Since 2021, Alberta Health Services management has pressured health-care professionals at two downtown Edmonton mental health clinics to transfer their patients’ prescriptions to Shoppers Drug Mart, the Progress Report has learned.

Shoppers pharmacists have taken on growing roles at these clinics, which three current and former health-care workers at the clinics told the Report has disrupted their relationships with patients, created at least one job redundancy for an AHS-employed pharmacist and furthered the privatization of public health-care in Alberta. 

The health-care professionals, who worked at the 108th St. Addiction and Mental Health Services clinic and the nearby Forensic Assessment and Community Services (FACS) clinic have been granted pseudonyms to shield them from professional retribution.    

The FACS and 108 St. clinics. Image by Duncan Kinney. 

A source provided the Progress Report with an April 9, 2021, memo to employees at the 108th St. clinic, which announced that Shoppers had been “contracted by AHS as the primary pharmacy services provider” for that clinic. 

This contract isn’t publicly available, nor have any of the clinic’s employees seen it. 

“There was zero communication to any of us about how or why this happened from AHS,” said Avery, a health-care professional who works at the 108th St clinic. 

“I don't know if there was a bidding process or anything. Why this pharmacy over another one? I think it is a step towards privatization, trying to embed it within the public system and make it harder to get it out.” 

The partnership, the memo announced, was set to formally begin May 3, 2021, but a “soft roll out” began on April 6 — three days before the clinic’s staff were informed of any changes. 

The prescriptions were still to be filled at the 108 St. clinic, they would just be done by a Shoppers, rather than AHS pharmacist, which the memo said would enable AHS clinicians “to spend more time with their clients.” 

In order to do so, nurses needed to obtain patients’ consent to transfer their prescriptions over to Shoppers. 

Chris, a former 108th St. health-care worker, said that given the nature of the clinic’s patients, obtaining their consent to transfer their prescriptions to a private corporation is inherently coercive. 

“We have vulnerable patients, very mentally ill clients,” they said, adding that some clients are court-ordered to attend the clinic and take their prescriptions, which include expensive antipsychotic injections. 

“They're often paranoid about it, like, ‘What is this? Am I in trouble? Do I have to do this?’ I had a few patients tell me that they were asked to sign something, and they didn't even know what it was, but they'll sign it because they felt intimidated, they felt scared,” said Chris. 

Many clients at the 108 St. clinic have a legal obligation to take these medications due to Community Treatment Orders and the Mental Health Act. 

The Shoppers pharmacists, who were given full access to the clinic, including desks across from the medication room, placed transfer consent forms with the Shoppers logo on each prescription box with an elastic band to remind clinicians to obtain permission for them to fill the prescriptions through Shoppers. 

The increasing prominence of the Shoppers pharmacists led management to transfer the 108th St. clinic’s in-house pharmacist to another clinic, where they took their specialized expertise and relationship with patients the Shoppers employees lack. 

“I’ve worked all over North America,” said Chris, “and I had never, ever seen this happen, where one pharmacy came into a publicly funded clinic and the expectation was that patients would be transferred to the pharmacy.”

An unidentified spokesperson for Loblaw, which owns Shoppers, declined to answer questions about any contracts with AHS. 

“These agreements are set out by Alberta Health Services and all questions should be directed to them,” they wrote. 

The Report provided AHS spokesperson James Wood with copies of emails to staff at the 108 St. clinic and the transfer authorization form. Wood said he would “look into this,” but didn’t respond by deadline, nor did he acknowledge a follow-up email. 

The Ministry of Health didn’t acknowledge a request for comment. 

Shoppers’ integration goes beyond filling prescriptions

Transferring prescriptions became a prelude to Shoppers’ deeper integration into the AHS clinic. The Shoppers pharmacists were invited to staff’s Friday huddles to “introduce their services,” according to an April email. 

“Not every client's needs will match their services but many may benefit and can look at connecting our clients to these services along with next steps,” the email continued. 

