Health and Social Services

Restrictive covenants are frequently included in contracts that govern business practices and relationships. They are intended to protect the legitimate interests of the parties, such as goodwill, confidential information, team stability and—more broadly—the value of a business.  That said, more often than not, restrictive covenants that apply to health care professionals  need to be modified. A so-called “professional-patient” relationship differs from an ordinary business relationship, as a clientele consisting of patients has its own distinct characteristics. Indeed, the Court of Appeal of Quebec has repeatedly reiterated that restrictive covenants—namely non-compete and/or non-solicitation clauses—cannot, directly or indirectly, compromise the continuity of care or restrict a patient’s free choice. Therefore, the analysis must extend beyond financial protection alone to include public order considerations relating to access to care and continuity of care.  The challenge thus lies in drafting clauses that are both useful and enforceable. This requires a focus on what actually needs to be protected, while avoiding restrictions that would dissuade a health care professional from continuing treatment or prevent patients from receiving care from their physician of choice.  The most common restrictive covenants  The purpose of a non-compete clause is to prevent individuals from engaging in competing activities after a contractual relationship has ended. With regard to employment, article 2089 of the Civil Code of Québec1 requires that the clause be limited as to time, place and type of employment, to what is necessary for the protection of the legitimate interests of the party in whose favour the “protection” is established.2   A non-solicitation clause does not necessarily target the practice of the profession as such, but rather actions intended to actively attract individuals or entities associated with the business, including patients, referrals or employees. Although it is often presented as less intrusive, it can nonetheless have effects comparable to those of a non-compete clause if it is worded so broadly that it effectively prevents a professional from seeing patients who wish to be under their care.  Unique characteristics of the health care sector: patients, continuity of care and public order  One particular restriction applies in the health care sector: a non-compete clause must neither treat patients as a commercial asset nor place the professional in a position of having to choose between: (i) complying with the clause; or (ii) ensuring the continuity of care required by a patient’s medical condition. Patients are not parties to the contract between the employer, the clinic or the purchaser and the health care professional, and are not considered objects in commerce.3 It is therefore risky to attempt to govern their conduct by way of a contract, as if they were parties to the agreement.4  It should be noted that this premise is considered when covenants are assessed.5 The law and various codes of ethics generally require professionals, in particular, not to “abandon” a patient, to ensure a secure transfer of records, and to uphold—within the limits of the regulatory framework—the patient’s freedom to choose their service provider.6 The contract, therefore, cannot be drafted as though the protection of goodwill alone justified restrictions that compromise continuity of care.  Jurisprudential insights from the Court of Appeal of Quebec  Where a health care professional practises at a clinic, a non-compete clause between the clinic and the professional must not prevent a patient from continuing to receive care from the professional of their choice should the patient-professional relationship be terminated. A clause that violates this rule is especially vulnerable to being deemed invalid if it directly or indirectly prohibits practitioners from treating or taking on patients connected to a clinic—particularly where it makes no exceptions for emergency care or the continuation of treatment.7 Thus, a clause that prohibits treating former patients of a clinic or accepting patients “originating” from it, with no exceptions—particularly regarding ongoing care—may exceed what is required to protect goodwill and may conflict with the continuity of care. Similarly, a non-solicitation clause that treats the mere act of responding to a patient’s request as solicitation may, in practice, turn a prohibition on solicitation into a prohibition on providing treatment,8 which should be avoided.  