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Category "College of Physicians and Surgeons of BC"

26May

Daphne Bramham: Tougher new regulations promise more agony for chronic pain-sufferers

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One in five Canadians lives with chronic pain, but the cries of an estimated 800,000 British Columbians are not only being ignored, their suffering is being exacerbated by regulators limiting their access to both drugs and treatment.

First, in a move unprecedented in North America, the B.C. College of Physicians and Surgeons imposed mandatory opioid and narcotic prescription limits on doctors in 2016 in an attempt to avoid creating additional addicts and having more prescription drugs sold on the street.

Physicians who don’t comply can be fined up to $100,000 or have their licences revoked.

Now, the college is setting tough regulations for physicians administering pain-management injections.

“I’m enraged,” says Kate Mills, a 33-year-old, palliative care nurse who has been on disability leave for the past 18 months. “People like me are living in chronic, intractable pain and being ignored by doctors who are either too scared or too callous to care.”

She has an uncommon, congenital condition that causes chronic inflammation near her sacroiliac joint and in her lower back, which pushes down on her nerves causing “exquisite pain” down her leg.

Her first doctor essentially fired her, refusing to treat the pain. The next one prescribed Oxycodone to help Mills through until she was able to receive a steroid injection at a clinic, which kept the pain in check for several months.

But by the time the injection’s effects were wearing off, her GP went on extended medical leave. The locum assigned to Mills refused to prescribe her any medication and told her to go to an emergency room where she was given a prescription.

After numerous ER visits, Mills finally found a doctor two weeks ago who is willing to provide medication for her between injections. But he agreed only after Mills signed a contract agreeing that she won’t sell the drugs, will only go to one pharmacy and take the drugs only as prescribed.

She is lucky, though. Her pain management clinic will likely meet the college’s new standards that were developed by an advisory panel over the past three years out of concern about patient safety.

“Increasingly,” the college says on its website, “Procedural pain management is being provided in private clinics and physician offices, but without much guidance on appropriate credentials, settings, techniques and equipment.”

The new regulations would require physicians’ offices or clinics to become accredited facilities with standards on par with ambulatory surgery centres.

That means having tens of thousands of dollars’ worth of equipment including resuscitation carts, high-resolution ultrasound, automated external defibrillators and electronic cardiograms with printout capability.

The college acknowledges that “patients do not require continuous ECG monitoring. However, the cardiac monitoring equipment must be available in the event a patient has an unintended reaction to the procedure.”

The disruption for patients will be huge, according to Dr. Helene Bertrand, a general practitioner, pain researcher and clinical instructor at UBC’s medical school.

She estimates that up to 80 per cent of the offices and clinics where the injections are currently being done won’t measure up and already wait times are up to 18 months.

When the new requirements come into force, Bertrand predicts patients will be waiting anywhere from four to seven years for treatment.

Bertrand herself will have to quit doing prolotherapy, which she has done for the past 18 years on everything from shoulders to necks to spine to ankles. That’s despite the fact she’s never been sued, never had a complaint filed with the college and has published, peer-reviewed research that revealed an 89 per cent success rate among 211 patients in her study group.

(Prolotherapy involves injecting a sugar solution close to injured or painful joints causing inflammation. That inflammation increases the blood supply and deposits collagen on tendons and ligaments helping to repair them.)

The college will not grandfather general practitioners already doing injection therapies. Instead it will restrict general practitioners to knees, ankles and shoulders. All other joint injections must be done by anesthetists or pain specialists.

For Joan Bellamy, that’s a huge step backward.

She’s suffered from chronic pain since 1983 and “undergone the gamut of medical approaches, often with excessive waits: hospital OP (outpatient), pharmacology, neurology, orthopedics, spinal, physiatry and private.”

Since 2000, she’s had multiple injections that have made a difference. But her doctor doesn’t meet the new qualifications.

“I am afraid that without her expertise … that pain will become an intolerable burden, and any search for treatment will result in inconceivable wait times and will debilitate me,” Bellamy wrote in a letter to the college and copied to me.

