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Port Stanley News RSS Feed  News Ford Government's Dangerous Plan Will Risk Patient Safety & Increase Healthcare Costs


Concerned Ontario Doctors
Ford Government's Dangerous Plan Will Risk Patient Safety  Increase Healthcare Costs

Significant Ethical & Safety Concerns with Ontario's Plan to Expand Role of Pharmacists Beyond Their Training & Promote the Pharmaceutical Industry

Toronto, ON (April 24, 2019) - Last week, the Ontario Minister of Health, Christine Elliott, announced the Ford government's plan to expand the scope of practice for pharmacists in Ontario. There has been much misinformation advanced by Ford's government which raises serious concerns regarding patient safety in the face of heavy lobbying efforts by the pharmaceutical industry in recent months. It is crucial for policy makers and the public to understand: 1) the training and expertise of doctors; 2) that good patient outcomes stem from an accurate diagnosis based on doctors' extensive training; 3) the dangerous threat of antibiotic resistance; 4) the dangers of conflicts of interests in healthcare to patient safety; 5) the false government narratives ignoring patient outcomes; 6) the Ontario government's doublespeak to protect its vested interests; 7) the Ontario government is failing to fund, train, retain and recruit an adequate supply of physicians; 8) the aggressive pharmacist lobbying and pharmacist fraud; 9) concerns about invasion of your private medical records; 10) the pharmaceutical industry's cozy relation with the Ontario government; and 11) the Ontario government prioritizing corporate interests above patient safety.

Training & Expertise of Doctors

There are various members who are integral to the healthcare team and it is crucial to understand that each person has distinct roles in the healthcare system based on their vastly different levels of training and areas of expertise. Medical doctors receive 10-16 years of university training and receive thousands of hours of direct hands-on clinical postgraduate training with acute care training. Family doctors receive a minimum of 15,000 hours of direct hands-on clinical training and Specialists receive 30,000 to 60,000 hours of direct hands-on clinical training. In medicine, central to the Hippocratic Oath is "first do no harm". The years of gruelling university and on-call training physicians receive is crucial in order to equip them with the clinical knowledge and expertise needed of when not to prescribe medications, when not to order investigations, and when not to intervene.

In contrast, pharmacists are only required to have a bachelors degree after 5 years of undergraduate education. According to the College of Ontario Pharmacists, the licensing and regulatory body of Ontario pharmacists, pharmacists are trained to handle and dispense medications, understand drug interactions and side-effects, and provide counselling. Pharmacists are not trained to diagnose or treat medical conditions. The most dangerous part of healthcare for patients is that members of their team don't know what they don't know: that can make the difference between a life and death decision.

Good Patient Outcomes Stem from an Accurate Diagnosis Based on Doctors' Extensive Training

It is important to know that pharmacists already have the ability to refill chronic medications for patients that were initially prescribed by doctors. However, this new proposal would enable pharmacists to assess and prescribe medications in pharmacies for what Minister Elliott and the Ontario Pharmacists Association (OPA) describe as "low-grade issues" or "common ailments" such as "coughs, sore throats, pink eye", rashes or urinary tract infections. Ontarians must understand that what Minister Elliott and the OPA are describing as "issues" and "ailments" are merely symptoms, not a diagnosis. Most coughs, sore throats and pink eye are viral and self-limiting requiring absolutely no treatment. However all of these symptoms, including rashes and urinary symptoms, could be signs of a more serious diagnosis; all of these patient symptoms require a thorough evaluation, physical examination and clinical expertise of doctors to make a diagnosis and then tailor the treatment, and if required further investigations, tailored towards proving the patient's specific diagnosis.

Pharmacists are not trained to diagnose illnesses and they are not trained in physical examination skills. What the OPA has stated is that they would rely on patients to "self-diagnose" and request medication, and that the pharmacists could use an "algorithm" or "check lists" to help make the decision. This is very dangerous and increases exposure of patients to misuse and harms of medications, including the development of antibiotic resistance. It also leads to the risk of a misdiagnosis and further complications. Measles, immune disorders and cancers, for example, that can present as a "rash", liver injury that can present as an "itch", appendicitis that can present as "reflux" or a heart attack that can present as "asthma". It requires the expertise training of a doctor to know the very lengthy differential for each "minor" symptom and have the knowledge of how to then clinically evaluate, diagnose and treat the patient. Pharmacists are not trained to do this.

