Be cautious when prescribing to Americans, doctors warned
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Should more Canadian doctors be helping American patients buy cheaper drugs in Canada? The College of Physicians and Surgeons of Ontario and Canadian Medical Protective Association (CMPA) have both issued warnings on the topic. Dr. John Carlisle, the college's deputy registrar, says that under Canadian law it is improper for a physician to write a new prescription or countersign one without taking appropriate steps to reach a diagnosis, formulate a treatment plan, provide the necessary information and obtain consent. “What may, on the surface, seem like a simple transaction (“just sign here”) with a favourable financial incentive for you can go sour if civil litigation or a regulatory complaint occurs,” Carlisle wrote in a recent issue of the college's *Members' Dialogue*. He says care provided to visiting Americans “should meet the same high standards as that provided for our citizens.”

Meanwhile, the CMPA warns that a Canadian physician who is sued in the US over a service provided in Canada will not be eligible for the association's help if the service provided was solicited through advertising or other means. Coverage will be provided if the suit is launched in Canada.

Dr. Adam Newman, who helped write prescriptions for a busload of American patients who came to Kingston, Ont., last October, didn't seek legal advice before meeting them. Instead, he had them sign a waiver that had been drawn up for the Medical Reform Group by a lawyer. “The CMPA says it won't defend doctors who are sued in the US,” says Newman, “so the waiver says that if anyone brings action against me, they have to do it in Canada.”

He says the most common prescriptions he wrote were for ACE inhibitors and calcium-channel blockers. “The patients had either a letter from their physician detailing their conditions or they brought their prescriptions with them,” he said. “The experience was entirely different from what I'm used to. For one thing, I feel a bit of a failure if I have a patient taking 9 different medications. As for seeing them, I made clear that I wasn't trying to be their family doctor. I simply told them, ‘This is what your doctor says you can take.’ “