Doctor fined $25 000 over Internet prescriptions
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* Pauline Comeau

*   © 2004 Canadian Medical Association or its licensors

The BC college's decision to levy its maximum fine against a doctor for countersigning prescriptions originally written by US doctors has again focused attention on the Internet pharmacy industry.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/171/6/560/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/171/6/560/F1)

Figure. **Cross border pharmacies “fail to meet [physician's] standard of care.”** Photo by: Canapress

Dr. Satnam Singh Gandham, a Richmond FP, admitted he was guilty of unprofessional conduct in countersigning prescriptions written by US doctors, without face-to-face patient contact. 

In July, the College of Physicians and Surgeons of BC fined Gandham $25 000, issued a formal reprimand and ordered him to pay $4000 in costs. According to the decision, “such a practice was contrary to the College's directive and failed to meet the standard of care required of a medical practitioner in BC.”

The $25 000 fine, the first of its kind in BC, is thought to be the largest yet levied against a Canadian doctor for such an offence. Since 2003, Manitoba's College of Physicians and Surgeons has fined 2 doctors $10 000 each for countersigning prescriptions. 

The Federation of Medical Regulatory Authorities of Canada stated in May that “Countersigning a prescription issued by another physician without direct patient contact is not an acceptable standard of medical practice.”

Last year, the Canadian Medical Protective Association decided not to cover physicians involved in US litigation as a result of signing or countersigning Internet prescriptions. 

David MacKay, head of the Canadian International Pharmacy Association, a lobby group for Internet pharmacy businesses, says the colleges over-dramatize what could go wrong given that the original prescriptions are written by licensed US physicians who have established “doctor–patient” relationships with the patients.

“The [BC] college ... is more concerned with liability and reflection on themselves than they are with the conduct of individual physicians,” MacKay said. 

“We have hundreds of physicians willing to engage in this process and each of them believes they are conducting themselves in a highly ethical manner and actually enhancing the continuum of care for the patient.” — *Pauline Comeau*, Ottawa