Discover more from The Orchard
Lab Testing, Brought to You By Loblaw
Friends of Medicare wants an investigation into private lab services offered at Shoppers Drug Mart.
Alberta Premier Danielle Smith admits that DynaLIFE’s private lab services haven’t been working out so well, but her solution — in accordance with her deep-seated libertarian views — is more privatization.
DynaLIFE Medical Labs, the private lab service provider the government contracted testing out to in late-2022, has been beset by long waits for results caused by staff shortages.
Smith said that if the testing backlog isn’t reduced soon she intends to “make other arrangements to be able to bring in additional personnel,” which sounds like further contracting out.
It just so happens that one of Canada’s largest corporations has recently opened clinics where patients can get certain lab services provided for a fee, apparently allowing them to jump the DynaLIFE queue if they can afford it.
Enter Shoppers Drug Mart, which boasts new “innovative” pharmacist-run medical clinics at five of its Alberta locations. So innovative are these clinics that patients can pay for certain lab services out of pocket, representing a significant escalation in health-care privatization.
It takes time and effort to produce stories like these. If you value my work and think I should be compensated for it, please consider a paid Orchard subscription starting at $5 a month.
These clinics offer cholesterol, blood sugar, strep throat, COVID and influenza testing. The only other province where Shoppers offers these services is Nova Scotia.
Premier Smith has long endorsed various forms of health-care privatization in Alberta, including having people pay out-of-pocket for certain services, for which the NDP hammered her in the 2023 election campaign to little avail.
The issues created by the privatization of lab services are being used to further their privatization and create new market opportunities. This allows companies like Loblaw — which owns Shoppers, Loblaw’s and Superstore, among other properties — to swoop in with their own money-making schemes.
Chris Gallaway, executive director of Friends of Medicare, told The Orchard that Shoppers appears to be “trying to normalize paying for tests.”
It’s unclear to him whether the tests are medically necessary, and Shoppers is allowing those with money to jump the DynaLIFE queue, or if Shoppers is upselling patients, which is a major concern wherever health care is privately delivered.
These questions ought to be answered through a public investigation, Gallaway said.
The first pharmacist-led clinic in Alberta was opened in June 2022 at the Superstore in Lethbridge as a pilot project.
As part of the pilot, Shoppers provided a $500,000 grant to the University of Alberta to evaluate it while at the same time providing a pipeline of pharmacy students to serve their placements at Shoppers. Naturally, U of A researchers came to the conclusion the program was great.
The company then opened four more in Alberta — in Fort Saskatchewan, Brooks, Red Deer and Edson — in December. Premier Smith attended the grand opening of the Brooks clinic, which is located in her Brooks-Medicine Hat riding, on December 9.
Gallaway said it would be understandable if Shoppers received a government contract to conduct testing in remote areas where hospitals aren’t open at all hours, but this is clearly not the case.
Shoppers health and wellness spokesperson Jemma Adamo was coy when The Orchard asked whether these services could be reimbursed by Alberta Health Services.
“Patients are not required to pay for the cost of clinic visits with our Pharmacists [sic] with a valid Alberta health card, however some services may result in additional fees [emphasis added],” Adamo told The Orchard in an email.
Curiously, she wasn’t asked whether patients would have to pay for a clinic visit.
The pharmacist-led clinics are being pitched explicitly as an alternative to issues plaguing the public health-care system, which has been the focus of all media coverage.
Adamo said these clinics are an example of the “innovation and collaboration” necessary “to overcome” the “complex issues” plaguing Canada’s health-care system.
This was echoed by local officials.
“We’re hearing from citizens all over the province that they can’t get in to see a doctor, the walk-in clinics are fully booked, go to emergency and they wait 10 hours. That’s not acceptable,” Fort Saskatchewan Mayor Gale Katchur told Global News upon the opening of a pharmacist clinic in the city northeast of Edmonton.
The fact that these clinics represent an entrenchment of health-care privatization has been entirely absent from public debate.
There’s nothing wrong with giving pharmacists increased responsibility in the health-care system, as long as their pay increases to reflect it.
But these pharmacist-led clinics are being used as a smokescreen to distract from “expanding the corporate reach into health care,” Gallaway noted.
