuse) from opening their own non-medical clinic the next day.
Fundamentally, the province’s medical legislation isn’t meant to address the non-medical use of this kind of imaging technology: as long as clinics aren’t physically harming people, the government is reluctant to use laws meant to protect patients’ physical safety for what are, in the end, consumer complaints.
The public isn’t being thrown to the wolves: a separate section of Bill 160 would give inspectors with the Ministry of Health and Long-Term Care substantial powers to inspect “any premises” suspected of the unsafe operation of ultrasound machines — but the government says it’s simply too early in the legislative process to predict whether those powers will be used to restrict non-medical sonograms. The bill has to pass the legislature, the government needs to enact regulations, and the new college needs to set professional standards — after those pieces are in place, the government will be able to take a fresh look at the situation with new legal tools at hand.