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Private Cancer Clinic Owners Threaten to Sue Whistleblowers

Five Alberta doctors alleged conflict of interest, first reported by The Tyee. Each has now received a cease-and-desist letter.

Charles Rusnell 12 Feb 2024The Tyee

Charles Rusnell is an independent investigative reporter based in Edmonton.

The owners of a privately owned Edmonton cancer care clinic are threatening to sue a group of doctors who filed a whistleblower complaint against an Alberta Health Services administrator, who is a minority share owner of the clinic.

The Canadian Cancer Care or CCC clinic issued a cease-and-desist letter to five whistleblower doctors after The Tyee obtained the confidential complaint and published conflict of interest allegations made against AHS official Dr. Daniel O’Connell.

Based on the complaint, O’Connell has been the subject of an internal AHS investigation since November 2022. Despite this, in December 2023, AHS appointed O’Connell, an ear, nose and throat or ENT surgeon, as permanent head of the ENT section in Edmonton.

O’Connell has declined interview requests. The allegations against him are unproven.

In an interview, surgeon Dr. Raiyan Chowdhury and oncologist Dr. Brock Debenham, two of the CCC clinic founders, said they issued the threatening letter to stop the spread of what they said was “misinformation” about the clinic.

They said the complaint, and subsequent media exposure, created the misconception that the clinic offers private, for-profit cancer surgery and care.

“We had death threats coming to us,” Debenham said. “We had all these patients saying, ‘Oh, you guys are charging cancer patients to be seen.’ It is just not true. But that is what happened.”

Neither the whistleblower’s complaint nor The Tyee story contained any reference to CCC offering for-profit surgery or care. Debenham provided the letter to The Tyee, which is not named in the legal threat.

Former CCC staff told The Tyee that cancer patients were also confused about the care they could receive. And The Tyee has obtained an internal AHS memo that shows senior AHS managers had concerns about the clinic.

‘Unique centre for cancer care’

The clinic opened in its new building on Edmonton’s Gateway Boulevard in early April 2019.

On its website, CCC said its clinic would serve patients requiring “workup of suspected or concurrent cancer, management of long-term cancer treatment side effects, surveillance of cancer patients after treatment and discharge from your surgeon, the Cross Cancer Institute, or other smaller facility, [and] cancer screening.”

Global Edmonton featured the “unique centre for cancer care” in an April 10, 2019, story.

In her report, Global TV health reporter Su-Ling Goh said that “unlike a regular doctor's office or primary care clinic, this one provides all the care a cancer patient might need before and especially after treatments under one roof.”

In an interview for the Global story, Chowdhury said he and a group of doctors started the clinic because they were “really worried about what is happening to the patients once they leave those [cancer] facilities.”

Followup is critical to prevent the cancer from coming back. But, Goh said, after patients are discharged from hospitals, they often fall through the cracks, especially if they don't have a family doctor.

“Only about seven to eight per cent of patients get the exact type of care that they should receive by guidelines,” Chowdhury said in an on-camera interview. And, Goh said, the clinic’s “team ensures they get the right test at the right times and avoid screening they don't need.”

The Tyee asked Chowdhury how he justified his claim that only about seven to eight per cent of all cancer patients get the exact type of care they should by guidelines.

Chowdhury provided a study conducted by star University of Alberta researcher and oncologist Dr. Charles Butts and several other researchers that followed 152 Stage 3 colorectal cancer patients.

Both Chowdhury and Debenham insisted this study is widely cited and could be extrapolated to all cancer patients.

‘It was heart-wrenching’

In the Global TV story, Chowdhury didn’t address the fact that some CCC cancer patients would be seen by family doctors who did not have extensive practical training in cancer care.

Debenham told The Tyee that two family doctors took a specialized general practitioner oncology course.

In 2019, these doctors worked out of a family practice clinic housed in the new building owned by Chowdhury and his partners. Over the next several years, there was a revolving door of family doctors who came and went from the family medicine clinic.

Former CCC staff, who spoke on condition of anonymity, said the clinic’s family doctors did not, and could not, provide any care to cancer patients that they wouldn’t normally receive from a family doctor.