The issue does not lie solely in explicit prohibitions. It can also stem from a mechanism designed to deter professionals from accepting patients in order to avoid penalties. In this regard, a penalty clause triggered by the act of treating a patient may exert economic pressure that could affect the patient’s choice and the continuity of care, even if the provision does not expressly refer to the discontinuation of care.9  Professional context vs. commercial context  From a structuring perspective, one often useful approach is to draw a clear distinction between clinical practice and commercial involvement.10 A prohibition against providing clinical care is the measure that most directly affects the continuity of care, as it prevents the professional from providing care precisely when a patient wishes to continue treatment.11 The stronger the pre-existing therapeutic relationship and the longer the course of treatment, the greater the risk of hindering the patient’s freedom of choice and the continuity of care.12 In other words, discontinuing treatment is generally more problematic in long-term care (e.g., orthodontics, psychiatry) than in one-off procedures (e.g., dental cleanings). Where restrictive covenants result in the disruption of the continuity of care, their consequences are too serious to be left to the vagaries of the market.13   Conversely, certain restrictions relating to the leadership, management, operation or control of a competing business may sometimes be more justifiable where they protect a specific legitimate interest without actually preventing the continuity of care. While this approach does not ensure a clause’s validity, it does reduce the likelihood that the clause will be deemed invalid, provided that the clause is carefully worded in terms of time limit, scope and definition of protected activities, and that it accurately reflects what is actually observed in clinical practice.  Five recurring issues with drafting  Territory  The issue of territory continues to come up frequently as a point of contention. In health care, territory must be defined based on the actual service area and the legitimate interest to be protected, while considering the impact on access to care.14 A territory that is too big could mean less services,15 particularly in specialized fields, whereas a territory that is too small could render the clause commercially ineffective.16 It is also important to note that territorial scope must be assessed on a case-by-case basis. A standard clause provided by a recognized association may even be deemed ineffective if it does not reflect the legitimate interests of the business in question.17  That said, even in the absence of an established territory, a restrictive clause may be valid, provided that the target clientele is clearly defined.18   Time limit  The time limit must be clearly established and reasonable. A clause with no time limit—or one with an ambiguous start date—is particularly problematic.19 Even where the time limit has been clearly established, it must be based on a defensible business rationale and must not exceed what is necessary, especially where the restriction affects clinical practice rather than specific conduct.  Activities The definition of prohibited activities is often crucial. Broadly worded provisions—such as a general prohibition against providing “similar” services—become difficult to enforce without conflicting with clinical requirements.20 In practice, it is generally more prudent to focus on identifiable and verifiable conduct rather than prohibiting a physician from treating a patient who wishes to be under their care. Where treatment is ongoing, it may be necessary to include an explicit provision regarding continuity of care to reduce the likelihood that the clause will be deemed invalid.21  Non-solicitation clause  A non-solicitation clause requires a particularly careful definition of the concept of “solicitation”. A non-solicitation clause that would prevent a professional from earning a living would likely be deemed invalid and unreasonable.22 The recurring point of contention remains the distinction between actively and specifically trying to attract patients, and responding to a patient’s request to seek care from a particular professional. The degree of precision in targeting the clientele is also very important.   Penalty clause   The penalty clause must be handled with caution. In a health care context, the amount of a penalty or the form it will take can dissuade professionals from continuing treatment. Imposing a penalty simply for providing treatment—regardless of whether active solicitation or unfair conduct23 occurred—could be perceived as indirect coercion that infringes the patient’s freedom of choice.24 The penalty is more likely to fulfill its purpose when it targets specific and quantifiable acts, while remaining proportionate to the anticipated commercial prejudice.  It is also important to note that if any one of these analytical criteria is deemed unreasonable, that alone may be sufficient to render the restrictive covenant invalid in its entirety.25   Conclusion  The rulings of the Court of Appeal of Quebec26 underscore a crucial point, namely that the protection of goodwill or an investment, however legitimate it may be, cannot result in a restriction on a patient’s freedom of choice or in an infringement—indirect or otherwise—on the continuity of care. When drafting clauses, the soundest approach is generally to target conduct that is genuinely problematic from a business perspective—such as active solicitation, the use of confidential information and unfair competition—rather than imposing a general prohibition against treating patients.  Where more significant restrictions are being contemplated, distinguishing between clinical practice and commercial involvement may help reduce the likelihood that the clause will be found invalid, provided that it remains reasonable as to duration, territory and scope of activities, and that it is consistent with the clinical imperatives established by case law.  