The near future for pain-sufferers looks grim with most physicians able to offer them little more than over-the-counter painkillers.

Ironically at a time when the provincial medical health officer and others are lobbying hard to have all drugs legalized so that addicts have access to a safe supply, chronic pain-sufferers are being marginalized. For them, it’s more difficult than ever to get what they need.

It’s forcing many of them facing a lifetime of exquisite and unbearable pain to at least contemplate one of two deadly choices: Buy potentially fentanyl-laced street drugs; or worse, ask for medically assisted dying.

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28Feb

Daphne Bramham: First Nations’ solution to a modern, medical crisis

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Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”


Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /

PNG

“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.


The Crosstown Clinic in downtown Vancouver.

JONATHAN HAYWARD /

THE CANADIAN PRESS

“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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29Jan

Overbilling Vancouver physician faces discipline hearing

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The medical office of Dr. Viem Chung Nguyen at 1209 Kingsway in Vancouver.


PNG

A Vancouver doctor who was ordered to repay $2 million related to medical service over-billings now faces a disciplinary hearing for refusing to answer questions from the College of Physicians and Surgeons of B.C.

Nguyen has been summoned to the college discipline committee meeting Feb. 12. The purpose of the hearing is to inquire into his “conduct or fitness to practise medicine in B.C.”

He is charged with failing to respond to multiple communications and correspondence from the college. But when there are serious findings by the Medical Services Commission about irregular, or even fraudulent, billing by doctors, as there was in 2017, the case often ends up back at the college for an investigation into the doctor’s ethical and professional conduct.

Nguyen graduated from the University of Montreal medical school in 2002. He specializes in physical and rehabilitation medicine, otherwise known as physiatry. Such doctors — there are three dozen in B.C. — have a broad range of knowledge about the musculoskeletal, neurological, rheumatological and cardiovascular systems.

Outpatient physiatrists (those working in communities as opposed to in hospitals) would see patients with orthopedic injuries, spine-related pain and dysfunction, occupational injuries and overuse syndromes, and chronic pain, for example.

Kristy Anderson, a spokeswoman for the Ministry of Health said Nguyen can’t bill the Medical Services Plan until he is eligible to re-enroll after May 31 of this year. Strangely, Nguyen’s medical receptionist told a reporter over the phone that an appointment could be booked after a doctor’s referral and that he doesn’t charge patients directly; a B.C. Services Card (formerly known as the CareCard) can be used, she said.

Although the government insists that doctors should never bill patients directly for medically necessary services, Nguyen can do so during the temporary de-enrolment.

“During this time, Dr. Nguyen can practise medicine; it is only the college of physicians and surgeons that can remove that right. But he cannot bill to the Medical Services Plan,” Anderson said.

Susan Prins, spokeswoman for the college, said that as a specialist in physical medicine and rehabilitation, “it is reasonable that a major part of his work might be privately funded, independent medical exams, but I can’t confirm that’s the case.”

Neither of the officials could answer why the receptionist told a reporter posing as a prospective patient that a visit would be publicly funded.

It’s unclear if Nguyen has paid back the $2 million he agreed to repay after an audit found a large number of billing irregularities. The government refuses to divulge such information. 

“Due to privacy restrictions under the Freedom of Information and Protection of Privacy Act, the ministry is unable to release any third-party financial information or personal details,” said Anderson. 

“If an individual fails to pay an amount assessed by the audit, they are referred to the Ministry of Finance to pursue collection action as outlined in the Financial Administration Act or the governing statutes,” she added. 

Last year, the commission issued a report that said an onsite audit found poor documentation of Nguyen’s patient records and “for several patients, there was no evidence that Dr. Nguyen ever provided any care to that patient.” 

According to the latest commission report, the government body was able to recover about $8 million in 2017-18 from 18 audited doctors who were deemed to have over-billed in recent years.

There are about 11,000 doctors in B.C.

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Twitter: @MedicineMatters

Appeal court rejects bid by first doctor ever thrown out of B.C. Medical Services Plan

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23Jan

Fake ‘Dr. Lip Job’ gets suspended sentence for posing as a physician

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Justice Nitya Iyer.