Avery identified one of these services as medication reviews. In February, the CBC reported that Shoppers stores in Ontario were facing corporate pressure to order unnecessary virtual medication reviews in order to bill the government upwards of $75 per call through its MedChecks program.

In Alberta, pharmacists can bill the government $60 for a standard medication management assessment and $20 for a follow-up. 

The Progress Report obtained another email from management, dated Nov. 10, 2023, which announced patients would now be able to provide consent verbally to have their prescriptions transferred. 

The Shoppers clinicians, the email added, would now be able to offer “non-specialist” Hepatitis C treatment, including testing, assessment, therapy and post-therapy treatment. The email reiterated that, in addition to providing injection prescriptions, Shoppers clinicians are able to deliver the injections. 

“We are looking to make the most of this partnership, so please review your caseloads for clients who may be appropriate for this service,” the email urged the clinic’s employees. 

Over the past year, the push to transfer prescriptions has “slowed down,” according to Avery, who attributes this to pushback from AHS staff.

A more recent push and sharp push back at FACS

The Forensic Assessment and Community Services (FACS) clinic, located on 106th St., also in downtown Edmonton, provides mental health-care services to people who are court-ordered to seek treatment and deemed at medium-to-high risk to reoffend, including those who have been deemed “not criminally responsible” in court. There is a legal obligation for these clients to get treatment at this facility. 

In April 2024, management similarly sought to pressure staff to transfer their patients’ prescriptions to Shoppers, using identical methods to those employed at the 108th St. clinic in 2021. 

“One day, we came in and saw there were those consent forms” attached to prescription boxes, said Drew, a health-care professional at FACS. 

According to Drew, a Shoppers employee “was filling in our patients names, filling in the medication, and he wanted us to then sign over, basically having the patient sign it to transfer the prescription to Shoppers.”

“As far as I was taught in school, it's unethical. We can't be recommending pharmacies to patients,” they added. 

This is especially coercive working with a vulnerable population that is legally obliged to attend the clinic and take whatever medications they’re prescribed. “They'll sign anything you put under their nose,” said Drew. 

After a few months of employees refusing to broach the topic of transferring the prescriptions with their patients, combined with a changeover in management, the clinicians are no longer being asked explicitly to transfer the prescriptions to Shoppers, Drew said. 

“We just said this is completely against our nursing ethics to be recommending pharmacies and making a profit for some random pharmacist who's not part of the care team,” they said. 

Breaching patient trust 

Lorian Hardcastle, a health law specialist at the University of Calgary, told the Progress Report that it’s common for health-care professionals to recommend a specific pharmacy to patients if the patient asks and the practitioner is aware of a pharmacy that has the patient’s particular medication in stock. 

“Those kinds of ad hoc conversations are one thing,” Hardcastle said. “But in this case, they're sending patients to this pharmacy as a matter of policy … without any sort of discussion with the patients about their needs.” 

She added that it’s certainly “disruptive” for patients with complex mental health needs, who may have established a trusting relationship with their AHS pharmacist to be told that they need to give permission for a new pharmacist to access their prescription records. 

“In order to get proper medical care, you need to trust the provider that you're seeing to want to share your information with them,” said Hardcastle. “These are patients with potentially sensitive medical information that they may not want to be shared with Shoppers.”

AHS regularly contracts with private companies to provide a particular service at its clinics and hospitals, whether it’s contracting out laundry services or dealing with pharmaceutical companies to provide medications. 

“Sometimes there are good reasons for certain kinds of arrangements to be in place, even with the corporate sector,” said Hardcastle. “You have to buy services from someone.” 

What makes this arrangement between AHS and Shoppers so “odd” and “problematic,” in Hardcastle’s view, is that there seems to be no “paper trail” of it.

“This isn't AHS buying a service from Shoppers,” she said. It’s a much more informal, open-ended collaborative agreement. 

“There isn't the transparency, accountability and the ability to review these arrangements if they're just happening casually behind closed doors, so I think if this is going to be the norm, then there should be information posted, it should be publicly available, and AHS should be regularly reviewing it,” said Hardcastle.