The content of this article is published for general information purposes only and should not be construed as constituting a legal opinion or legal advice. Be sure to contact a member of our team for advice specific to your situation.  CCQ-1991. Payette c. Guay inc., 2013 CSC 45, para. 61. Mirarchi c. Lussier, 2007 QCCA 284, para. 46. Mirarchi c. Lussier, para. 43. Mirarchi c. Lussier, 2007 QCCA 284, para. 27. Mirarchi c. Lussier, 2007 QCCA 284, para. 29-35. Mirarchi c. Lussier, 2007 QCCA 284, para. 50-53. Pitl c. Grégoire, 2018 QCCA 1879. Mirarchi c. Lussier, 2007 QCCA 284, para. 52. Mirarchi c. Lussier, 2007 QCCA 284, para. 35. Mirarchi c. Lussier, 2007 QCCA 284, para. 29. Mirarchi c. Lussier, 2007 QCCA 284, para. 49. Mirarchi c. Lussier, 2007 QCCA 284, para. 51. Gestion Philippe Girard inc. c. Clinique de réhabilitation prosthodontique de Québec inc., 2022 QCCA 1146, para. 103. Gestion Philippe Girard inc. c. Clinique de réhabilitation prosthodontique de Québec inc., 2022 QCCA 1146, para. 104. Pitl c. Grégoire, 2018 QCCA 1879, para. 60. Pitl c. Grégoire, 2018 QCCA 1879, para. 64-69. Services financiers Bertrand Lapointe inc. c. Groupes financiers Claude Grefford inc., 2026 QCCA 98, para. 9.; Payette c. Guay inc., 2013 CSC 45. Pitl c. Grégoire, 2018 QCCA 1879, para. 79. Gestion Philippe Girard inc. c. Clinique de réhabilitation prosthodontique de Québec inc., 2022 QCCA 1146, para. 102 and 104. Théberge c. Lévesque, 2007 QCCA 898, para. 52. Pitl c. Grégoire, 2018 QCCA 1879, para. 43. Théberge c. Lévesque, 2007 QCCA 898, para. 59. Théberge c. Lévesque, 2007 QCCA 898, para. 54. Pitl c. Grégoire, 2018 QCCA 1879, para. 70-71. and the Supreme Court of Canada

In the Henry decision rendered on January 16, 2026,1 the Professions Tribunal reiterated what framework applies to a guilty plea in disciplinary matters. In this case, the professional had pleaded guilty during his conviction hearing. After having ascertained that his pleas were made freely and voluntarily, the Disciplinary Council of the Ordre des dentistes (the “Council”) declared him guilty. However, the Council had not ensured that the professional admitted to the facts relating to the key elements of the offences at issue. During the penalty hearing, the professional raised questions about his guilty pleas. Although the Council had considered whether his pleas were valid and whether to withdraw them and return the case to a conviction hearing, the hearing continued and penalties were imposed on the professional. On appeal of the Council’s decision, the Professions Tribunal concluded that the Council had erred in accepting the professional’s guilty pleas when it had become clear that he denied the facts put forward in support of the charges against him. The Professions Tribunal concluded that the Disciplinary Council of the Ordre des dentistes had erred in accepting the appellant’s guilty plea when it had become clear that he denied the facts put forward in support of the charges against him.   The Professions Tribunal reasons were based on the following: The Professional Code2 contains no specific provisions governing the entering of a guilty plea.3 In the absence of specific rules, disciplinary law can draw inspiration from the criteria developed in criminal and penal law.4  By pleading guilty, the professional waives their right to a formal investigation and associated procedural safeguards.5  Pleading guilty is a significant decision in disciplinary proceedings, as it inevitably brings the investigation to a close and has detrimental consequences on the professional who pleads guilty.6 This decision serves as a reminder of the two-prong test7 a Disciplinary Council must use to accept a guilty plea: Admission by the professional: The professional must have formally admitted to the key legal elements of the offence.8 To be valid, a guilty plea must be voluntary, unequivocal and made with full knowledge of its effects and consequences.9 Acceptance by the Council: The Council may only accept the plea after ensuring that the professional knows and understands the nature of the offence they are charged with and the effects of their guilty plea. The Council must also confirm that the professional admits to the facts relating to the key elements of the offence in question.10 This decision also introduces the requirement to submit a joint statement of the facts11 or provide an account of the facts that led to the offences in order to properly contextualize them.12 Failure to comply with these requirements could result in the professional’s guilty plea being contested or dismissed by the Disciplinary Council. More recently in the Fernandez decision,13 the Disciplinary Council of the College des médecins was called upon to rule on whether the requirements of the Henry decision applied, in particular regarding the filing of a joint statement or account of the facts giving rise to the offences. In this case, the Council had taken cognizance of the Henry decision after having accepted the professional’s guilty plea, and no joint statement had been filed. After allowing the parties to present their observations, the Council declared itself satisfied with the parties’ claims that the Fernandez case differed from the Henry case in that Dr. Fernandez