BC College of Physicians changed Professional Standards, allowing addiction doctors to profit from drug testing industry

Picture of urine samples in bottles, with tiny urine bubbles.

The College of Physicians and Surgeons of British Columbia have changed their Practice Standards, allowing addiction physicians to have financial interests in the medical monitoring companies that their patients are required to attend.

This was revealed in a decision issued last month by the Health Professions Review Board of BC.

The Board was reviewing a decision that the College of Physicians made in response to a complaint I filed against three BC addiction physicians. I alleged that the physicians violated the College Standard on Conflict of Interest.

The physicians perform what are known as Independent Medical Exams (IME) on workers suspected of having some sort of issue with substance use. The assessment is usually requested by the workers employer.

After diagnosing a worker with substance use disorder, the physicians universally recommend medical monitoring, which becomes a condition of the workers continued employment. The physicians have financial interests in medical monitoring companies.

Medical Monitoring companies track a person’s adherence to a return to work contract which is based on the treatment and monitoring recommendations of the IME physicians.

Return to work contracts typically mandate total abstinence from psychoactive substances (including Opioid Agonist Therapies), drug testing, attending an inpatient rehabilitation centre (typically 12-step), and attending peer support meetings (typically 12-step).

If the worker does not follow every condition of the return to work contract or records a positive drug test, the monitoring company reports this to the persons employer and this can lead to job loss. Monitoring contracts are usually 2–5 years long and workers have to pay up to a thousand dollars a month to the monitoring companies.

According to Jonathan Chapnick, workplace lawyer and author of Test ’Em All: Drug Testing Law and Policy, and Beyond the Label, Rethinking Workplace Substance Use Policy, drug testing and medical monitoring does not do what it purports to do, which is to detect performance impairment in the workplace.

Rather than target any workplace problem, Chapnick says that drug testing and monitoring targets and discriminates against people with disabilities. (video at 25min 15sec)

Last year Rebecca Humberstone, a Registered Nurse and my fellow Board Member with the Workers for Ethical Substance Use Policy (WESUP) went public in a CBC article with allegations of conflict of interest against IME physicians in BC.

According to the CBC, the physicians that own Precision Medical Monitoring Company have a contract with Humberstone’s employer, Vancouver Island Health Authority (VIHA), to provide monitoring services for their employees.

VIHA would not pay for Humberstone’s monitoring unless she used the services of the monitoring company owned by the doctor that assessed her and recommended the monitoring.

I filed a complaint to the College against the three physicians profiled in the CBC article- Dr. Jennifer Melamed, Dr. Marie Durnin-Goodman and Dr. Robert Baker- alleging that they are violating the College Standard on Conflict of Interest and should not have financial interests in monitoring companies if they conduct IME’s that result in referrals to their monitoring companies.

In response to my complaint, all three physicians admitted their financial ties to monitoring companies and did not refute my allegations that some of their patients are required by their employers and insurance companies to use the services of the monitoring companies that they own. Dr. Melamed and Durnin-Goodman refused to provide the College with a copy of the Precision/VIHA contract.

In their defence, the physicians said they never directly refer their patients to their own companies, always disclose their conflict to their patients, and always inform their patients of other monitoring companies.

I argued that the College should have applied the findings and directions of the Review Board in a 2017 decision that addressed a similar situation. In that case, following two reviews, the Review Board ruled that two physicians with financial interests in monitoring companies were in a conflict of interest, and ordered the College to take action.

However, after that 2017 decision, the College made changes to their Professional Standards. They removed the word “patient” from their Standard on IME’s and replaced it with the term “examinee”.

The College concluded that because of the changes they made to the wording of their Standard, physicians conducting IME’s are not in a doctor-patient relationship and their obligation is to the third party that contracted the assessment, not to the “examinee”.

The College determined that because of the changes to their Standard, the reasoning behind the 2017 Review Board decision no longer applies and that the physicians I complained about did not violate the revised Conflict of Interest Standard. “Under the current IME Standard a (physician) is not required to recuse themselves when a conflict of interest arises but instead need only disclose possible conflicts with the examinee”.

I appealed the College’s decision to the Review Board. The Review Board concluded that based on the revised College Standards, the College investigation was adequate and their decision was reasonable. They confirmed the College decision.

The Review Board does not have the power to dictate what the College Standards should be.

Despite confirming the College’s decision, Review Board Chair John M. Orr expressed concerns:

“Both (College) Standards establish methods or procedures for managing the real or perceived conflict of interest but neither Standard requires physicians to decline to treat or monitor individuals whom they previously examined. Neither Standard prohibits an assessing physician from owning or operating a treatment or monitoring company to which examinees are referred…Individuals are most often referred to companies in which the physicians have or had financial interests…The College has taken the position in creating the current Standards that this real and perceived conflict can be mitigated simply by providing disclosure to the parties involved. Of course, as the complainant points out, such disclosure doesn’t assist the attendee who has little or no choice in the matter and disclosure does not remove the conflict.”

The Review Board’s criticism of the College Standards and the Review Board’s lack of power to address the College’s flawed Standards reflect broader problems with the self-regulation of health professionals in BC.

In 2019 Harry Cayton, the former Chief Executive of the U.K. Professional Standards Authority, investigated all 20 professional health colleges regulated under the BC Health Professions Act. In his report he concluded that health regulation in BC is too broken to be mended, and suggested the system needs an entire overhaul.