Woman accused of forging doctor's prescriptions went undetected for over a year

A 40-year-old woman working as a surgical office assistant for a well-known Winnipeg plastic surgeon is accused of forging prescriptions for Percocet between Dec. 6, 2012, and Dec. 16, 2013.

Percocet is a form of oxycodone, a pill commonly trafficked on the street. According to court records, the accused was giving the fake prescriptions to her son to fill and sell.

Their actions went undetected for over a year despite increased checks and balances by the provincial government to better monitor controlled substances.

A Wal-Mart spokesperson tells CBC News the woman was eventually caught after one of its pharmacists noticed something wasn't right.

In Manitoba, pharmacists are required to input new prescriptions into a provincewide computer database called the Drug Programs Information Network (DPIN). It gives pharmacists a real-time view of what drugs a patient is on and can alert them to potential abuse.

"MY/MZ are codes that need to be responded to because that means they've gotten those drugs or similar drugs in the same class, that do the same thing at other pharmacies," said Nadine Small Denbrok, a pharmacist in Winnipeg.

Small Denbrok has been a pharmacist for nearly 20 years and currently works at a Main Street methadone clinic that treats 170 people struggling with prescription opiate addictions.

She said even with the increased government oversight, doctors are still writing duplicate prescriptions that many pharmacists continue to fill without question.

"There's rarely a prescription that goes through that doesn't have those codes, so it's like, well, how much monitoring are they actually doing if I'm getting those codes on every single prescription I fill when I'm working in this area?" Small Denbrok explained.

Changes made to act

In 2012, then-health minister Theresa Oswald said the government had made changes to the Prescription Drugs Cost Assistance Act to strengthen monitoring and improve prescribing practices for narcotics and other controlled drugs.

They included establishing a new category of drugs called "monitored drugs" and working with regulatory bodies, such as the College of Physicians and Surgeons of Manitoba and the College of Pharmacists of Manitoba, to monitor prescribing practices.

In 2014, the government created the Manitoba Monitored Drugs Review Committee (MMDRC), an advisory committee of experts that looks for trends and patterns in doctors' prescribing habits and pharmacists' dispensing methods that could lead to inappropriate use.

But it appears that cases of misuse continue to slip through the cracks.

CBC News obtained the pharmaceutical record of a patient that we're told is either abusing prescription drugs or more likely trafficking them.

The same doctor wrote him nearly eight months' worth of prescriptions for controlled substances commonly sold on the street.

He filled them at two different pharmacies within 90 days, even though there would have been multiple warning codes flagging the pharmacist that similar drugs had already been dispensed.

Patricia Caetanto, executive director of the Provincial Drug Program, says the system in place is designed to catch cases like that and refer the doctors and pharmacists in question to their respective colleges for further investigation — and, if necessary, disciplinary action.

"They determine through those reports who's prescribing appropriately and potentially inappropriately, and then those respective colleges do their work to educate or investigate whether or not those rates are acceptable." Caetanto said.

Colleges aim to educate, not discipline

In the last year, MMDRC has referred 13 doctors with questionable behaviour to the College of Physicians and Surgeons. None were formally disciplined.

The College of Pharmacy received three complaints and it has completed two of the investigations; it is still working on the third. A spokesperson told CBC News no formal charges have been laid in either case.

"We've heard a few things, we've heard that physicians feel pressured by their patients that they need to prescribe what the patient is asking for. and in that case that's where the prescriber assistance education program will help." said Caetano. 

The registrar of the College of Physicians and Surgeons, Dr. Anna Ziomek, said where possible, colleges will try to better educate doctors instead of discipline them.

"I think as physicians, we are not trained to suspect that somebody is trying to pull the wool over your eyes and get a prescription from you," she said.

"We're trained to believe patients, to empathize with them, but at the end of the line we have a responsibility around making sure that we are using reasonable guidelines and standards to treat patients," Ziomek added.

Ziomek said years ago, the province had looked at setting up a DPIN terminal in every doctor's office, but after a review on the topic it found that it would be incredibly expensive to do.

"Ideally if one were to design a system that would be very helpful, [it] would be having a DPIN terminal in everybody's office so that before I hand you that prescription for morphine, I can look and see if you've had any prescriptions for any other narcotic or benzodiazepines [a form of tranquilizer] or how many other prescribers are you seeing, how many pharmacies are you filling your prescriptions in," Ziomek explained.

Small Denbrok says if the province wants to see fewer prescription drugs being trafficked on the streets, it must ensure that the colleges do more to hold doctors and pharmacists who break the rules to account.

"It's frustrating just because I went into the profession to help people and, I mean, to me it's never going to go away, but … there's pharmacists and doctors out there who are just OK with it," she said.