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John Lehmann/The Globe and Mail

Child's death becomes lightning rod

Regulations for naturopaths vary widely across Canada – and few have faced disciplinary sanctions, reports Wendy Stueck

It was an echinacea tincture, bought by worried parents for an ailing child at a naturopathic clinic in Lethbridge.

But that product, called Blast and taken home by the parents of little Ezekiel Stephan, became a symbol of much more. The trial of the parents, David and Collett Stephan, revolved around parental responsibility. It also became a lightning rod for debate about alternative medicine, triggering a barrage of mostly negative coverage that focused on the dubious science behind some naturopathic treatments.

And the case triggered an investigation by the College of Naturopathic Doctors of Alberta of naturopath Tracey Tannis after 43 medical doctors signed a letter of complaint to the college alleging – based on testimony during the trial – that she failed to meet the standard of care.

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Typically, such an investigation would remain confidential unless and until it resulted in disciplinary action. It became public after the letter of complaint, and the college's response, were released to the media.

It is not known whether that complaint will result in any sanctions against Dr. Tannis. Under Alberta's Health Professions Act, the status of complaints or investigations is confidential until the matter is referred to a hearing. And reviewing a complaint "may take several months to years," depending on the complexity of the complaint and the length of the investigation, CNDA assistant registrar Kristen Tanaka told The Globe and Mail.

David Stephan, left, and Collet Stephan speak to supporters after arriving at the courthouse with their children in Lethbridge, Alta., on Friday, June 24.

David Stephan, left, and Collet Stephan speak to supporters after arriving at the courthouse with their children in Lethbridge, Alta., on Friday, June 24.

Jeff McIntosh/THE CANADIAN PRESS

Relatively few naturopaths in Canada have faced disciplinary sanctions.

Manitoba, where naturopaths have been regulated since 1946, has had no disciplinary proceedings, and the registrar for the Manitoba Naturopathic Association – the province is moving to a self-regulating college for naturopaths – "respectfully declined any comment" on whether the association has received complaints in recent years.

Naturopaths in Alberta have been regulated for nearly four years, and the self-regulating college has received a small number of complaints, but none have been referred to a public hearing, meaning they remain confidential, a process in line with other self-regulating professions.

British Columbia, which has had a college since 2000, has the most extensive regulatory track record, and has sanctioned several registrants with fines and temporary suspensions.

Last October, the college suspended naturopath Jonas LaForge for a year for several infractions, including providing cash-only Botox services in and around the Lower Mainland, and providing Skype consultations to marijuana dispensaries.

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Dr. LaForge also failed to disclose to the college that he had a criminal record in the United States, the college said in a public notification.

In April, however, Dr. LaForge's photograph and professional qualifications were listed prominently on the web site of The Coliseum Medical Spa, a West Vancouver business that advertises naturopathic services including "cleansing and detoxing" and vitamin injections.

The web site was revised after inquiries from The Globe and a recent CBC story that included details of Dr. LaForge's suspension and criminal record in the United States.

As well, an advertisement in a May supplement to the North Shore News included "anti-aging with Dr. LaForge ND."

Asked about the web site and the advertisement, Dr. LaForge said the web site entry was an oversight and that he was unaware of the advertisement until learning of it from The Globe.

"I am currently under suspension," he said in a telephone interview. "I am not practising as a naturopathic doctor."

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Naturopaths by numbers

A look at the regulatory landscape in Canada

British Columbia

Regulation: under provincial legislation since 1936. Brought under B.C.’s Health Professions Act and college created in 2000

Registered practitioners: 485

Discipline: Over the past three years: 70 investigations. Of those, 21 resolved by consent order; 22 through “other appropriate action”; 21 discontinued after registrant was found to have met the standard of care; three closed because of insufficient evidence; three ongoing. No formal discipline hearings over the same time period. Under provincial legislation, hearings are not required if the college can address concerns through other means, such as a consent order. Such orders can include fines, suspensions and conditions

Saskatchewan

Regulation: under provincial legislation since 1954. College to be formed under the Naturopathic Medicine Act, which was passed in 2015 but is not yet in force

