Dr. Sarah Jones review calls for ban on doctors picking up prescriptions
Review of prescription monitoring program also calls for a second medical consultant
A review of the questionable opioid prescribing practices over a six-year period by Dr. Sarah Jones has prompted a call to bar doctors from picking up and delivering prescriptions.
The probe was ordered by Nova Scotia Health Minister Leo Glavine, on the heels of the drug trafficking charges laid against Jones, a family physician in Upper Tantallon.
Jones has pleaded not guilty to all the charges against her.
The review of the Jones case and Nova Scotia's prescription monitoring program was carried out by the Michael G. DeGroote National Pain Centre at McMaster University in Hamilton, Ont.
'Low down, dirty trick'
In February, Bridgewater police accused Jones of trafficking 50,000 pills using false prescriptions written to a single patient, Merel Chase, between January 2014 to August 2015.
Chase told CBC News he had no knowledge of the alleged scheme and called it "a pretty low down, dirty trick."
The prescription monitoring program has been criticized for failing to act sooner on Jones's suspicious prescribing, which was picked up by its monitoring system. The program did not report her activity to police and the allegations came to light only after Chase was admitted to the hospital for an unrelated health problem.
'High likelihood of being diverted'
The report authors said it is "highly unusual" for a doctor to write prescriptions for a patient, and then pick them up for delivery.
They said that should trigger a warning by pharmacists if a doctor is ordering and picking up opioid pills for the patient as "controlled substances have a high likelihood of being diverted for personal use if an individual is involved in the process of ordering/dispensing/delivering of medications."
In fact, pharmacists flagged the practice twice. Once was in October 2010 — six years before Jones was charged — and concerns were raised again in March 2014.
The review said "banning that practice altogether" of physician-delivered medications would ensure it wouldn't happen again.
Medical consultant's work
The review authors also examined the actions of the monitoring program's medical consultant, Dr. Peter MacDougall. He knew about Jones's opioid practices as far back as 2010.
MacDougall's notes and recommendations, including telling her she "needed to stop" delivery opiods, were kept in a private notebook and not recorded in a centralized database for other prescription monitoring staff to access, said the review authors.
If staff had been able to read his file on Jones, "it is likely that the business support analyst would have escalated the case to other individuals, higher in the chain of command at an earlier time point," the review said.
The authors also noted Jones's sharply escalating prescriptions, from 600 tablets to 2,600 tablets. It goes against optimal pain management, and alternate medications should have been prescribed.
Prescription monitoring staff, including the business support analyst, were aware of the big jump in June 2012 and February 2014.
These cases were handled by the business support analyst and other data collecting staff. "Such cases should be sent to the medical consultant" who is up to date on current opioid prescribing recommendations and guidelines, the review said.
The report also recommends that "most importantly a second medical consultant" be hired to "provide a fresh perspective" on cases that have been flagged and reviewed by another medical consultant. The lack of a second set of eyes is a "systemic risk of having a key program dependent upon a single individual."
MacDougall is now the director of pain medicine at The Ottawa Hospital. He continues to be the Prescription Monitoring Program's medical consultant — a position he's held since 2007. He stopped providing services for the Nova Scotia Health Authority at the end of August.
Program will be strengthened, says Glavine
The health minister is not assigning blame for the failure to report Jones.
"There is no perfect monitoring system," said Glavine.
"When somebody sets out to defraud a system and [in] a well-orchestrated process, then I'm not sure if anyone or the process itself could've made the interventions that would've had a different outcome."
He said his goal is for Nova Scotia to have a "leading" drug monitoring program in Canada by implementing the recommendations. Glavine said he's also looking at whether funding to improve the program, or more oversight, are required.