In 2018, the World Health Organization (WHO) stated that "dangerously high levels of antibiotic resistance" in all parts of the world as "one of the biggest threats to global health, food security, and development today". Antibiotic resistance leads to higher medical costs, prolonged hospital stays and increased mortality. It is on the rise because of overuse and misuse of antibiotics in medicine and agriculture. The WHO has urged for a concerted effort from both governments and society as a whole to tackle this ongoing issue which poses a "global health security threat". Despite alarming bells from the WHO and Canadian medical bodies, the Ontario government has still taken no action to develop a robust action plan to tackle antibiotic resistance, and now tragically proposes steps to make it much worse.

Minister Elliott has also indicated that pharmacists may be granted the ability through legislation to administer vaccination under five years of age. This would be a grave mistake as family doctors and paediatricians do routine vaccinations for infants and toddlers at 2, 4, 6, 12, 15, 18 and 48 months of age concurrent with thorough well baby assessments and paediatric physical examinations to ensure a child is meeting developmental milestones, while also screening and counselling for common paediatric conditions and addressing parental concerns. Pharmacists are not trained to do this and these early paediatric visits are crucial to establish continuity of care and develop a life-long foundation of trust between a physician and young families.

Conflicts of Interest in Healthcare are Dangerous for Patients

Another area of great concern is conflict of interest. A major conflict of interest arises when a practitioner both prescribes and dispenses a medication to patients. This is reportable to the licensing and regulatory body of doctors, the College of Physicians and Surgeons of Ontario (CPSO). Similarly, the College of Ontario Pharmacists (COP) also clearly states in its mandatory "Code of Ethics" under "Accountability" that pharmacists must "avoid conflict of interest". The COP states that the ethical principle of Accountability (Fidelity) refers to the pharmacist's "fiduciary duty to be a responsible and faithful custodian of the public trust" by "ensuring that they act in the best interest of their patients and society", practice "only when competent to do so", "refrain from participating in unethical business practices" and "avoid conflict of interest". It is harmful to patients and unethical for pharmacists to both prescribe and dispense medication. The Ford government must never make exceptions for unethical practices and the big pharmaceutical industry; it is dangerous for patient safety.

Ontario Government is Selling a False Sense of "Convenience" while Ignoring Patient Outcomes

Minister Elliott claims that this is about "convenience for patients", but research already shows that the majority of patients are already able to see their family doctor within 1-2 days and doctors are also easily accessible at walk-in-clinics with evening and weekend hours. Minister Elliott also claims that this will help to ease pressure off of emergency rooms; however, there is no evidence for her assertion. In fact, there is a large body of evidence and scientific studies that have shown very clearly that patients who have continuity of care with their family doctor, have early disease detection, reduced disease morbidity, reduced emergency room visits, reduced hospitalizations and a longer life-span; all of which decreases healthcare costs.

Ontario Government's Doublespeak to Protect Its Vested Interests

Minister Elliott claims this is about "reducing red tape" for pharmacists, when in fact the Ontario government has done nothing but create more and more burdensome regulations and restrictions for Ontario physicians over the past few years with the passage of numerous draconian legislation. The Ontario government has violated basic and fundamental rights and freedoms of Ontario's doctors, including physicians' autonomy, privacy, freedom of conscience, right to a fair due process and right to the presumption of innocence. Instead, the Ontario government has empowered bureaucrats to access patients' private medical records, ration and restrict essential healthcare, and dictate provincial medical standards.

