When Health Minister Sarah Hoffman recently cancelled further funding to a primary care clinic operated by Pure North, a controversial private health foundation, she cited concerns about potential overlap between the foundation's alternative health initiatives and the clinic's primary care service.
But Hoffman's rationale baffles University of Alberta law professor Erin Nelson.
Nelson, a specialist in health law, said the grant agreement between Alberta Health and Pure North is so vague it essentially allowed the foundation's nurse-practitioner-led clinic, Precision Health, to offer any treatments it chose, including alternative treatments.
"The agreement itself doesn't appear to limit what kinds of services nurse practitioners could offer," she said.
Nelson said she was also surprised by the ministry's repeated claims that the operations of Pure North and Precision Health were entirely separate. The agreement clearly shows the Precision Health clinic was to be an extension of Pure North's wellness clinic, housed in the same office in downtown Calgary, she said.
Unproven health treatments
Opposition MLAs and the Friends of Medicare say Hoffman should have never provided funding to Pure North and they say the ministry clearly failed to properly monitor the foundation's clinic.
Hoffman has refused repeated interview requests from CBC News. Neither her press secretary, Tim Wilson, nor the ministry's spokesperson, Cameron Traynor, will answer specific questions.
Pure North is the private, non-profit health foundation of multimillionaire philanthropist and outspoken vitamin D advocate Allan Markin. The foundation offers unproven alternative-health treatments, including high doses of vitamin D, chelation therapy, and the removal of mercury-amalgam dental fillings.
In October 2016, Pure North was one of four community groups that received pilot-project funding from Alberta Health to operate nurse-practitioner-led clinics designed to treat high-needs patients such as inner-city residents and low-income seniors. Pure North was to get $4.2 million over three years.
On Tuesday, Hoffman announced she was ending the funding after CBC News revealed the clinic had twice prescribed a 74-year-old patient vitamin D in single doses of 50,000 international units — more than 12 times Health Canada's tolerable upper intake level.
According to the grant agreement, Pure North had already received roughly $925,000. It was to receive up to a $1.65-million instalment of the total $4.2-million grant around June 30. A ministry spokesperson said the money was not paid out.
For months, Hoffman and her officials repeatedly told CBC News the ministry funding for the Precision Health clinic would be "at risk" if it offered any of the foundation's controversial alternative treatments, such as high-dose supplements.
The minister's press secretary, Tim Wilson, even said the ministry had recently considered revising the grant agreement to make Alberta Health's position even more clear. Wilson said ministry lawyers concluded no revisions were needed because the agreement was categorical.
"If Pure North uses the funding for anything other than those services listed (in the grant agreement) which includes insured, primary care services, and activities which support the delivery of those services, the minister may terminate the grant agreement," Wilson wrote in a May email to CBC News.
Grant agreement allowed alternative treatments: lawyer
Nelson however, said the agreement was not categorical. And she said the section Wilson referenced, which was part of Pure North's proposal, only gives a list of health-care services that Precision Health will "include," like laboratory tests, drug prescriptions, and "therapeutic interventions."
Using a word like "include" opened the door for the Precision Health clinic to offer additional treatments not mentioned in the agreement.
"That kind of language is not the kind of language that lawyers would use to limit or restrict," Nelson said.
"What they signal when they use a word like 'include' is that these things will be, or must be, offered. But it doesn't limit the possibility that other things or the potential for other things to also be included."
Despite the ambiguity, the ministry would be able to cancel the funding using a clause of the agreement that states Alberta Health or Pure North could terminate it "without cause or reason" with a month's notice.
Pure North spokesperson Stephen Carter told CBC News it will not, at this time, contest the minister's decision.
"Given the very real chill placed upon [nurse] practitioners' rights, it is likely best we are in no way associated with this government," Carter said in an email.
In June, Carter initially denied — three times — that the Precision Health clinic offered any supplements. But when told CBC News had proof a patient had been prescribed vitamin D, Carter said providing supplements like high-dose vitamin D is within the scope of the clinic's nurse practitioners.
He also said Pure North doesn't provide any instructions to Precision Health nurse practitioners about the services they choose to provide to their patients. The foundation has repeatedly said vitamin D at high doses is safe and is not an alternative treatment.
Ministry claimed clinic was separate from Pure North program
Despite the apparent disconnect between the ministry's and Pure North's interpretation of the agreement, both have repeatedly stressed one key point: the Precision Health clinic is completely separate from Pure North's wellness program.
Alberta Health associate deputy minister Andre Tremblay told the legislature's public accounts committee in May there was "no relationship" between the two. Nelson called Tremblay's statement "surprising."
She said the agreement makes it clear "the intention is for the nurse-practitioner project to be integrated into, or incorporated into, an existing wellness clinic."
"That to me doesn't suggest a lot of distinction or separation," Nelson said.
Carter insisted Pure North and Precision Health were entirely separate despite admitting to a laundry list of ways in which they were connected.
Precision Health treats Pure North clients and, in fact, the foundation used its client list to recruit patients for the clinic. Carter also said Pure North paid for "many" vitamin D blood tests for Precision Health patients.
Although Precision Health operated from within the same office as Pure North, and served many of the same patients, Carter stressed they have separate staff and finances, as well as separate electronic medical records systems.
Liberal MLA Dr. David Swann dismisses any suggestion Pure North and Precision Health operated independently.
"There is nothing in the grant agreement that suggests they're separate," Swann said.
"In fact, every indication (in the agreement) is that they're completely connected and the nurse practitioners are involved with whatever program Pure North is involved in, as well as other ancillary health services that the patient might need," he said.
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