New scheme irks Nunavut pharmacists

Brooke Fulmer, the pharmacist at Cambridge Bay’s Kitnuna pharmacy, worries this pharmacy won’t exist a year from now if the Government of Nunavut forges ahead with a plan to revamp and outsource pharmacy services in the territory. (PHOTO BY JANE GEORGE)

CAMBRIDGE BAY — By this time next year, Cambridge Bay residents may have lost access to a local pharmacy to fill prescriptions or provide over-the-counter medications and personal care items.

That’s because the Government of Nunavut’s Department of Health and Social Services wants to adopt a costly plan to reorganize pharmaceutical services in the territory.

The new scheme would see all Nunavut health centre or hospital prescriptions handled remotely by pharmacists in Ottawa.

According to documents obtained by Nunatsiaq News, the GN would not renew contracts now held by Inuit birthright corporations in Rankin Inlet and Cambridge Bay.

This means that after next October a resident pharmacist will no longer fill prescriptions in Cambridge Bay.

“None of the stuff makes sense,” said Brooke Fulmer, a former director of pharmacy for the GN who now works at Cambridge Bay’s retail drug store.

The plan is “flawed,” Fulmer said, because it moves Nunavut further away from its goal of “care closer to home” and dilutes the quality of care.

What’s more, if the GN plan moves ahead in Cambridge Bay, the retail pharmacy there will disappear after Kitnuna’s current pharmaceutical contract expires next October, Fulmer predicts.

As a result, people will lose the kind of seamless care he offers to patients from the local hospital, located across the street.

“The GN plan is in fact a step backwards,” Fulmer said.

Fulmer now looks at each and every prescription himself before filling it, whereas far-away pharmacists won’t be available 24-7, leaving the issuance of medicine to less-qualified technicians.

“We live here. When a storm comes or the Internet goes down, we’re still here,” he said.

If the new plan goes ahead, Cambridge Bay residents would have to order prescriptions from Yellowknife, as they did before the community’s retail pharmacy opened four years ago, or order them from some new online pharmacy, and perhaps wait days for the order to arrive.

They’ll also be obliged to buy over-the-counter medications at local stores where they won’t find expert advice from a resident pharmacist.

Instead, a less-qualified pharmaceutical technician within the local health centre will consult by telephone or use the territory’s new e-health telecommunications network with a team based at the Ottawa General Hospital.

A January 2011 presentation prepared by Alana Froese, the GN’s current director of pharmacy, maintains that pharmacy services, furnished by the GN, would be more efficient and economical than services now provided by the two pharmacies owned by Kitikmeot Corp. and Sakku Investments Corp.

In Cambridge Bay, KC’s Kitnuna pharmacy handles all drug distribution in the Kitikmeot region, while Sakku’s pharmacy provides services and advice on medicines to the Kivalliq health centre.

The GN’s new plan would use “clinical pharmacists” who wouldn’t live in Nunavut but would be based at a “distant location” — Ottawa.

They would also use:

• an Iqaluit-based “territorial drug distribution supervisor;”

• three “pharmacy technicians” in Iqaluit;

• one pharmacy technician each in Rankin Inlet and Cambridge Bay.

All these workers would be linked “visually using tele-pharmacy equipment to communicate, support each other and check each other’s work.”

Their salaries would all be picked up by the GN.

The salary of the new drug supervisor, whose position is now posted, amounts to more than $100,000 a year, including northern benefits.

The job’s qualifications can be obtained by taking a one-year correspondence course. Qualified pharmacists are asking why this position will receive more pay than a registered nurse with a four-year degree.

It’s not clear either if the GN has enough network bandwith to support the level of videoconferencing and data transfer suggested in the plan.

But this long-distance plan, using GN-paid pharmacy techs and “remote” pharmaceutical advice is already in effect at the Qikiqtani Regional Hospital, since Iqaluit’s Valupharm decided to end its dealings with the GN late last year.

Due to the hefty salaries slated for the new GN bureaucrats, the scheme is likely to double the cash-strapped GN’s current cost of providing pharmaceutical services.

In 2006, the GN contracted each of the development corporations to provide pharmaceutical services for Rankin Inlet and Cambridge Bay at a cost of $100,000 along with another $125, 000 for warehousing and handling in Cambridge Bay.

The warehousing has since been phased out, but complete pharmacy services are delivered in Cambridge Bay, over and above what the original contract called for, while Rankin delivers only in-hospital consulting services.

The private-public partnership between Kitnuna, a Kitikmeot Corp. subsidiary, has worked well for nearly five years, saving money for the GN and providing a good service, Fulmer said.

“So why change it?” he asked, pointing to the delivery of pharmacy services as a perfect example of the GN’s Nunavummi Nangminiqaqtunik Ikajuuti policy, designed to encourage Inuit-owned businesses.

The GN’s new plan would also cut out Inuit-owned businesses out of a lucrative business opportunity, he said.

There could be new revenues for the territorial government in communities where no one — except the development corporations— wants to start a pharmacy, the GN’s new plan suggests, because the territory could offer its own online pharmacy.

And in Rankin Inlet, after Sakku’s pharmacy no longer plays a role, the North West Co. may step in to boost service at its drug store at the Northern — and the same could possibly occur also in Cambridge Bay.

The new plan also makes a distinction between the competence of retail pharmacists and hospital pharmacists.

Rankin Inlet and Cambridge Bay need a “clinical hospital pharmacist” in their hospitals, the GN plan states.

But Fulmer said all pharmacists are “clinical” and that it’s “ridiculous” to suggest otherwise.

Retail pharmacists are perfectly capable of delivering high quality professional services to the one or two inpatients at the mini-hospitals in Cambridge Bay and Rankin Inlet, he said.

The new plan also says that patients go to a health care facility to receive urgent drug treatment, but that people go to retail pharmacies for non-urgent treatments.

“Just too silly to warrant a comment,” said Fulmer about that idea.

He added that people who need to take medications like antibiotics, cardiac and hypertension medication don’t believe their treatments aren’t urgent or important.