Ontario Government Failing to Fund, Train, Retain & Recruit an Adequate Supply of Physicians

Ontario ranks second last for doctors per capita amongst the wealthiest nations in the world. The Ontario government recklessly cut 50 medical residency training positions in recent years resulting in approximately 200 fewer doctors practicing in Ontario annually. Ontario has medical school graduates who are forced to leave the province each year to complete their residency training and practice elsewhere in Canada. Large international studies have found that providing access to care is not as important as access to quality healthcare; poor-quality care leads to increased morbidity and mortality. Having allied healthcare professionals try to fill in the gap of a physician shortage is not the answer. Ontario must solve the physician shortage with physician led healthcare. The Ford government has not restored cuts to medical residency training positions and is doing absolutely nothing to train, retain or recruit an adequate supply of physicians. The Ford government has also cut billions of dollars from the critical frontline patient care that doctors provide amidst the worst healthcare crisis in Ontario's history. All of these provincial policies and reckless cuts have been directed at reducing medical residency training positions, rationing and restricting patients' access to essential healthcare, making Ontario a toxic environment for physicians to practice and driving physicians out of the province. Ontarians must demand better or there will be a time in the near future when there are no doctors available at your and your family's time of most need.

Aggressive Pharmacist-Lobbying of the Ontario Government & Pharmacist Fraud

While Ontario's doctors are now into their eighth consecutive year of billions of dollars in deep cuts to the critical frontline patient care they provide, pharmacists have seen consistent increases in their renumeration under the Ontario Public Drug Programs over the past decade with no cuts. The Ministry of Health (MOH) pays pharmacists the highest dispensing fee in Canada. In 2017, the Ontario Auditor General's Report and value for money audit of public drug programs revealed that the pharmacists' MedsCheck program, implemented in 2007, enabling pharmacists to charge the MOH $60 to $150 for each patient medication review, had cost taxpayers over $550 Million and there was absolutely no clinical data on patient outcomes to objectively know if it had improved patient outcomes. In 2017, the MOH's Public Drug Program costed taxpayers $5.9 Billion with $83 Million to pharmacists for medication reviews and administration of the influenza vaccination. Oddly, the MOH pays pharmacists $10 per patient to administer influenza vaccination versus $4.50 to family doctors (and pennies for those doctors in team-based capitated-models). Of note, the MOH only pays family doctors $32.70 for a patient exam, assessment, diagnosis and treatment, and $21 for a minor assessment, both of which include a medication review; family doctors who practice in team based capitated-models are paid $3.15 to $4.90 per patient. These are OHIP payments from which 40-60% in overhead expenses are then deducted. None of these family doctor or specialist assessment fees have increased even one cent in the past 12 years despite years of billions in ongoing cuts and massive increases in physicians' overhead expenses, inflation and federal tax burdens.

The Office of the Ontario Integrity Commissioner's public lobbying records reveal that the Ontario Pharmacists Association is heavily lobbying to have legislation passed to allow pharmacists to act in the exact same capacity as family doctors, without equivalent training. The OPA is lobbying to have full prescribing rights and "redefine where pharmacists can provide direct patient care through, for example, the ability to set up independent consulting practices,.. to enable pharmacists to perform common point-of-care diagnostic blood tests,.. to enable pharmacies to dispense medical cannabis,.. to expand the MedsCheck program." It is deeply troubling and dangerous for patients when the right and privilege to practice medicine is granted through government legislation and not earned through graduation from medical school and residency training.

The Auditor General also found $9.1 Million in inappropriate pharmacy claims in 2016/17 with nearly $1 Million in claims made in the name of deceased patients in 2015/16. However, the Auditor General found that the Ministry not only failed to recover millions of dollars from pharmacies but had also failed to refer several potentially fraudulent pharmacy billings to the Ontario Provincial Police in a timely manner, ultimately not leading to any police investigations. In February 2019, an explosive Global News investigation had found pharmacy fraud was still rampant. Minister Elliott had said that she takes it "seriously" and that "action" was needed, but nothing has been done. In January 2019, a major undercover CBC Fifth Estate investigation had found some pharmacists were profiting millions of dollars from illegal kickbacks for generics from pharmaceutical companies. Such fraud will only be easier if the Ford government gives pharmacists unethical powers to both prescribe and dispense medications.

Are Your Private Medical Records Safe?