“All these large corporations hide behind [expanding the] scope of practices, but really they're looking for ways they can make more money,” he said.
Lorian Hardcastle, a University of Calgary law professor who specializes in health law, told The Orchard that while the Canada Health Act requires primary care functions to be government-funded, there is a massive “gray area” of functions that can be provided for a fee if a doctor isn’t present.
“What we’re seeing across the country is private actors are finding gaps, finding gray areas, and filling those gaps with for-pay services,” Hardcastle explained. “These companies are very entrepreneurial.”
She said these private health-care companies likely prefer their services be government-funded, rather than paid out of pocket, which would allow them to see more patients.
This would eliminate the equity issue of queue jumping, but would raise issues of quality and costs of health care, as well as corporate welfare:
Pharmacists all of a sudden are doing these tests in vast, vast numbers and there's pressure from corporations to do so as a means of revenue generation, then we could see health-care costs being driven up and being driven up, lining the pockets of corporations.
Health-care privatization takes different configurations across the country, Hardcastle added.
While doctors can still bill the government when they see patients through the Telus Babylon health app in Alberta, in Ontario the costs of virtual services are increasingly being shouldered by patients themselves.
In both cases, Hardcastle said, the issue is one of corporate encroachment. It’s just a matter of whether profit margins are being subsidized by the government or patients themselves.
Shoppers and its parent company have engaged in intensive lobbying efforts to expand the scope of its pharmacists’ responsibilities.
In January 2023, Shoppers president Jeff Leger applauded Ontario’s government for allowing pharmacists across the province to assess and prescribe medications for 13 minor health issues in a news release that noted “there is no out of pocket charge for patients.” That caveat was absent from the Alberta announcements.
The policy change in Ontario came after a year of lobbying the Ministry of Health on Loblaw’s behalf by Laryssa Waler Hetmanczuk of GT and Company. Hetmanczuk worked as Premier Doug Ford’s executive director of communications from 2018 to 2020.
But Loblaw isn’t done lobbying the ministry, suggesting they’re looking for more than just pharmacists being able to prescribe medications.
As recently as June 9, the company used the services of Santis Health lobbyist Stephanie Gawur, who has “contributed to several Progressive Conservative leadership campaigns in Ontario,” according to her bio on the Santis website.
Unlike the lobbyist registry in Alberta, lobbyists in Ontario aren’t required to provide further details of the subject matter they discuss.
In B.C., Shoppers lobbied the Health Ministry in July 2022 through Parhar Investments & Consulting’s Moe Sihota, a former NDP MLA, about “[e]xpanding the Scope of prescriptions that may be filled directly by Pharmacists [sic].”
On May 31, Shoppers got its wish, with pharmacists given the ability to prescribe contraception and treatment for 21 minor ailments.
Since 2017, while Rachel Notley was premier, Loblaw has lobbied the province “to see how pharmacies can further be a benefit to the health care system” through the firm Hill + Knowlton.
The lobbyists on file for 2017 and 2018 are Natalie Sigalet, former premier Alison Redford’s chief of staff, and Kassandra Kitz, who went on to serve various roles in the UCP government.
Days into the pandemic, with the UCP in charge, pharmacists’ responsibilities were extended again to provide COVID assessments, opening the door to provide further testing services.
In June 2021, Loblaw began lobbying the government, including Alberta’s Health Ministry, through Wellington Advocacy CEO Nick Koolsbergen, Jason Kenney’s chief of staff and campaign manager when Kenney was Leader of Opposition.
By December, Alberta Health Services, which delivers health care, was added to Koolsbergen’s file.
The stated purpose of these meetings were to “share details and raise awareness on an ongoing basis of the services offered in Alberta by Shoppers Drug Mart and Loblaw Companies Limited.”
Koolsbergen met with the Alberta government for the same purpose as recently as March 2023, suggesting these five pharmacist-led clinics are just the beginning.
Adamo confirmed this intention, saying the company is “in the process of adding new clinic locations to help more Canadians access the healthcare [sic] services most important to them.”
Expect Shoppers, and other for-profit companies like it, to be permitted to take on increasing health-care functions in the future as the public system decays due to negligence.
Edited by Stephen Magusiak