Registered practitioners: 40

Discipline: Over past two years: three investigations. Of those, two were found to involve no misconduct; one is ongoing. One formal disciplinary action since regulation began in 1954

Alberta

Regulation: under the Health Professions Act, with a self-regulating college, since July 25, 2012. Previously unregulated

Registered practitioners: 254

Discipline: Over past two years: four complaints. None resulted in a hearing or disciplinary action. An investigation of naturopath Tracey Tannis – which became public after a letter of complaint and the college’s response to that letter were released to the media – is ongoing. Typically, subjects of complaints are not identified unless, and until, an investigation results in disciplinary action

Manitoba

Regulation: under provincial legislation since 1946. One of 22 health professions expected to be brought under Manitoba’s Regulated Health Professions Act, umbrella legislation that took effect in 2014

Registered practitioners: 36

Discipline: None

Ontario

Regulation: regulated since 1925. Brought under the Regulated Health Professions Act and college created in 2015

Registered practitioners: 1,290

Discipline: From July, 2015, to May 31, 2016: 11 new complaints, plus eight inherited from the former regulatory body. Seventeen registrar investigations, of which 15 are still in progress. Two referrals for discipline, one of which has been resolved and one in progress

The College of Naturopathic Physicians of B.C. would not say whether the advertisement or the online information violated the terms of Dr. LaForge's suspension.

"Because of the confidentiality requirements in the [B.C.] Health Professions Act, the College cannot confirm or deny the existence of an investigation regarding this matter," Sarah Pivnick, the college's manager of investigation and regulatory compliance, said in an e-mail.

Naturopathic practitioners and colleges point out that they operate under the same rules that govern other health professionals, including doctors, dentists and pharmacists.

They argue the low number of regulatory hearings is unsurprising. Naturopaths number in the dozens or hundreds, compared with thousands of nurses, doctors and pharmacists. And the type of care they provide, such as dietary advice, is typically less risky than, say, extracting a tooth or a tumour.

But the death of a child has pushed naturopathic medicine into the spotlight, and with it, the question of whether the current regulatory regime does enough to protect the public.

"I am absolutely appalled that, in four years, the [College of Naturopathic Doctors of Alberta] has not required even a single naturopath to undergo discipline of any kind," says Michelle Cohen, an Ontario general physician who spearheaded the complaint to the CNDA stemming from the Stephan trial.

CNDA president Beverly Huang said all complaints received by the college have been handled in accordance with Alberta's Health Professions Act. The act includes provisions for confidential settlements through an alternative complaint-resolution process.

A sense of security

Dr. Tannis was thrust into the spotlight because of her interactions with the Stephan family. According to a June 8 finding of fact by Justice Rodney Jerke of the Court of Queen's Bench of Alberta, the couple obtained an echinacea tincture for Ezekiel – who by then was too stiff to sit in his car seat – at a naturopathic clinic in Lethbridge in March, 2012, after the boy had been sick for days with symptoms that included a fever.

The trial heard conflicting evidence about whether Dr. Tannis had actually met Ms. Stephan before Ms. Stephan left the clinic with the echinacea tincture.

And the judge zeroed in on March 12, 2012 – the day before Ms. Stephan visited the naturopath – as the time when the Stephans failed in their duty to their son by not taking him to a doctor.

The parents were sentenced on Friday, David Stephan to four months in jail and Ms. Stephan to three months of house arrest. Both are to be on probation for two years after completing their sentences.

The case raised concerns about the naturopathic doctor's own practice and about broader regulatory issues in Alberta and elsewhere in Canada.

"If patients are drawn to buying treatments from a clinic rather than a health food store, it is because they have a greater sense of security in doing so," the 43 medical doctors said in their letter of complaint to the CNDA.

"That security comes with an attendant responsibility on the part of the clinic."

The concern echoes critics' complaints that regulating naturopathy opens the door to suspect and potentially harmful treatment, including homeopathy, a naturopathic mainstay that involves using massively diluted solutions and has been debunked in studies.

Even some naturopathic doctors do not use homeopathy.