But that isn’t what patients believed, including some referred by the clinic’s owners, one former staffer said.

They said cancer patients — including some with terminal diagnoses — showed up at the clinic believing they would receive specialized cancer treatment and care.

“There were a lot of people who came to us thinking that we were going to save their lives or that we were going to do something different,” the former staffer said. “It was heart-wrenching.”

Debenham said the clinic’s website clearly spelled out what services would be provided and who would provide them. Oncologists, like himself, and other specialists provide all the specialized followup and diagnostic care for cancer patients while family physicians take care of their other medical issues.

Chowdhury stressed that the clinic isn’t unique; successful cancer care clinics exist in other provinces, and he and his partners simply brought the concept to Alberta.

AHS apparently taken by surprise

An internal memo shows AHS was unaware a cancer care clinic had been opened.

On April 11, 2019, a day after the Global TV story aired, Dr. David Zygun, AHS zone medical director for Edmonton, and Dr. Matthew Parliament, senior medical director for CancerControl Alberta, issued a memo to the entire AHS staff in the Edmonton area.

The memo said a “privately owned cancer clinic” had opened and that it was not affiliated with AHS, CancerControl Alberta or the Cross Cancer Institute.

“As is standard practice, Alberta Health Services does not endorse the recommendation of specific primary care physicians or clinics to patients in our facilities,” the memo said. Zygun and Parliament appear to specifically tell doctors not to preferentially refer cancer patients to the clinic.

“If a patient of Alberta Health Services does not have a family physician or expresses a desire to replace their current family physician, AHS personnel refers the patient to their local primary care network and/or the College of Physicians and Surgeons [of Alberta] for information about physicians who may be able to assume their care.”

Chowdhury said the memo was the result of a misunderstanding.

“The reason they sent that memo out is there was this perception that this was some type of private, for-profit oncology clinic and it wasn’t,” he said, adding that once the senior AHS officials visited the clinic, they realized the memo was sent in error.

AHS declined an interview request. A spokesperson said it would be inappropriate to comment.

The memo, however, appears to align with one of the main allegations in the whistleblowers’ conflict of interest complaint in saying that “Alberta Health Services does not endorse the recommendation of specific primary care physicians or clinics to patients in our facilities.”

The complaint alleges O’Connell initially failed to disclose his relationship with the CCC clinic and, without the complainants’ knowledge, patients were directed from the public system to the privately owned clinic. They claimed O’Connell appeared to be acting as an intermediary on behalf of CCC to benefit it.

They also accused O’Connell of arbitrarily reducing hospital operating room hours for some surgeons and blocking the hiring of a young surgeon and academic who preferred to work in the public system. The young surgeon told The Tyee that Chowdhury then attempted to recruit him.

In response, the cease-and-desist letter says "certain members of the Section of Otolaryngology have made false allegations regarding CCC and its affiliated physicians, and certain members of the Section of Otolaryngology have engaged in other concerning behaviour."

In the Tyee interview, Chowdhury and Debenham declined to provide specific examples of that behaviour. The letter's allegations are unproven.

The letter also states that the CCC clinic had no influence over hiring, hospital privileges or operating room resources, and it stressed that O’Connell is a minority shareholder with no operational or voting authority in the clinic.

“Dr. O’Connell is a five per cent shareholder and his involvement in CCC is quite minimal,” Chowdhury said. “I mean, he sees patients there but that is about it.”

But health-care consultant Steven Lewis said it’s a “red herring” to suggest CCC simply has been caught up in a dispute between O’Connell and the whistleblowers. O’Connell works directly with Chowdhury and the others and owns part of the clinic.

“It is even more absurd to imply that he is not a party to the cease-and-desist letter, especially since there wouldn't be an issue except for O'Connell's relationship and alleged conduct,” Lewis said.

The letter says CCC reserves the right to take legal action and to file complaints against the five doctors to the College of Physicians and Surgeons of Alberta, AHS and the University of Alberta, where all of the whistleblowers hold academic positions.

All five doctors declined interview requests.

If you have any information for this story, or information for another story, please contact Charles Rusnell in confidence via email.  [Tyee]

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