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“How will we refill our prescriptions now?”

Outside Charles Duncan's medical practice, in Fonthill. VOICE PHOTO

 

In less than a month, pharmacists will no longer honour some prescriptions —or refills—written by Charles Duncan

BY DAVE BURKET
The VOICE

Since news broke that Fonthill family practitioner Dr. Charles Duncan would surrender his medical license effective October 31, in the face of investigations over professional misconduct, several of his patients have contacted the Voice with various concerns, including whether their existing pharmaceutical prescriptions would continue to be valid following Duncan’s departure.

The answer is yes, and no.

The Voice sought clarification from the Ontario College of Pharmacists (OCP), and each of the three pharmacies serving Pelham—Boggio’s, Shoppers Drug Mart, and PharmaChoice.

It turns out that there is a large gray area regarding prescriptions written by a doctor who subsequently is no longer licensed.

“Generally speaking, in a case where a physician’s registration is no longer active,” says OCP spokesperson Maria Babbage, “a new prescription is valid if it was written before the date that their registration status changed. Refills are not valid after that point.”

Both the college and each local pharmacist, however, emphasized their duty of care toward patients currently taking medications—stressing that, in most instances, pharmacists may elect to continue filling urgent prescriptions, but only for up to six months.

To do so, however, they may be required to take on liability that formerly fell on Duncan’s shoulders.

“We do it for short periods when physicians are away, or appointments get moved or delayed,” says PharmaChoice pharmacist Glen Sisak. “In most cases, the patient benefit-risk ratio would be in favour of continuing the medication. The pharmacists must document their rationale, and the guiding principle is patient safety and continuity of care.”

Sisak, who has been a practicing pharmacist in Niagara for 30 years, cautions, however, that neither he nor any pharmacist may continue to dispense narcotics, controlled drugs, or benzodiazepines (such as Valium, Xanax, Ativan, and the like) for any period of time once a doctor’s license is no longer valid.

Shoppers Drug Mart pharmacist Frank Sicoli agrees that a new prescription written before the date of Duncan’s resignation will be valid, but any refills would not.

“I have been in the community for 25 years,” says Sicoli, “and certainly will be helping in any way I can, but the patient has to work with me in trying to find a physician.”

That’s because for many medications, ongoing blood or other tests are required to monitor their effectiveness. Absent such test results, pharmacists would effectively be flying blind.

“Pharmacists are unable to order repeat lab work themselves,” says Aaron Boggio, of Boggio Fonthill Pharmacy. “Therefore if the values are outdated, the patient will likely require lab work and follow-up from a physician sooner than later.”

Boggio says his pharmacy group belongs to Clinical Connect, a database containing medical information, including test results, from acute care hospitals and other sources. (However, it does not appear to include test results from Alpha Labs or LifeLabs.)

Boggio says that in some scenarios, leaving a patient without the medication would cause more harm than deciding to renew it. In others, renewing that medication without follow-up would cause more harm to the patient than stopping it for a short period.

Glen Sisak agrees.

“I think most pharmacists would be inclined to do it to treat blood pressure, diabetes, thyroid, and so on,” he says.

In such cases, pharmacists are “renewing” a given prescription, and it is the pharmacist’s name—not Duncan’s—that goes on the bottle.

Again, this temporary measure is permitted for no longer that six months. After that, the patient must obtain a new prescription from a new doctor, walk-in clinic, or hospital emergency room.

For a pharmacist to temporarily renew a prescription, he or she must obtain the patient’s “informed consent” to do so.

Sisak cites an example.

“As a scenario, a patient comes in who has been stabilized on a blood pressure medication for a number of years. The pharmacist may ask how he’s tolerating the drug—any new side effects? May ask to see his blood pressure log book, or take a reading in the store, to ensure the blood pressure is still under control.”

Sisak says that once safety and efficacy are established, the pharmacist may decide to renew the medication for a short period of time.

On the other hand, he says, there are clear cases when such decisions are best made by a doctor.

“Another patient may come in, requesting a renewal of their statin cholesterol medication. During discussion with the patient, the pharmacist observes yellowing of the skin and eyes. The patient can’t remember when he last had blood work. The pharmacist may decide that it is in the patient’s interest to seek medical attention for laboratory work prior to renewing the prescription. The potential harm from possible liver toxicity may outweigh the benefit of continuing the drug.”

Decisions to renew are made by individual pharmacists—not store policy—meaning that different decisions might come down depending on which pharmacist a patient sees in stores with more than one.

Fees may also vary.

Both Boggio’s and PharmaChoice provide renewals at no charge.

Frank Sicoli, at Shoppers Drug Mart, says, “There may be a professional fee associated with the professional service of extending the prescription.”

 

RELATED: Facing sexual assault allegations, Fonthill doctor quits

 

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