Chemotherapy outsourcing done by hospitals across Canada

Hospitals in at least three provinces besides Ontario and New Brunswick outsource their chemotherapy preparation.

Newfoundland, Saskatchewan and B.C. buy prepared chemotherapy drugs

Hospitals in at least three provinces besides Ontario and New Brunswick outsource their chemotherapy preparation.

After about 1,200 people in New Brunswick and Ontario received lower-than-intended doses of the chemotherapy drugs cyclophosphamide and gemcitabine supplied by Mississauga, Ont.-based Marchese Health Solutions, the Ontario Hospital Association (OHA) surveyed its members about their reliance on external providers of pre-compounded intravenous medications, including those used for chemotherapy.

Federal and provincial governments are working to close a gap in oversight surrounding companies that prepare chemotherapy in bulk for hospitals. (CBC)

Newfoundland and Labrador, Saskatchewan and British Columbia contract out bulk preparation of chemotherapy drugs like cyclophosphamide to Baxter Canada. Manitoba and Nova Scotia said they prepare all chemotherapy in-house. 

There is no suggestion that Baxter is involved in any overdilution of drugs.

The OHA found nine of 88 hospitals who responded said they bought pre-compounded IV medications from Baxter. 

Hospitals in British Columbia buy cyclophosphamide and gemcitabine from Baxter, as does Saskatchewan's Cancer Agency. Eastern Health in Newfoundland and Labrador said it outsources bulk preparation of cyclophosphamide to Baxter Canada.

Health Canada says Baxter Canada is federally licensed for six drug activities:

  • Fabrication.
  • Packaging/labelling.
  • Testing.
  • Importing.
  • Distribution.
  • Wholesaling. 

Regulatory oversight of admixing — the bulk mixing of drugs for multiple patients in different locations without individual prescriptions — needs to be tightened, federal and provincial health officials say.

"In terms of the activities themselves, admixing is not listed … [in Baxter's licence]. That's something that was deemed to be under provincial jurisdiction," said Steve Outhouse, director of communications for federal Health Minister Leona Aglukkaq.

Health Canada has inspected Baxter for the areas that clearly fall under federal jurisdiction, Outhouse said.

"In terms of admixing, that's something that under the federal government's view had been a provincial responsibility so there was no inspections that would have happened for those activities."

Alison Drinkwater, director of public affairs for Baxter, did not immediately respond to requests for comment from CBC News.

"In 1986, Baxter opened Canada's first out-of-hospital admixture facility," the company's website reads. "Featuring state-of-the-art quality control processes and clean room technology, Baxter's Central Intravenous Admixture (CIVA) pharmacy service provides Canadian hospital pharmacists and healthcare professionals with sterile parenteral therapies in a wide array of compounded formulations with extended shelf-life. Baxter's CIVA Pharmacy Services provides a range of IV therapies."

"It's important to note that Baxter is an established Canadian drug manufacturer which has been and continues to be regulated by Health Canada, serving patients across the country," said Zita Astravas, press secretary to Ontario Health Minister Deb Matthews.

A survey released this week by the Ontario Hospital Association suggested that hospitals in the province also buy precompounded IV medications such as epidurals, narcotics and antibiotics from Baxter CIVA, Marchese, Galenova, Gentes & Bolduc and others.

During question period in Ontario's legislature on Wednesday, NDP health critic France Gélinas asked Matthews about how long the oversight gap has existed and how it "extends to some of the biggest players in the health-care system."

Matthews called it a problem that requires a national solution, adding the federal minister has acknowledged that.

Matthews said she's posted regulations directing hospitals to purchase only from accredited suppliers.

Ontario's College of Pharmacists is also developing a regulation to give them access to inspect premises where pharmacists and pharmacy technicians practice, including where drugs are prepared.

With files from CBC's Renée Pellerin, Tari Wilson and Kamala Rao