Patient or Profit-Oriented Medicine?

"The patients knew they were being manipulated. They were being used as billing numbers. Pharmacy and medicine are separate ... and there's good reason for that. If the physician has a vested interest in the drugs, then obviously that will influence how he prescribes."
"It's a way of transferring the profitability of the pharmacy to the doctors." 
William Brown, pharmacist, Brantford, Ontario

 

Glenn Lowson / National Post     Bill Brown filed a complaint against Dr. Dhillon alleging that the doctor is pressuring and intimidating methadone patients to fill their prescriptions at the pharmacy in the building he owns

"[Some doctors deliver excellent service focusing on providing methadone treatment, while others are] set up just to roll patients through."
"It's a way to make a lot more money than their peers in family medicine do."
Dr. Philip Berger, medical director, Inner-City Health Program, St.Michael's Hospital, Toronto 

Canada has its share of drug addicts, and among them are people who have been prescribed opioids post-surgery, or for pain management by their physicians who may fail to adequately monitor their use of the drugs, leaving patients to become addicted. The fact is that Canada is facing an epidemic of prescription-opioid abuse. And that's additional to the heroin addicts for whom the use of methadone has become a way to wean them away from their deadly addiction.

Methadone treatment is prescribed as well for those patients who have become addicted to prescription drugs.

And, it would seem, as Dr. Berger of Toronto's St. Michael's Hospital remarked, that many doctors have abandoned their broad practise of medicine as a service to the public through a patient workload, and have decided instead to focus their medical diagnostic and health skills on methadone treatment for recovering addicts. Clearly this is done for distinct reasons; some medical practitioners may feel their profession requires doctors dedicated to aiding addicts shed their self-destructive habit.

While others, lured by simplifying their practise -- shifting it away from the grind of testing their diagnostic skills on a multitude of patients presenting with a wide range of symptoms, arranging protocols to help them recover health, and monitoring their progress -- have chosen a preferential single-focus practise, much in demand, and becoming singularly profitable. One of those profiteers is a doctor from Brantford, Ontario.

Dr. Jatinder Dhillon established a company in Brantford, Ontario, JRD Corp. specializing in methadone treatment for patient-addicts. He also established a pharmacy as part of his business model, and once he diagnosed a patient's needs, prescribed medication, he also steered them to procure their medication at the pharmacy he has sole interest in. It's a kind of profitable double-dipping, that is morally and ethically unsound.

A complaint was brought against Dr. Dhillon by pharmacist William Brown because of their shared history. Dr. Dhillon bought the building that Mr. Brown's pharmacy was located in, as a home for his business, and he presented Mr. Brown with a rental renewal that was significantly increased from what he had been paying; effectively evicting the pharmacy so he could set up his own, Hope Pharmacy. And then Dr. Dhillon's staff was directed to steer patients to Hope Pharmacy.

Colborne Street Clinic and Hope Pharmacy in Brantford on April 22, 2016.
Glenn Lowson / National Post

Ontario's College of Physicians and Surgeons examined the allegations of conflict-of-interest, then cleared Dr. Dhillon of any wrong-doing. This, despite there was evidence that Dr. Dhillon made use of intimidation, threats and gifts to encourage methadone patients to use the pharmacy linked with his clinic. The background of all of this is the booming multimillion-dollar industry represented by the needs of methadone patients.

Mr. Brown appealed that ruling. And presented new evidence; signed statements from patients and pharmacy workers, to have that ruling re-assessed. Mr. Brown noted that dozens of Dr. Dhillon's patients claimed to have been coerced to bring their prescriptions to Hope Pharmacy. The doctor threatened to cut off the doses of methadone he would permit patients to take home with them, rather than having to attend the clinic daily to have methadone administered at the clinic.

An appeal board of the Health Professions Appeal and Review Board is taking another look at the complaint and the circumstances. "He denied doing anything immoral or unethical", the ruling had stated. To further complicate things, an investigative journalist uncovered a study by five addictions experts suggesting that some patients are placed on methadone on an indiscriminate basis resulting from incentives for doctors to recruit additional patients in a lucrative business.

A number of physicians involved in this field of drug addiction remediation have been billing the Ontario government over $900,000 each yearly. The government had established a $150-million-a-year program to deal with the soaring numbers of addicted patients. An obvious allure to many professionals whose principles are somewhat compromised, to say the least. The appeal board cited charges that Dr. Dhillon emailed prescriptions automatically from his clinic to his associated Hope Pharmacy.

The charges, if proven to be true, would be "very serious and unethical, in particular considering the vulnerability of the methadone-patient population", stated the Ontario College of Physicians and Surgeons committee reviewing the original claims with the added evidence. According to the appeal board the college should have investigated the complaint more thoroughly to begin with. With the new evidence to consider it will approach the matter from a fuller perspective.