An Edmonton fertility doctor who worked out of the Regional Fertility and Women’s Endocrinology Clinic at the Royal Alexandra Hospital has written a letter to his patients advising them of actions that “contravened (his) professional obligations.”
In an April 2021 letter, Dr. Tarek Motan said he made a deal with pharmaceutical companies to get rebates on certain fertility drugs.
“Between August 2015 and November 2017, while I was working at the fertility clinic, I had entered into a financial rebate arrangement with three pharmaceutical companies,” Motan’s letter reads.
“I paid for fertility drugs such as Gonal-f, Puregon and Menopur, from these pharmaceutical companies without obtaining proper authorization and approval from AHS or my regulatory college.
“In return, I received monetary rebate from these companies that I placed into an account which I administered for education. The drugs were shipped to, dispensed and sold to patients that attended the Glengarry Pharmacy.”
The same letter was sent to Global News by several Alberta patients.
Global News has reached out to Motan for further comment. This article will be updated if he responds.
“Patients that attended at the RAH fertility clinic were advised to purchased their drugs at Glengarry Pharmacy,” the letter continues. “You may have been one of those patients. As part of the arrangement, a portion of the rebate monies was paid to Glengarry Pharmacy.
“This all occurred without me seeking or obtaining approval from the College of Physicians and Surgeons of Alberta. As well, I did not inform AHS, my patients or clinic staff at the fertility clinic about the rebates I received or the arrangements I entered into with Glengarry Pharmacy.
“My actions contravened my professional obligations.”
A manager of Glengarry Pharmacy told Global News on Monday it has “no comment” on the letter.
Lauren, 33, from Edmonton, was a patient of Motan’s at the RAH fertility clinic from 2015 to 2017. She did four intrauterine inseminations (IUI), one egg retrieval and one transfer. Global News has agreed to only use a pseudonym to protect the privacy of her health information.
She received the letter from AHS and Motan on Friday.
“(There’s) a lot of anger and frustration. Some people were lucky enough to have their fertility treatments work but a lot of us weren’t.
“You kind of wonder: I was completely overstimulated. Personally, I was put on the maximum amount of drugs, so you kind of wonder — through that time of having a physically and emotionally hard time because you’re on a high level of hormones — if that affected your outcomes,” she said.
“If you are already (hormonally) imbalanced and then you’re put on the maximum amount of hormones, it definitely affects you in terms of depression and anxiety. A lot of women get ovarian hyper-stimulation syndrome. You’re pumped with all these drugs and your ovaries are so full it’s possible they can twist and contort and rupture.
“Some women still have hormonal changes from that.”
Lauren says she feels taken advantage of by both the doctor and the pharmacy.
“It’s definitely difficult because you’re already in a desperate and vulnerable situation… You put your trust in people who you think have your best interest at heart.
“It’s really unfortunate.”
Lauren said she and her husband were lucky to have some medical coverage. Still, after maxing out both their coverages, they still paid about $5,000 out of pocket for the treatments.
“Fertility drugs are extremely expensive and a lot of them aren’t covered. For IUI, it’s not as expensive, but for one round of IVF you could be paying $8,000 to $10,000 in fertility medication.
“When you’re on the higher does it’s a lot more expensive and you’re going through the medication faster,” she added. “I was also stimulated for the maximum amount of days.”
After three different clinics and six years, Lauren is now pregnant.
“I wonder if it could have happened a lot sooner,” she said. “It’s nice to kind of bring some light to this.
“I hope something gets done and there are some repercussions because a lot of women were affected. It’s too bad.”
An AHS spokesperson stressed “action has been and continues to be taken” on the incident.
Kerry Williamson said: “patient care and safety is our priority at Alberta Health Services.
“AHS agreed to facilitate the mail out of the letter to patients, on behalf of the physician, to ensure all patients that may have been affected, are notified. Patients and others that want to make a complaint about a physician can do that through the College of Physicians and Surgeons of Alberta.
“We can offer no further comment or specifics about this matter,” Williamson said.
Motan’s letter explained that he also would overprescribed certain drugs “on occasion.”
“In my practice at the fertility clinic, since 2014 I, on occasion, prescribed high doses of fertility medications to patients which, in my judgment, improved the chance of a successful outcome. This may have put some patients at increased risk of experiencing adverse effects including ovarian hyperstimulation syndrome.
“I acknowledge that I advised some of my patients that it was beneficial to start at high doses of some fertility medication based on my professional judgment because I had more successes with this technique decreasing the number of IVF cycles needed.
“That approach was contrary to the medication product literature that recommended that doses be individualized for each patient and that patients be started on lower doses,” the letter said.
“In addition, the higher doses meant that patients also experienced higher cost and prescribing the higher doses of some of the drugs resulted in higher rebate accounts.”
The regulatory body, the College of Physicians and Surgeons of Alberta, sent Global News a statement.
“Overprescribing medication and profiting from those prescriptions contravenes CPSA’s Standards of Practice and the CMA Code of Ethics and Professionalism. Although we cannot speak to specifics of this situation due to Health Professions Act legislation, CPSA is responsible for processing complaints using the options available under the legislation.”
The Alberta College of Pharmacy (ACP) told Global News it received a complaint in 2019 “about the professional conduct of the licensee and owner of Glengarry Pharmacy in relation to the practices of a member of the AHS medical staff, who was later identified as Dr. Tarek Motan.”
The college launched an investigation into the conduct of the pharmacist involved and how Glengarry Pharmacy was operating. The investigated ended in January 2020.
“The pharmacist involved acknowledged their conduct in the matter and ACP required changes in the pharmacist’s conduct and in the operation of the pharmacy to ensure that the public is protected,” said Barry Strader, communications director for the college.
“ACP’s Standards of Practice for Pharmacists and Pharmacy Technicians require a pharmacist to assess the appropriateness of each prescription, taking into consideration the needs of the individual patient.”
“It’s important that pharmacists maintain awareness of the power imbalances that can exist between healthcare providers and patients and ensure their sensitivities to these imbalances to prevent potential conflicts of interest. This may be important to support the autonomy and objectivity of the pharmacist in assessing appropriate therapy.”
In the letter, Motan apologizes to patients for his “lack of transparency.”
“To help answer any questions you may have upon receiving this letter, a call line is available through Health Link. To reach this call line in Canada and in the US, please dial 1-877-266-8893. Calls will be answered by an information specialist who can help you with your questions or concerns,” Motan writes.
— With files from Su-Ling Goh, Global News
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