had admitted to the facts relating to the essential elements of the charge, that he had filed a 17­­-page statement, and that the Syndic had filed documents containing the accounts of eight patients. It will be interesting to follow how case law will develop on this issue to confirm what direction the various disciplinary councils will take. The members of Lavery’s professional and disciplinary law team regularly represent professional orders and professionals. They are available to advise you and answer your questions. Summary A guilty plea may expedite the disciplinary process, but it has the effect of depriving the accused professional of certain procedural safeguards. It is important to ensure that the conditions of validity and acceptance of a guilty plea are met, otherwise it may be dismissed or overturned on appeal. Summary evidence must be taken before a professional pleads guilty, whether it be through the filing of a joint statement of facts, the presentation of an account of the facts by one of the parties or the submission of documentary evidence. Henry c. Dentistes (Ordre professionnel des), 2026 QCTP 1 2 CQLR C-26. Henry c. Dentistes (Ordre professionnel des), 2026 QCTP 1, para. 24 Id. Id. Id., para. 27 Id., para. 25 Id., para. 26 Id., para. 28 Id., para. 27 and 29. Id., para. 30 Id., para. 31 Médecins (Ordre professionnel des) c. Fernandez, 2026 QCCDMD 5

The reform of the occupational health and safety system that was initiated in 2021 has reached one of its final steps as new obligations for employers come into force. As of October 6, 2025, employers must comply with several provisions of the Act to modernize the occupational health and safety regime (“the AMOHSR”), as well as the Regulation respecting prevention and participation mechanisms in an establishment (“the Regulation”), in effect since October 1, 2025. As concerns about psychosocial risks are growing in our society and, in particular, in the workplace, the need, or even the obligation, for employers to take reasonable measures to protect the health, safety and physical and psychological integrity of workers has become very important. In fact, according to a study conducted by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), statistics on psychosocial risks (violence, stress, harassment) show that there has been a 71.4% increase in injuries attributable to this type of risk since 2020.1 Thus, recent legislative and regulatory changes aim to strengthen the protection of workers’ physical and psychological health. They require employers to take a proactive approach in order to adapt to societal changes. It goes without saying that this approach also promises to reduce the costs arising from legal action, complaints, and claims for employment injuries made to the CNESST. Psychosocial risks in the workplace The recent amendments made by the AMOHSR explicitly recognize the importance of employers identifying, correcting and controlling psychosocial risks in the workplace, on the same footing as all other risks that may affect the health and safety of workers.  The main new features of the permanent regime The permanent regime establishing prevention and participation mechanisms in an establishment is enacted by the Regulation, under the Act respecting occupational health and safety (AMOHSR). It replaces the “interim mechanisms” that initially applied when the AMOHSR came into force. The main changes concern the obligations to prepare a prevention program or action plan, to implement it and to update it. The obligations of establishments with 19 or fewer workers a) To prepare and implement an action plan. The action plan is a prevention tool intended to eliminate, at the source, dangers to the health, safety, and physical and mental well-being of workers.2 The AMOHSR stipulates that the action plan must, at a minimum, include the following elements:3 “the identification of the risks that may affect the health of the establishment’s workers, including the chemical, biological, physical, ergonomic and psychosocial risks related to the work, as well as the risks that may affect the workers’ safety; the measures and priorities for action to eliminate or, failing that, to control the identified risks, giving precedence to the hierarchy of preventive measures established by regulation as well as the scheduling to accomplish the measures and priorities; the supervision and maintenance measures to ensure that the identified risks are eliminated or controlled; the identification of the individual protective means and equipment that, in addition to being in compliance with the regulations, are those best adapted to meet the needs of the establishment’s workers; and the occupational health and safety training and information.” b) To designate a health and safety liaison officer. The liaison officer plays a key role in the establishment’s worker participation mechanism. In particular, this person collaborates on the preparation and implementation of the action plan. The liaison officer issues written recommendations to the employer and participates in the identification and analysis of risks, including psychosocial risks, that may affect the health and safety of workers.4 Obligations of establishments with 20 or more workers a) To prepare and implement a prevention