EXCLUSIVE: AHS pressured health care providers to refer prescriptions for sick patients to Shoppers Drug Mart.

Beginning in 2021, Alberta Health Services managers have pressured health professionals at two Edmonton mental health clinics to transfer their patients’ prescriptions to Shoppers Drug Mart, the Progress Report has learned.

Consumer entrepreneurs have taken on a growing role in these clinics, which three current and former health workers at the clinics said The report has damaged their relationships with patients, creating at least one shortage of work for a pharmacist employed by AHS and advancing the privatization of public health care in Alberta.

Health professionals, who worked at the center 108th St. Clinic Addictions and Mental Health Services and nearby Forensic Analysis Clinic and Community Services (FACS). they have been given pseudonyms to protect them from being paid by experts.

FACS and clinics 108 St. Photo by Duncan Kinney.

The source issued a Progress Report on April 9, 2021, an invitation to the staff of the 108th St. clinic, which announced that Shoppers “has a contract with AHS as a primary chemical service provider. ” for that clinic.

This contract is not publicly available, and no clinic staff has seen it.

“There was no communication with any of us about how or why this happened from AHS,” said Avery, a health professional who works at the 108th St. clinic.

“I don’t know if there was an application process or anything. Why is this pharmacy over the other? I think it’s a step towards privatization, trying to put it into the public system and make it difficult to get it out.”

The partnership, the memo announced, was scheduled to begin on May 3, 2021, but the “soft flow” began on April 6 – three days before clinic staff were notified of any changes.

Prescriptions still had to be filled at the 108 St. clinic, they would only be filled by the customer, not an AHS pharmacist, which the memo said would help AHS nurses “spend more time with their clients. ”

In order to do so, the nurses had to get the consent of the patients to pass on their orders to the Traders.

Chris, a former health worker at 108th St., said that depending on the nature of the clinic’s patients, getting their consent to transfer a prescription to a private company is mandatory. .

“We have vulnerable patients, very mentally ill clients,” they said, adding that some clients have been ordered by the court to go to the clinic and pick up their prescriptions, which include expensive antipsychotic injections.

“They’re often confused about this, saying, ‘What is this? Am I in trouble? Do I have to do this?’ I’ve had several patients tell me that they were asked to sign something, and they didn’t even know what it was, but they signed it because they felt scared, they felt they are scared,” said Chris.

Many clients at the clinic at 108 St. they have a legal obligation to take these medicines because of the Community Treatment Orders and the Mental Health Act.

Shoppers franchisees, given full access to the clinic, including desks across from the pharmacy, placed consent forms with the Shoppers logo on each prescription box containing elastic band to remind nurses to obtain permission to fill a prescription by. Customers.

The growing popularity of Shoppers Pharmacists led management to transfer the 108th St. clinical pharmacist. at another clinic, where they brought their specialized knowledge and patient relationships that Shoppers staff needed.

“I’ve worked all over North America,” said Chris, “and I’ve never seen this happen, where a pharmacy went into a publicly funded clinic and the expectation was that patients would be referred. at the pharmacy.”

An anonymous spokesperson for Loblaw, which owns Shoppers, declined to answer questions about any contracts with AHS.

“These agreements are produced by Alberta Health Services and all questions should be directed to them,” they wrote.

The report provided AHS spokesman James Wood with copies of emails to staff at the 108 St. clinic. and a referral consent form. Wood said he would “look into the matter,” but did not respond by deadline, nor did he respond to a follow-up email.

The Ministry of Health did not respond to a request for comment.

Customer engagement is more than just filling orders

Referrals became a precursor to deeper integration of Clients into the AHS clinic. Retailers were invited to Friday staff meetings to “promote their services,” according to an April email.

“Not every client’s needs will fit their services but many can benefit and may look to connect our clients to these services along with the next steps,” the email said. you continued.

Avery identified one of these services as drug testing. In February, the CBC reported that Ontario grocery stores were facing business pressure to order unnecessary drug tests in order to charge the government more than $75 per call through its MedChecks program.

In Alberta, pharmacists can bill the government $60 for a routine medication administration test and $20 for tracking.

Progress Report received another email from management, dated Nov. 10. 2023, which announced that patients will now be able to give verbal consent for their orders to be transferred.

Shoppers nurses, the email added, will now be able to provide non-specialist Hepatitis C treatment, including screening, diagnosis, treatment and post-treatment. The email stated that, in addition to prescribing vaccinations, Shoppers nurses are able to administer vaccinations.

“We want to make the most of this partnership, so please check your bags for customers who may be eligible for this service,” the email urged clinic staff.

In the past year, the referral process has “settled,” according to Avery, who attributes this to pushback from AHS staff.

Push back and push back on FACS

Forensic Analysis Clinic and Community Services (FACS).located on 106th St., also in downtown Edmonton, provides mental health care services to people who are court-ordered to seek treatment and are considered to be at moderate to high risk of to make a mistake again, including those who are considered “not responsible for the crime.” court. There is a legal obligation for these clients to receive treatment at this center.

In April 2024, management also sought to pressure employees to transfer their patients’ orders to Customers, using similar methods to those employed at the 108th St. clinic. in 2021.

“One day, we walked in and saw there were those consent forms” stuck in the prescription boxes, said Drew, a FACS health care specialist.

According to Drew, an employee at Shoppers “was filling out our patients’ names, filling out the medications, and he wanted us to sign it, basically he had the patient sign to hand over the prescription. doctor to the Consumers.”

“As far as I was taught at school, it is a crime. We cannot recommend drugs to patients,” they added.

This is very compelling to work with vulnerable people who are legally required to go to the clinic and take any medication they are prescribed. “They’ll sign anything you put under their noses,” said Drew.

After several months of staff refusing to discuss referrals with their patients, combined with a change in management, nurses are no longer being explicitly asked to transfer referrals to clients, Drew said. .

“We just said it is completely against nursing ethics to advocate for pharmacies and make a profit for another pharmacist who is not part of the care team,” they said.

Breaking the patient’s trust

Lorian Hardcastle, a health law expert at the University of Calgary, told Progress Report that it is common for health professionals to recommend a particular pharmacy to patients if the patient asks and the doctor knows k’ a chemical containing a specific patient’s medication. in stock.

“Those kinds of ad hoc discussions are one thing,” Hardcastle said. “But in this case, they are sending patients to this pharmacy as a matter of policy … without any kind of discussion with patients about their needs.”

He also said it was “disruptive” for patients with complex mental health needs, who may have built up a trusting relationship with their AHS pharmacist, to be told they need to give a prescription to a pharmacist. new to access their medical records.

“In order to get the right medical care, you need to trust the provider you’re seeing to want to share your information with them,” Hardcastle said. “These are patients who have medical information that they may not want to share with consumers.”

AHS often contracts with private companies to provide certain services in its clinics and hospitals, whether it is contracting for laundry services or dealing with pharmaceutical companies to supply medicines.

“Sometimes there are good reasons for certain types of arrangements to be in place, even in the commercial sector,” Hardcastle said. “You have to buy services from someone else.”

What makes this arrangement between AHS and Shoppers “strange” and “problematic,” according to Hardcastle, is that there appears to be no “paperwork” to it.

“This is not AHS buying services from Consumers. It’s an informal, open partnership,” he said.

“There is no transparency, accountability and the ability to check these arrangements if they happen in an informal way, so I think that if this is going to be the norm, there should be information, it should be made public. is available, and AHS should review it regularly,” Hardcastle said.