Vancouver Sun

A woman who forged a medical licence so she could buy pharmaceuticals like Botox to then inject into duped customers has been given a 30-day suspended sentence and two years’ probation in B.C. Supreme Court.

Rajdeep Kaur Khakh’s digressions included contempt of court and passing herself off as a doctor so she could inject Botox into facial wrinkles and filler material into lips or other facial areas. Only licensed and trained doctors, dentists, registered nurses (or nurse practitioners) under the supervision of doctors, and naturopaths are allowed to perform such procedures under Health Professions Act regulations and Ministry of Health scopes of practice.

Khakh, who couldn’t be reached for comment, was cited for contempt in March 2018; she signed a consent order at the time prohibiting her from “practising medicine.” But last July, the College of Physicians and Surgeons of B.C. learned Khakh was up to her old tricks administering dermal fillers “numerous times at a location in Vancouver.”

The college has been trying to stop Khakh from posing as a doctor for more than three years but each time the college got promises from her to stop, she would continue to do it. For a time, she marketed her services under the Instagram handle “DrLipJob.” She also marketed herself as Dr. Rajii or Dr. R.K., when she injected customers in their homes, cars and other locations.

Although Khakh avoided jail, college spokeswoman Susan Prins expressed satisfaction with the sentence.

“The college … believes that the judge’s reasons will accomplish the task of getting Ms. Khakh to obey and respect court orders in future, and deter other unlicensed practitioners from engaging in unlawful practice. In her comments, Madame Justice (Nitya) Iyer sent a very serious message to Ms. Khakh about breaching consent orders and emphasized the critical public-protection role that regulators fulfil.”

Last November, the college filed a petition with the court in which it sought to have Khakh fined for contempt and/or jailed. Under the current sentence by Iyer, she will have to serve a 30-day jail term if she breaches any of the terms. Khakh must report to a probation supervisor once a week and must also pay a $5,000 fine. Of that amount, $300 is going to go to a former customer who was a witness for the college.

The college first learned of Khakh in 2015 when pharmaceutical companies informed it that she owed $164,000 for products that were advanced on credit. At the time, Khakh was providing services at a spa in Surrey and using a forged medical licence.

“It is certainly the only instance of forging medical credentials to further one’s unlawful practice that I know of,” said the college’s chief legal counsel, Graeme Keirstead.

According to an affidavit filed in court by the college, the forged licence was found on a photocopier at the Clearbrook public library by an employee who notified the college. The name “Dr. Rajdeep Kaur Khakh” was substituted for the original name on the certificate and the expiry date of the licence had been altered.

“Upon review, the document appeared to be a copy of a genuine, but expired, (licence),” Keirstead said, adding that the identification number on the certificate belonged to a practising physician who was registered with the college.

Khakh had previously told a reporter that she went to medical school at the University of Punjab but failed licensing exams.

The college went to great lengths to investigate Khakh, using a security company multiple times for undercover investigations and also going to the spa with a cease-and-desist letter.

The college pursued another similar case, but in that situation a patient got a serious infection after having surgery with a fake doctor in her home-based clinic. A public health warning was issued.

Patients of Khakh’s have complained about their results, but there don’t appear to be any serious adverse events reported.

The college said this in a statement: “Receiving a medical service such as injections from an unlicensed practitioner is risky and has the potential for complications, including reaction to agents, infections or greater harm due to human error. There is no assurance that the practitioner is competent or qualified to provide treatment or that the material and equipment used are safe.”

Prins said unlicensed individuals aren’t accountable to any regulatory body, “which means the public has nowhere to turn if the service or treatment they receive results in complications. We can’t emphasize enough how important it is for patients to check the credentials of the health practitioner they are planning to see to ensure they are licensed and registered with a health regulatory authority (college), and that they have the necessary credentials to perform the procedure.”

Physician credentials can be verified by looking at the directory on the college’s website at cpsbc.ca.

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