Chris Spooner is among them. The licenced naturopathic doctor and CNPBC board member does not use homeopathy in his practice in Vernon, B.C. As a self-described science-based practitioner, he said he cannot "wrap my head around it." He has been dismayed by recent media coverage of naturopathy, saying it has overlooked regulatory and educational developments and the distinction between licenced naturopathic doctors and unregulated practitioners.

"There's no doubt there is a changing of the guard happening. … We recognize there is a need for evidence," he said.

Dr. Spooner – under provincial legislation in B.C. and other provinces, naturopathic physicians are allowed to use that title – is among practitioners pushing boundaries between conventional and alternative medicine. He works with agencies such as the Ottawa Integrative Cancer Centre, one of a growing number of centres across the country melding different health-care disciplines, including naturopathy and traditional Chinese medicine.

Sometimes those disciplines and outlooks collide: the University of Alberta in June withdrew a workshop billed as spoon-bending and the power of the mind for doctors after a public outcry. The workshop was to have been offered through the university's Complementary and Alternative Research and Education Program, or CARE.

A similar outcry erupted last year over a University of Toronto researcher's plans to conduct a randomized, double blind, placebo-controlled study – the gold standard in clinical research – of homeopathic treatment for children with attention deficit hyperactivity disorder.

Regulating for the future

Critics view such incidents as part of a worrying slide by governments and universities away from evidence-based regimes. And as more Canadian naturopaths come under the umbrella of regulated health professions, there are questions from the medical community about the long-term impact.

Naturopathic physicians maintain they can help people live healthier lives and avoid chronic pain and disease – which implies savings to the health-care system. Skeptics say there is little proof of that.

"Is this really how the government proposes to bring down disease rates – by giving people sugar and water pills?" said Lloyd Oppel, an emergency medicine doctor and a member of Doctors of B.C.'s Council on Health Economics and Policy. "Because they [government] have told the public that a profession that does so is a bona fide health profession."

Dr. Heidi Rootes (left) demonstrates what she describes as Vancouver's first mobile therapy lounge, IV vitamins.

Dr. Heidi Rootes (left) demonstrates what she describes as Vancouver’s first mobile therapy lounge, IV vitamins.

John Lehmann/The Globe and Mail

Heidi Rootes, a naturopathic doctor in Vancouver, defends the existing regulatory regime, saying it requires practitioners to have a specified level of education and includes a clear scope of practice.

"And part of our continuing education is our jurisprudence and what we can and can't do," she said. "There's no excuse for saying, 'I didn't know.' You're responsible to know."

Dr. Rootes, who, like Dr. Spooner, does not practice homeopathy, runs a vitamin injection and wellness boutique in the Yaletown neighbourhood.

The clinic is outfitted with plush massage chairs, soothing purple walls and private treatment rooms with big-screen televisions.

The clinic, opened two years ago, proved so popular that Dr. Rootes and her partner recently launched a mobile service, which they run out of a refurbished ambulance that has been painted purple and decked out with the company's logo.

Some people seek vitamin treatments to boost their energy or get over a hangover. Others may be battling an illness, such as cancer, and see vitamin injections as a way to help immune systems weakened by chemotherapy or radiation.

In all of those instances, Dr. Rootes tells patients to disclose and discuss any complementary treatment they are getting with their other physicians.

She maintains she has seen patients' health improve from vitamin treatments and that the public is well-served by the existing regulatory system, saying licenced naturopaths can work with conventional medical practitioners to enhance patient health.

"If I have a broken leg, I'm not going to go to a naturopath, I'm going to go to the emergency room," she said.

Tracey Tremayne-Lloyd, a Toronto-based health lawyer, believes the number of complaints and disciplinary sanctions related to naturopaths will increase.

"As [naturopaths] have become regulated health professionals, they will be subject to the same type of scrutiny as nurses and doctors and dentists and pharmacists," she says. "People know where to send their complaints…they'll look up the college and they'll start bringing scrutiny to [practitioners]."

Investigative timelines for health colleges are "extremely variable" and a year or more to resolve complaints is not unusual, she said.

With a report from The Canadian Press

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