program. The prevention program includes all the elements of the action plan, but is more complex and offers a long-term overview of how prevention is organized in the workplace.5 The AMOHSR specifies the minimum elements that the prevention program must include.6 In short, this program includes the following in addition to what is provided for in the action plan: Pre-employment medical checkups and medical examinations during employment Establishing and updating a list of dangerous substances and contaminants Maintaining an adequate first aid service to respond to emergencies The AMOHSR amended this program, which was initially provided for under the AROH, to explicitly include the protection of workers’ mental health by adding the analysis of psychosocial risks. b) To establish a health and safety committee. The health and safety committee (“HSC”) plays an important role, particularly in developing the prevention program, identifying risks, including psychosocial risks, and analyzing the workplace; it proposes measures to correct and control these risks.7 In the absence of an agreement between the employer and the workers, the Regulation provides for the makeup of the HSC, the procedures and methods for appointing the workers’ representatives, and the rules of operation of the HSC.  c) To designate a health and safety representative. The health and safety representative is a member of the HSC and assists it in its mandates, including workplace inspections, receiving and analyzing accident reports, and identifying hazards, including psychosocial risks, for workers.8 In the absence of an agreement between the members of the HSC, the Regulation stipulates the minimum time required for the performance of the health and safety representative’s duties (which depends on the number of workers and the level of the establishment).9 The training obligation The health and safety liaison officer must participate in a theoretical training course developed by the CNESST within one year of their appointment as liaison officer.10 The health and safety representative and the members of the HSC must also complete a theoretical training course of a minimum duration of one day, delivered by the CNESST or by a person or organization recognized by it, within 120 days of their appointment.11 Note that the CNESST offers employers an information tool through its occupational health program which focuses on three increasingly prevalent psychosocial risks: violence, harassment and exposure to a potentially traumatic event. This program provides an overview of the identification of these risks and offers, as an example, a table of preventive measures that can be taken depending on the risk and the psychosocial factor concerned. 12 Conclusion By putting an emphasis on psychosocial risks and adapting the prevention mechanisms, these additions to the health and safety regime aim to guarantee a healthy and safe working environment. The legislation gives employers a transition period to comply with the new obligations. As of October 6, 2025, employers have one year to implement either the prevention program or the action plan.13 Both must be updated annually.14 These new obligations are part of a trend among legislators to enhance workplace prevention measures, focusing in particular on worker participation, training, and information sharing. To that end, the Regulation respecting the measures to prevent or put a stop to sexual violence was published in draft form on October 29, 2025.15 Employers will have new obligations regarding the information they must provide to workers, particularly concerning workplace risks that have been identified or analyzed in relation to situations of sexual violence.16 Furthermore, under this draft regulation, a procedure for handling complaints or reports will need to be established, as well as specific training on situations of sexual violence.17 Companies must assess and adjust their practices in order to meet these new obligations. Commission des normes, de l’équité, de la santé et de la sécurité du travail, Statistiques sur les risques psychosociaux liés au travail (statistics on work-related psychosocial risks), October 2025. S. 147 AMOHSR inserting s. 61.2 of the Act respecting occupational health and safety (“the AROH”). Ibid; CNESST, Contenu du plan d’action (content of an action plan). S. 167 AMOHSR inserting s. 97.2-97.3 of the AROH. CNESST Comment se préparer à nos nouvelles obligations en santé et en sécurité au travail? (how to prepare for the new occupational health and safety obligations) October 2025, p. 7. S. 144 AMOHSR amending s. 59 of the AROH; CNESST. Contenu du programme de prévention. S. 150 AMOHSR replacing s. 68 of the AROH; s. 154 AMOHSR amending s. 78 of the AROH. S. 161 AMOHSR replacing s. 87 of the AROH; s. 163 AMOHSR amending s. 90 of the AROH.   Section 7 of the Regulation. S. 167 AMOHSR inserting s. 97.5 of the AROH. Sections 34-36 of the Regulation. CNESST. Programme de santé au travail(occupational health program), October 2025. Section 4 of the Regulation. Section 5 of the Regulation. GAZETTE OFFICIELLE DU QUÉBEC, October 29, 2025, Vol. 157, No. 44 Section 3 of the draft Regulation respecting the measures to prevent or put a stop to sexual violence (“Draft Regulation”). Sections 4-6 of the Draft Regulation.

