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Daphne Bramham: Self-governing pharmacists or government? Who should keep bad health professionals in line?


Last year, an estimated 15,400 British Columbians were using methadone as a treatment for opioid addiction.


Jason Payne / PNG

The disciplinary action taken against Diamondali Tejani paints a stark picture of the challenges that the College of Pharmacists of B.C. has had reining in bad operators.

Tejani finally had his registration suspended beginning Sept. 1 and has been forbidden from being a pharmacy manager, director, owner or shareholder in a pharmacy for two years and fined him $15,000 for what he did and didn’t do in 2016.

It was the third time he’d been disciplined. In 2012, his methadone dispensing privileges were suspended for 30 days, but there were no other details included in the college’s posting on its website.

In 2000, he was suspended for three weeks following his conviction in provincial court for tax evasion.

The cause for the most recent suspension dates back to between July 8 and Nov. 25, 2016. Tejani paid cash incentives to drug users to fill their daily dispensing orders.

As owner, manager and a pharmacist at Surrey’s Boston Pharmacy, the College also said he would have, or should have, known that a patient consultation was required every day.

That wasn’t the end of it. His staff didn’t enter or reverse daily dispense prescriptions on PharmaNet when the patient didn’t show up. Instead, they’d provide patients with missed doses and also dispensed several prescriptions without prescription labels.

Daily dispenses of methadone can be a lucrative business. British Columbia allows pharmacists to charge up to $10 for each prescription for up to three prescriptions each day. That’s in addition to the fees they collect for witnessing the ingestion of methadone.

The most recent figures show the total pharmacy costs for methadone maintenance for 13,894 patients was nearly $46 million in 2011/2012 — $40 million of which was paid by Pharmacare. Last year, an estimated 15,400 British Columbians were using methadone as a treatment for opioid addiction.

Providing methadone daily is lucrative enough that pharmacists like Tejani have actively courted business. Some still do.

Physicians, recovery house operators and recovering addicts have all told me about pharmacies offering incentives as well as threats.

The kickbacks include money to recovery house operators who insist on residents going to a particular pharmacy for their three daily dispenses and money or gifts to customers themselves.

I’ve been told about some recovery house operators threatening to evict residents unless they go to those pharmacies with their three daily scripts. I’ve heard physicians folding under pressure from patients who will be evicted unless they get daily scripts for methadone and usually a sleeping pill or an over-the-counter pain medication like naproxen (a.k.a. Aleve). Their justification? It’s better for recovering addicts to have a roof over their heads than be homeless.

The College gets those complaints. But many of the complaints are never filed because as several recovery home residents have told me, ‘Who’s going to believe an addict?’

The College’s members also haven’t always supported its actions. When the College passed a bylaw in 2013 to outlaw incentives, it resulted in a three year court battle with Safeway and Thrifty Foods who wanted prescriptions to be part of their loyalty rewards programs.

But the appellate court sided with the College and, finally, it was able to enforce the bylaws similar to what Quebec and Newfoundland and Labrador have had in place since 2008.

Still it’s fair to say that professionals’ ability to regulate themselves has been a long-standing issue here, dating back at least to a 2003 ombudsman’s report that found public trust lacking.

This April, British expert Harry Cayton filed a report to the government that recommended a new regulatory framework for health professionals that will significantly reduce their autonomy.

Instead of members electing half or two-thirds of college’s boards, the health minister would appoint them along with all the public members. All college boards would also be required to have equal numbers of professionals and members of the public.

The College of Pharmacists would be one of only five professional regulatory bodies because of its unique jurisdiction over drug schedules regulation and operation of pharmacies.

The others would be the two largest — the College of Physicians and Surgeons and the nurses. The other 15 would be lumped into two new colleges — one for oral and one for everything else from chiropractors to lab technicians to speech and hearing professionals.

Colleges would be overseen by a separate body that reports to the minister. Colleges would continue to investigate complaints, but another separate, independent panel appointed by the minister would make the disciplinary decisions.

Cayton also recommended firm time limits for each stage of investigations and the elimination of professionals’ ability to negotiate agreements/settlements late in the process.

The government is accepting online feedback until Jan. 10 Presumably after that, it will move ahead with changes.

Clearly, there are problems with the current system. But it’s an open question whether a complete overhaul will to lead to better quality services care or whether it will mean more government control and more bureaucracy.

dbramham@postmedia.com

Twitter: @bramham_daphne

 

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