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Canada Ontario health minister examining lack of oversight at private IV infusion clinics

Ontario’s health minister is looking into the lack of formal oversight at private clinics that administer intravenous medications, but she will not commit to requiring the facilities to be licensed and inspected.

Christine Elliott said on Monday that the Progressive Conservatives are open to re-evaluating the governance of private infusion clinics as part of a larger, ongoing review of health-care strategy.

Immediate action, however, is not on the table.

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“Right now, I know that [private infusion clinics] are being operated by qualified medical professionals, so I don’t have any concern about that. I think it’s just the overall operation of the clinics that we are taking a look at,” Ms. Elliott said.

The Globe and Mail reported on Monday that Cancer Care Ontario and the Ministry of Health and Long-Term Care warned in separate briefing notes last year that the lack of oversight at private infusion clinics could pose health risks to patients.

The briefing notes, obtained through a freedom-of-information request, say that without formal licensing, there is no guarantee that medications will be stored and prepared properly, or that physicians will be at the private clinics when they need to be.

However, the documents do not mention any incidents in which patients were harmed at private infusion clinics, which administer IV prescription drugs for conditions such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis and, in some cases, cancer.

Four private infusion-clinic operators – Innomar, Bayshore, McKesson and Provis – all told The Globe their own high standards ensure the facilities are safe, clean and staffed by registered nurses and doctors who are overseen by their own self-regulatory colleges.

But France Gélinas, health critic for the Ontario NDP, called it “appalling” that the government continued to allow private infusion clinics to operate in a regulatory void. “There has to be transparency, there has to be accountability. And right now, none of that exists,” she said. “It’s just a time bomb before something goes drastically wrong.”

Ms. Gélinas said there is no excuse for delaying action, especially considering that Bonnie Lysyk, the province’s Auditor-General, also raised concerns about the lack of oversight at private infusion clinics in her annual report last year.

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“[Cancer Care Ontario] requires facilities providing cancer drug therapy to have an on-site emergency department, but this requirement does not apply to private specialty clinics, because they are not regulated by the ministry or CCO,” the Auditor-General wrote in a chapter on cancer treatment services. “In addition, there is no legal requirement that private specialty clinics use oncologists or nurses specialized in oncology to provide care. ... No other provinces regulate private health clinics in their jurisdictions either."

Although chemotherapy is usually delivered in hospitals, patients with private insurance or deep pockets can get access to cancer drugs that Health Canada has approved but the Ontario Health Insurance Plan (OHIP) does not cover.

The Auditor-General recommended that Cancer Care Ontario consider setting standards and overseeing chemotherapy at private infusion clinics. She also suggested the clinics be added to an inspection program run by the College of Physicians and Surgeons of Ontario.

Right now, the doctors' regulator inspects only out-of-hospital facilities that perform procedures under anesthesia, such as endoscopy clinics and cosmetic surgery centres.

More than 350 private clinics provide intravenous medications across Canada. Third-party specialty pharmacy companies operate the centres, which are financed by the pharmaceutical companies that make IV medications.

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