Employers are regularly faced with complex mental health situations, particularly when their employees are absent due to illness or injury, or when accommodation measures need to be considered. In such cases, they usually request supporting documentation specifying the diagnosis in question. Diagnosing a mental disorder used to be an act reserved exclusively for doctors,1 although the Code of ethics of psychologists does mention “psychological diagnosis.”2 The Act to amend the Professional Code for the modernization of the professional system and to broaden certain professional practices in the field of health and social services,3 also known as Bill 67, which received assent on November 7, recognizes that certain health professionals other than physicians are qualified to make mental health diagnoses. These legislative changes are in keeping with the goal of making professional care and services more accessible to the public, and are in line with the position the Collège des médecins du Québec has taken in recent years.4 The professionals involved and the new authority granted in terms of diagnosis5 Psychologists (including neuropsychologists): Mental disorders Neuropsychological disorders, if a training certificate has been issued to the professional Guidance counsellors: Mental disorders, if a training certificate has been issued to the professional Intellectual disability Speech therapists and audiologists: Language disorders and learning disorders related to language Sexologists: Sexual disorders, if a training certificate has been issued to the professional Nurses: Mental disorders, with the exception of intellectual disability, if the nurse has university training and clinical experience in psychiatric nursing It should be pointed out, however, that this legislative change is not intended to create a new activity reserved for these professionals. Rather, its aim is to recognize that some mental health assessments, and the clinical conclusions arising from them, are really diagnoses.6 Impact on employers When a diagnosis of a mental disorder is made, it is possible that the professional concerned, such as a psychologist or neuropsychologist, might recommend the appropriate treatment, including stopping or returning to work.7 These legislative changes8 could make it more complicated for employers and insurers to refuse to implement this recommendation solely because the healthcare professional is not a physician. We believe it is also possible that these changes will lead to new requests for reasonable accommodation with regard to several increasingly frequent mental issues (e.g. attention deficit disorder with or without hyperactivity, autism spectrum disorder, intellectual giftedness, major depressive disorder, etc.), without a physician necessarily being involved at the diagnosis stage. The expansion of professional practices to promote access to care and services for employees could therefore have the effect of increasing the number of requests submitted to employers in connection with mental disorders. It will be important to monitor how employers and others position themselves and adapt their policies in relation to diagnoses established by the professionals concerned. By way of illustration, it’s possible that some employers may decide to require that an employee with a mental health issue undergo more frequent medical examinations, insofar as circumstances allow. Entry into force The changes introduced by Bill 67 came into force on November 7, 2024.9 Professionals who already met the regulatory requirements on that date are deemed to be qualified to make diagnoses.10 Medical Act, CQLR, c. M-9, s. 31; Professional Code, CQLR, c. C-26, s. 31 to 34; Bernard Cliche, Éric Latulippe, François Bouchard, Paule Veilleux and Isabelle Royer, Le harcèlement et les lésions psychologiques, 2nd ed., Cowansville, Éditions Yvon Blais, 2012, p. 329 and 330: [translation:] “The diagnosis of a mental disorder is reserved exclusively to physicians.” See also the arbitration case law, including Gatineau (Ville de) et Association des pompiers et pompières de Gatineau, 2016 QCTA 236. Code of ethics of psychologists, CQLR, c. C-26, r. 212, s. 38. SQ, 2024, c. 31. Collège des médecins du Québec, Projet de loi no 67 et élargissement des pratiques : notre position (Bill 67 and the expansion of practices: our position), September 18, 2024 [online: Projet de loi no 67 et élargissement des pratiques : notre position | Collège des médecins du Québec]. Bill 67, s. 4 and 45. Remarks by the sponsor of Bill 67, Ms. Sonia Lebel, during the bill’s committee stage, October 10, 2024. In the case of psychologists, for example, section 37(e) of the Professional Code already stipulated that they could “determine, recommend and carry out interventions or treatments with a view to fostering the psychological health and restoring the mental health of a person”. Before Bill 67 came into force, an arbitration award established a link between a professional’s ability to make a diagnosis and their ability to recommend a work stoppage: Aliments Cargill ltée et T.U.A.C., section locale 500, D.T.E. 2010T-817 (Arbitration Tribunal), par. 98 to 103. Bill 67, s. 87. Bill 67, s. 85.