With the passage of Bill 74, the Ontario government has declared its intention to have patients' private medical records at its Ontario Health Teams on an Electronic Medical Records (EMR) system likely synchronized to specific pharmacy vendors. On February 5, 2019, the Ford government had launched its "Data Strategy Consultations" to use electronic data to "unlock economic opportunities". From the wording of the Ontario government's public release and website, it appears that it is planning to pass legislation this year to monetize and sell Ontarian's health data. This is very troubling given many investigations have already uncovered EMR companies secretly selling data from patients' private medical records. A Toronto Star investigation recently found that up to five million Ontarians are impacted because of EMR companies, such as IQVIA profiting from the sale of private health data. The Hamilton Spectator has also reported on Ontario physicians raising concerns over the big pharma's role in patient records whereby a clinical tool doctors' use to write prescriptions and care for patients is being secretly co-opted. Doctors fear that patients' private medical records are being tapped so big pharmaceutical companies can increase profits by taking market share away from its generic competitors.

The Pharmaceutical Industry's Cozy Relationship with the Ontario Government: Corporate Interests Above Patient Safety

The single largest cost in healthcare in Ontario and Canada is medications. The Ontario pharmaceutical industry has annual revenues of $38 Billion from pharmacies, hospitals, long-term care homes and the Ontario government via its provincial drug plans. Elections Ontario's public records show a strong flow of donations from the pharmaceutical industry to political parties and politicians. What is not being reported in the news or shared publicly by Minister Elliott is the aggressive lobbying efforts by the pharmaceutical industry, many of whom have their Canadian corporate headquarters in Mississauga, Ontario. While Minister Elliott and Premier Ford have refused to meet and consult with frontline doctors regarding Ontario's healthcare crisis, they have made ample time over the past six months to meet and engage with big pharma. On March 20, 2019, Minister Elliott held a large "Life Sciences Roundtable" in Toronto with the Minister of Economic Development, Todd Smith, and MPP for Streetsville-Mississauga, Nina Tangri. The Ontario Integrity Commissioner's public lobbying records reveal that in the subsequent month, the CEO, CFO, VPs and/or senior executive teams of major players in the pharma industry (from Loblaws which owns Shopper's Drug Mart and Accuro EMR to Merck Canada, Novartis, Pfizer Canada, Roche, Apotex, GlaxoSmithKline, Takeda and Innovative Medicines Canada, etc) have met with the Premier's Office and the Ministers of Health, Finance, Economic Development and Consumer Services, the Treasury Board Secretariat and many MPPs to "discuss practices and policies related to pharmacy", "drive policies aimed at improving patients' access to (their) medications and vaccines", "drive value for pharmaceuticals in Ontario", promote "cannabis industry", "promote the value of the pharmaceutical industry", have products listed on provincial drug "formulary and have publicly funded immunization programs" and "propose solutions for integrated health care". The Ford government has even officially made promotion of the pharmaceutical industry a primary pillar of its "Open For Business" campaign promising to give lucrative tax incentives and help companies drive sales.

The heavy corporate and lobbying interests at play are very concerning, especially given this government just passed Bill 74, erroneously named the People's Health Care Act, last week. The legislation was secretly created by Ford's bureaucrats, approved by Cabinet Council orders and then steamrolled through the legislature while refusing to consult with 98% of frontline doctors, nurses, healthcare workers and patients who wanted to provide input. This is the most massive overhaul of Ontario's healthcare system in 50 years.

The People of Ontario Must Speak Up Before It's Too Late

What is very clear is that Minister Elliott and Premier Ford are not making decisions that will help to address our province's historic healthcare crisis. Vested mega-corporate interests are being given priority over the needs of Ontario's vulnerable patients while the voices of frontline doctors are still being completely ignored. It is deeply troubling that hidden within the Ford government's April 2019 budget was its intention to make it nearly impossible for civilians to sue the Ontario government for wrongdoing; this would include the inability to sue the Ontario government for failing to provide patients with timely and quality medical care leading to increased complications and death. This is very dangerous and deeply troubling given the Ford government's ongoing billions in cuts to frontline patient care despite our province's growing and aging population. The People of Ontario must demand the Ontario government fulfill its legal obligation to fund, train, retain and recruit an adequate supply of physicians, and that it provide access to timely and high quality patient care that is free of all conflicts of interest.

More information can be found at www.CareNotCuts.ca, Twitter: @OnCall4ON, Storify: OnCall4ON, Instagram: OnCall4ON, and Facebook: We Are Your Ontario Doctors.

Last Updated: Wednesday, 24 April 2019 15:03:25 PM EST

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